Glucocorticoids are used extensively to treat severe infectious diseases in China, but their effectiveness remains controversial. than the acute phase in severe and crucial instances treated with intravenous immunoglobulin (IVIG) and glucocorticoids. Only the CSF levels of IL-6, IP-10, and IL-8 were significantly correlated with white blood cell counts, and complete neutrophil and monocyte counts, in severe instances. Furthermore, the CSF levels of IL-6 were correlated with heat in both instances. Conclusions These data show that a major cytokine response and swelling, in both plasma and the CNS, are features of disease caused by EV71 illness. Systemic swelling caused by EV71 illness exacerbated the deterioration of the disease, and resulted in the disease progression to the crucial illness stage. family. Uncomplicated hand, foot, and mouth disease, or herpangina, is the principal medical manifestation in most individuals with EV71 illness. Severe CNS disease and complications including encephalitis, aseptic meningitis, and mind stem encephalitis, are associated with EV71 infections in seriously ill individuals . Pyridostatin hydrochloride EV71-infected individuals may succumb to respiratory failure caused by pulmonary edema (PE), followed by circulatory collapse, after CNS injury . Even though pathogenesis of EV71 illness is not well-defined, direct viral-mediated neuropathic damage and indirect immune-mediated effects are considered to have an effect . Previous studies have shown that the severity of medical manifestations associated with EV71 illness possibly depends on the host immune inflammatory response, including acute cytokine and chemokine storms in the blood and cerebrospinal fluid (CSF) [9-13]. Immune disorder caused by EV71 illness such as elevated proinflammatory cytokine and chemokine may play an important role in the disease end result of HFMD. Several Pyridostatin hydrochloride cytokines and chemokines, including tumor necrosis element (TNF-), IL-1,-6, ?10,-8 and-13 and IFN-, were indicated to be associated with brainstem encephalitis (BE) and pulmonary Pyridostatin hydrochloride edema (PE) caused by EV71 infection in the previous studies [9,14,15]. Specific therapies for focusing on EV71 are under development. On the basis that hyperinflammation plays a role in EV71 pathogenesis, intravenous immunoglobulin (IVIG) and glucocorticoids have been recommended to treat severe EV71 CNS infections. IVIG is definitely a polyclonal preparation from human being serum and has been used to treat Rabbit Polyclonal to SEPT7 many viral infections. Previous work offers shown that, after IVIG administration, the plasma levels of cytokines including IL-8 and IL-10 decreased significantly in individuals with PE . Glucocorticoids are used extensively to treat severe infectious diseases in China, but their effectiveness remains controversial. One study found that the levels of many serum cytokines in HFMD individuals treated with methylprednisolone did not differ significantly from those of untreated individuals . However, no paired assessment of CSF cytokine profiles between individuals in the acute and recovery phases, after administration of IVIG and glucocorticoid, has yet been performed. In the present study, we explored the diversity of cytokines in plasma and CNS specimens from different groups of individuals diagnosed with HFMD. Changes in cytokine and chemokine levels were measured in EV71-infected individuals given IVIG and glucocorticoid. Moreover, we also identified the correlations between cytokine levels and markers of swelling including heat, white blood cell (WBC) counts, or individual counts of neutrophils, lymphocytes, or monocytes. Methods Patient enrollment This study was authorized by the Ethics Committee of Nanjing Childrens Hospital, and informed written consent was from all legal guardians. Plasma and CSF specimens from individuals with HFMD were collected from April 2010 to May 2012 from Nanjing Childrens Hospital. All (n?=?93) individuals were confirmed to have EV71 infections using EV71-specific RT-PCR assay of throat swab specimens and/or evidence of EV71-specific IgM-positivity at the time of disease onset. Individuals with Coxsackievirus A16 (CA16) illness will become excluded RT-PCR. The primer sequences were: EV71 (sense) 5-GCAGCCCAAAAGAACTTCAC-3 and EV71 (antisense) 5-ATTTCAGCAGCTTGGAGTGC-3; and CA16 (sense) 5-ATTGGTGCTCCCACTACAGC-3 and CA16 (antisense) 5-TCAGTGTTGGCAGCTGTAGG-3. Hospitalized children with EV71 infections received IVIG after admission at a dose of 0.5?g/kg body weight about each of 4 consecutive days. Glucocorticoid was also given after admission, at 1-2-mg meprednisone/kg/day time, for at least 4 successive days. Study organizations Healthy and EV71-infected children were included in the study. EV71-infected individuals were divided into a mildly ill group, a severely ill group, and a critically ill group, using criteria of the Handbook for Treatment of HFMD (2010) prepared by the NHFPC . Mild instances were diagnosed with HFMD, with or without fever. Severe instances exhibited obvious symptoms of CNS involvement, as confirmed by the presence of medical features including lethargy, irritability, headache, decreased reflex and muscle mass strength, myoclonus, ataxia, nystagmus, oculomotor palsy, and acute limb weakness, with or without neuroimaging. Crucial instances were diagnosed when any one of the following symptoms was present: 1) coma with cerebral hernia, 2) respiratory failure or,.
Glucocorticoids are used extensively to treat severe infectious diseases in China, but their effectiveness remains controversial