1
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Korobova ZR, Arsentieva NA, Santoni A, Totolian AA. Role of IL-27 in COVID-19: A Thin Line between Protection and Disease Promotion. Int J Mol Sci 2024; 25:7953. [PMID: 39063193 PMCID: PMC11276726 DOI: 10.3390/ijms25147953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Cytokine storm is usually described as one of the main reasons behind COVID-associated mortality. Cytokines are essential protein molecules engaged in immune responses; they play a critical role in protection against infections. However, they also contribute to inflammatory reactions and tissue damage, becoming a double-edged sword in the context of COVID-19. Recent studies have suggested various cytokines and chemokines that play a crucial role in the immune response to SARS-CoV-2 infection. One such cytokine is interleukin 27 (IL-27), which has been found to be elevated in the blood plasma of patients with COVID-19. Within this study, we will explore the role of IL-27 in immune responses and analyze both the existing literature and our own prior research findings on this cytokine in the context of COVID-19. It affects a wide variety of immune cells. Regardless of the pathological process it is involved in, IL-27 is critical for upholding the necessary balance between tissue damage and cytotoxicity against infectious agents and/or tumors. In COVID-19, it is involved in multiple processes, including antiviral cytotoxicity via CD8+ cells, IgG subclass switching, and even the activation of Tregs.
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Affiliation(s)
- Zoia R. Korobova
- Laboratory of Molecular Immunology, Saint Petersburg Pasteur Institute, 197101 Saint Petersburg, Russia; (Z.R.K.)
- Department of Immunology, Pavlov First State Medical University of Saint Petersburg, 197022 Saint Petersburg, Russia
| | - Natalia A. Arsentieva
- Laboratory of Molecular Immunology, Saint Petersburg Pasteur Institute, 197101 Saint Petersburg, Russia; (Z.R.K.)
| | - Angela Santoni
- Department of Molecular Medicine, Pasteur Institute–Cenci Bolognetti Foundation, Sapienza University of Rome, 00162 Rome, Italy
| | - Areg A. Totolian
- Laboratory of Molecular Immunology, Saint Petersburg Pasteur Institute, 197101 Saint Petersburg, Russia; (Z.R.K.)
- Department of Immunology, Pavlov First State Medical University of Saint Petersburg, 197022 Saint Petersburg, Russia
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2
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Tosson AMS, Koptan DMT, Kamal M, Abd Elhady M. Assessment of Serum Interleukin-27 and Mean Platelet Volume in Late-Onset Neonatal Sepsis. Am J Perinatol 2024; 41:1232-1237. [PMID: 35580626 DOI: 10.1055/s-0042-1748165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Late-onset sepsis (LOS) is a substantial contributor to morbidity and mortality among neonates. The use of nonculture-based tools for early diagnosis is an area of active investigation. Therefore, we aimed to evaluate the diagnostic value of serum interleukin-27 (IL-27) and mean platelet volume (MPV) in full-term neonates with LOS. STUDY DESIGN In this single-center, cross-sectional study, 90 full-term newborns were assigned to two equal-matched groups as follows: (1) culture-proven sepsis and (2) control groups. Clinical data and laboratory findings as complete blood pictures, including MPV, highly sensitive C-reactive protein, and blood culture results, were recorded. Moreover, IL-27 levels were measured using enzyme-linked immunosorbent assay. RESULTS IL-27 levels (median = 4,364 pg/mL) and MPV (mean = 12.02 ± 1.54 FL) were significantly higher in the culture-proven sepsis group than in the control group (p < 0.001). For IL-27, the optimum cut-off value for the diagnosis of LOS was 283.8 pg/mL with sensitivity and specificity of 97.8 and 100%, respectively. For MPV, the optimum cut-off value was 11.6 FL, with diagnostic sensitivity and specificity of 77.8 and 97.8%, respectively. CONCLUSION IL-27 and MPV are promising markers for the diagnosis of LOS in full-term neonates. The diagnostic performance of IL-27 was superior to MPV. KEY POINTS · Late-onset neonatal sepsis diagnosis is time consuming.. · Nonculture-based rapid diagnostic tests are much needed.. · IL-27 is superior in LOS diagnosis to MPV..
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Affiliation(s)
- Angie M S Tosson
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina M T Koptan
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Kamal
- Neonatology Division, Benha Children Hospital, Benha, Egypt
| | - Marwa Abd Elhady
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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3
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van der Velden FJS, de Vries G, Martin A, Lim E, von Both U, Kolberg L, Carrol ED, Khanijau A, Herberg JA, De T, Galassini R, Kuijpers TW, Martinón-Torres F, Rivero-Calle I, Vermont CL, Hagedoorn NN, Pokorn M, Pollard AJ, Schlapbach LJ, Tsolia M, Elefhteriou I, Yeung S, Zavadska D, Fink C, Voice M, Zenz W, Kohlmaier B, Agyeman PKA, Usuf E, Secka F, de Groot R, Levin M, van der Flier M, Emonts M. Febrile illness in high-risk children: a prospective, international observational study. Eur J Pediatr 2023; 182:543-554. [PMID: 36243780 PMCID: PMC9899189 DOI: 10.1007/s00431-022-04642-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 02/07/2023]
Abstract
To assess and describe the aetiology and management of febrile illness in children with primary or acquired immunodeficiency at high risk of serious bacterial infection, as seen in emergency departments in tertiary hospitals. Prospective data on demographics, presenting features, investigations, microbiology, management, and outcome of patients within the 'Biomarker Validation in HR patients' database in PERFORM, were analysed. Immunocompromised children (< 18 years old) presented to fifteen European hospitals in nine countries, and one Gambian hospital, with fever or suspected infection and clinical indication for blood investigations. Febrile episodes were assigned clinical phenotypes using the validated PERFORM algorithm. Logistic regression was used to assess the effect size of predictive features of proven/presumed bacterial or viral infection. A total of 599 episodes in 482 children were analysed. Seventy-eight episodes (13.0%) were definite bacterial, 67 episodes probable bacterial (11.2%), and 29 bacterial syndrome (4.8%). Fifty-five were definite viral (9.2%), 49 probable viral (8.2%), and 23 viral syndrome (3.8%). One hundred ninety were unknown bacterial or viral infections (31.7%), and 108 had inflammatory or other non-infectious causes of fever (18.1%). Predictive features of proven/presumed bacterial infection were ill appearance (OR 3.1 (95% CI 2.1-4.6)) and HIV (OR 10.4 (95% CI 2.0-54.4)). Ill appearance reduced the odds of having a proven/presumed viral infection (OR 0.5 (95% CI 0.3-0.9)). A total of 82.1% had new empirical antibiotics started on admission (N = 492); 94.3% proven/presumed bacterial (N = 164), 66.1% proven/presumed viral (N = 84), and 93.2% unknown bacterial or viral infections (N = 177). Mortality was 1.9% (N = 11) and 87.1% made full recovery (N = 522). Conclusion: The aetiology of febrile illness in immunocompromised children is diverse. In one-third of cases, no cause for the fever will be identified. Justification for standard intravenous antibiotic treatment for every febrile immunocompromised child is debatable, yet effective. Better clinical decision-making tools and new biomarkers are needed for this population. What is Known: • Immunosuppressed children are at high risk for morbidity and mortality of serious bacterial and viral infection, but often present with fever as only clinical symptom. • Current diagnostic measures in this group are not specific to rule out bacterial infection, and positivity rates of microbiological cultures are low. What is New: • Febrile illness and infectious complications remain a significant cause of mortality and morbidity in HR children, yet management is effective. • The aetiology of febrile illness in immunocompromised children is diverse, and development of pathways for early discharge or cessation of intravenous antibiotics is debatable, and requires better clinical decision-making tools and biomarkers.
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Affiliation(s)
- Fabian J S van der Velden
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gabriella de Vries
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alexander Martin
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Lim
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ulrich von Both
- Division Paediatric Infectious Diseases, Dr. Von Hauner Children's Hospital, University Hospital LMU Munich, Munich, Germany
| | - Laura Kolberg
- Division Paediatric Infectious Diseases, Dr. Von Hauner Children's Hospital, University Hospital LMU Munich, Munich, Germany
| | - Enitan D Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.,Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Aakash Khanijau
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.,Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jethro A Herberg
- Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Tisham De
- Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Rachel Galassini
- Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Federico Martinón-Torres
- Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.,Grupo de Genetica, Vacunas, Infecciones y Pediatria, Instituto de Investigacion Sanitaria de Santiago, Universidad de Santiago, Santiago de Compostela, Spain.,Consorcio Centro de Investigacion Biomedicaen Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Irene Rivero-Calle
- Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Clementien L Vermont
- Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nienke N Hagedoorn
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marko Pokorn
- University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Luregn J Schlapbach
- Neonatal and Pediatric Intensive Care Unit, Children's Research Center, University Children's Hospital Zürich, University of Zürich, Zurich, Switzerland
| | - Maria Tsolia
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Children's Hospital 'P, and A. Kyriakou', Athens, Greece
| | - Irini Elefhteriou
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, Children's Hospital 'P, and A. Kyriakou', Athens, Greece
| | - Shunmay Yeung
- Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Dace Zavadska
- Department of Pediatrics, Rīgas Stradina Universitāte, Children's Clinical University Hospital, Riga, Latvia
| | - Colin Fink
- Micropathology Ltd, University of Warwick, Warwick, UK
| | - Marie Voice
- Micropathology Ltd, University of Warwick, Warwick, UK
| | - Werner Zenz
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Benno Kohlmaier
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Effua Usuf
- Medical Research Council Unit, Serrekunda, The Gambia
| | - Fatou Secka
- Medical Research Council Unit, Serrekunda, The Gambia
| | - Ronald de Groot
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael Levin
- Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Michiel van der Flier
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.,Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. .,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK. .,NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK.
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4
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Morita Y, Saito M, Rangel-Moreno J, Franchini AM, Owen JR, Martinez JC, Daiss JL, de Mesy Bentley KL, Kates SL, Schwarz EM, Muthukrishnan G. Systemic IL-27 administration prevents abscess formation and osteolysis via local neutrophil recruitment and activation. Bone Res 2022; 10:56. [PMID: 36028492 PMCID: PMC9418173 DOI: 10.1038/s41413-022-00228-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 01/07/2023] Open
Abstract
Interleukin-27 is a pleiotropic cytokine whose functions during bacterial infections remain controversial, and its role in patients with S. aureus osteomyelitis is unknown. To address this knowledge gap, we completed a clinical study and observed elevated serum IL-27 levels (20-fold higher, P < 0.05) in patients compared with healthy controls. Remarkably, IL-27 serum levels were 60-fold higher in patients immediately following septic death than in uninfected patients (P < 0.05), suggesting a pathogenic role of IL-27. To test this hypothesis, we evaluated S. aureus osteomyelitis in WT and IL-27Rα-/- mice with and without exogenous IL-27 induction by intramuscular injection of rAAV-IL-27p28 or rAAV-GFP, respectively. We found that IL-27 was induced at the surgical site within 1 day of S. aureus infection of bone and was expressed by M0, M1 and M2 macrophages and osteoblasts but not by osteoclasts. Unexpectedly, exogenous IL-27p28 (~2 ng·mL-1 in serum) delivery ameliorated soft tissue abscesses and peri-implant bone loss during infection, accompanied by enhanced local IL-27 expression, significant accumulation of RORγt+ neutrophils at the infection site, a decrease in RANK+ cells, and compromised osteoclast formation. These effects were not observed in IL-27Rα-/- mice compared with WT mice, suggesting that IL-27 is dispensable for immunity but mediates redundant immune and bone cell functions during infection. In vitro studies and bulk RNA-seq of infected tibiae showed that IL-27 increased nos1, nos2, il17a, il17f, and rorc expression but did not directly stimulate chemotaxis. Collectively, these results identify a novel phenomenon of IL-27 expression by osteoblasts immediately following S. aureus infection of bone and suggest a protective role of systemic IL-27 in osteomyelitis.
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Affiliation(s)
- Yugo Morita
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Motoo Saito
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Javier Rangel-Moreno
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Anthony M Franchini
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - John R Owen
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - John C Martinez
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - John L Daiss
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, USA
| | - Karen L de Mesy Bentley
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, USA
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Stephen L Kates
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Edward M Schwarz
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, USA
| | - Gowrishankar Muthukrishnan
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Orthopedics, University of Rochester Medical Center, Rochester, NY, USA.
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5
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Lin H, Yang L, Fang J, Gao Y, Zhu H, Zhang S, Summah HD, Shi G, Sun J, Ni L, Feng Y. Clinical Characteristics of Bloodstream Infection in Immunosuppressed Patients: A 5-Year Retrospective Cohort Study. Front Cell Infect Microbiol 2022; 12:796656. [PMID: 35444962 PMCID: PMC9014008 DOI: 10.3389/fcimb.2022.796656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Immunosuppressed patients with bloodstream infection are at risk of mortality. Our objective was to assess the independent risk factors of bloodstream infection with mortality in immunosuppressive states. Methods The medical data of a total of 896 patients who were hospitalized in our hospital were collected from January 2015 to December 2019. Evaluation of the independent risk factors of mortality was done by univariate and multivariate logistic regression analyses. Results Of the 896 immunosuppressed patients with bloodstream infection, 698 had over 60-day survivals and 198 had 60-day mortality. In our study, PCT (mean ±; standard: 11.40 ±; 31.89 µg/l vs. 62.45 ±; 17.10 µg/l, p = 0.007) and presence of age >60 years (40% vs. 14.19%, p = 0.001) were significantly different between situations with and without 60-day survivals in both univariate and multivariate logistic regression analyses. Age >60 years and PCT could be used as indicators for bloodstream infection with 60-day death in immunosuppressive states; the OR (95% CI) were 1.532 (1.099–2.135) and 2.063 (1.413–3.013), respectively. In different subgroups, PCT and age were also independent risk factors of blood system diseases, Klebsiella pneumoniae infection, diabetes, and ICU-stay subgroups. Conclusions Age and PCT were independently associated with mortality in immunosuppressive states, which may help to identify the highly risky situation of bloodstream infection in immunosuppressive states.
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Affiliation(s)
- Hongxia Lin
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lili Yang
- Institute of Respiratory Diseases, People’s Hospital of Fuyang City, Fuyang, China
| | - Jie Fang
- Department of Pharmacy, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yulian Gao
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Haixing Zhu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shengxiong Zhang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hanssa Dwarka Summah
- Department of Respiratory and Critical Care Medicine, Poudre D’Or Chest Hospital, Rivière du Rempart, Mauritius
| | - Guochao Shi
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jingyong Sun
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Yun Feng, ; Lei Ni, ; Jingyong Sun,
| | - Lei Ni
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Yun Feng, ; Lei Ni, ; Jingyong Sun,
| | - Yun Feng
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Yun Feng, ; Lei Ni, ; Jingyong Sun,
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6
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van der Velden FJS, Gennery AR, Emonts M. Biomarkers for Diagnosing Febrile Illness in Immunocompromised Children: A Systematic Review of the Literature. Front Pediatr 2022; 10:828569. [PMID: 35372147 PMCID: PMC8965604 DOI: 10.3389/fped.2022.828569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/25/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This study aims to assess the performance of biomarkers used for the prediction of bacterial, viral, and fungal infection in immunocompromised children upon presentation with fever. METHODS We performed a literature search using PubMed and MEDLINE and In-Process & Other Non-indexed Citations databases. Cohort and case-control studies assessing biomarkers for the prediction of bacterial, viral, or fungal infection in immunocompromised children vs. conventional microbiological investigations were eligible. Studies including adult patients were eligible if pediatric data were separately assessable. Data on definitions used for infections, fever, and neutropenia and predictive values were collected. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS Fifty-two studies involving 13,939 febrile episodes in 7,059 children were included. In total, 92.2% were in cancer patients (n = 48), and 15.7% also included hematopoietic stem cell transplantation patients (n = 8). Forty-three biomarkers were investigated, of which 6 (CRP, PCT, IL-8, IL-6, IL-10, and TNFα) were significantly associated with bacterial infection at admission, studied in multiple studies, and provided predictive data. Literature on the prediction of viral and fungal infection was too limited. Eight studies compared C-reactive protein (CRP) and procalcitonin (PCT), with PCT demonstrating superiority in 5. IL-6, IL-8, and IL-10 were compared with CRP in six, four, and one study, respectively, with mixed results on diagnostic superiority. No clear superior biomarker comparing PCT vs. IL-6, IL-8, or IL-10 was identified. DISCUSSION There is great heterogeneity in the biomarkers studied and cutoff values and definitions used, thus complicating the analysis. Literature for immunocompromised children with non-malignant disease and for non-bacterial infection is sparse. Literature on novel diagnostics was not available. We illustrated the challenges of diagnosing fever adequately in this study population and the need for improved biomarkers and clinical decision-making tools.
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Affiliation(s)
- Fabian J S van der Velden
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Great North Children's Hospital, Paediatric Immunology, Infectious Diseases and Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew R Gennery
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Great North Children's Hospital, Paediatric Immunology, Infectious Diseases and Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Marieke Emonts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Great North Children's Hospital, Paediatric Immunology, Infectious Diseases and Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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7
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Morita Y, Masters EA, Schwarz EM, Muthukrishnan G. Interleukin-27 and Its Diverse Effects on Bacterial Infections. Front Immunol 2021; 12:678515. [PMID: 34079555 PMCID: PMC8165262 DOI: 10.3389/fimmu.2021.678515] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/27/2021] [Indexed: 02/03/2023] Open
Abstract
Innate and adaptive immune responses against pathogens are known to be carefully orchestrated by specific cytokines that initiate and down regulate immune cell functions from the initial infection through tissue repair and homeostasis. However, some cytokines, including interleukin-27, are expressed at multiple phases of the infection, such that their pro and anti-inflammatory functions have been difficult to interpret. As elucidation of specific cytokine functions throughout infection is central to our understanding of protective vs. susceptible immunity and return to homeostasis vs. prolonged inflammation leading to septic shock, here we review the literature on IL-27 signaling and the various functions of this heterodimeric ligand member of the IL-12 cytokine family. Canonically, IL-27 is produced by antigen-presenting cells, and is thought of as an immunostimulatory cytokine due to its capacity to induce Th1 differentiation. However, many studies have also identified various immunosuppressive effects of IL-27 signaling, including suppression of Th17 differentiation and induction of co-inhibitory receptors on T cells. Thus, the exact role of IL-27 in the context of infectious diseases remains a topic of debate and active research. Additionally, as recent interest has focused on clinical management of acute vs. chronic infections, and life-threatening “cytokine storm” from sepsis, we propose a hypothetical model to explain the biphasic role of IL-27 during the early and late phases of immune responses to reconcile its known pro and anti-inflammatory functions, which could be therapeutically regulated to improve patient outcomes of infection.
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Affiliation(s)
- Yugo Morita
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States.,Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, United States
| | - Elysia A Masters
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States.,Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, United States
| | - Edward M Schwarz
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States.,Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, United States.,Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, United States
| | - Gowrishankar Muthukrishnan
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States.,Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, United States
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8
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Kronberger JF, Köhler TC, Lang CN, Jäckel M, Bemtgen X, Wengenmayer T, Supady A, Meschede W, Bode C, Zotzmann V, Staudacher DL. Bronchoalveolar Lavage and Blood Markers of Infection in Critically Ill Patients-A Single Center Registry Study. J Clin Med 2021; 10:486. [PMID: 33572924 PMCID: PMC7866381 DOI: 10.3390/jcm10030486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Microbiological sampling is an indispensable targeted antibiotic therapy for critically ill patients. Invasive respiratory sampling by bronchoalveolar lavage (BAL) can be performed to obtain samples from the lower respiratory tract. It is debated as to whether blood markers of infection can predict the outcome of BAL in a medical intensive care unit (ICU). Retrospectively, all ICU patients undergoing BAL from 2009-2018 were included. A total of 468 BAL samples from 276 patients (average age 60 years, SAPS2 47, ICU-mortality 41.7%) were analyzed. At the time of BAL, 94.4% patients were mechanically ventilated, 92.9% had suspected pneumonia, 96.2% were on antibiotic therapy and 36.3% were immunocompromised. Relevant bacteria were cultured in 114/468 (24.4%) cases of BAL. Patients with relevant bacteria in the culture had a higher ICU mortality rate (45.6 vs. 40.4%, p = 0.33) and were significantly less likely to be on a steroid (36 vs. 52%, p < 0.01) or antimycotic (14.9 vs. 34.2%, p < 0.01), while procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) counts were similar. The area under the receiver operating curve (AUC) values for positive culture and PCT, CRP and WBC counts were low (0.53, 0.54 and 0.51, respectively). In immunocompromised patients, AUC values were higher (0.65, 0.57 and 0.61, respectively). Therefore, microbiological cultures by BAL revealed relevant bacteria in 24.4% of samples. Our data, therefore, might suggest that indication for BAL should not be based on blood markers of infection.
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Affiliation(s)
- Jarno F. Kronberger
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.F.K.); (C.N.L.); (M.J.); (X.B.); (T.W.); (A.S.); (C.B.); (V.Z.)
- Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Thomas C. Köhler
- Department of Pneumology, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.C.K.); (W.M.)
| | - Corinna N. Lang
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.F.K.); (C.N.L.); (M.J.); (X.B.); (T.W.); (A.S.); (C.B.); (V.Z.)
- Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Markus Jäckel
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.F.K.); (C.N.L.); (M.J.); (X.B.); (T.W.); (A.S.); (C.B.); (V.Z.)
- Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Xavier Bemtgen
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.F.K.); (C.N.L.); (M.J.); (X.B.); (T.W.); (A.S.); (C.B.); (V.Z.)
- Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.F.K.); (C.N.L.); (M.J.); (X.B.); (T.W.); (A.S.); (C.B.); (V.Z.)
- Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Alexander Supady
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.F.K.); (C.N.L.); (M.J.); (X.B.); (T.W.); (A.S.); (C.B.); (V.Z.)
- Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Wolfram Meschede
- Department of Pneumology, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.C.K.); (W.M.)
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.F.K.); (C.N.L.); (M.J.); (X.B.); (T.W.); (A.S.); (C.B.); (V.Z.)
- Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Viviane Zotzmann
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.F.K.); (C.N.L.); (M.J.); (X.B.); (T.W.); (A.S.); (C.B.); (V.Z.)
- Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Dawid L. Staudacher
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.F.K.); (C.N.L.); (M.J.); (X.B.); (T.W.); (A.S.); (C.B.); (V.Z.)
- Department of Internal Medicine III, Medical Intensive Care, Medical Center, University of Freiburg, 79106 Freiburg, Germany
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Liu Z, Niu C, Ying L, Zhang Q, Long M, Fu Z. Exploration of the Serum Interleukin-17 and Interleukin-27 Expression Levels in Children with Bronchial Asthma and Their Correlation with Indicators of Lung Function. Genet Test Mol Biomarkers 2019; 24:10-16. [PMID: 31880470 DOI: 10.1089/gtmb.2019.0155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: To investigate the expression levels of serum interleukin-17 (IL-17) and interleukin-27 (IL-27) in children with bronchial asthma and to correlate these expression levels with lung function indicators. Methods: A total of 106 children with bronchial asthma (observation group: 76 in the acute attack phase, 30 in remission) and 60 healthy children (control group) aged 1-10 years were enrolled. Results: Levels of IL-17, IL-27, and fractional exhaled nitric oxide (FeNO) in the peripheral blood of children with bronchial asthma were higher compared to the control group. In addition, blood IL-17, IL-27, and FeNO levels in the children in the acute stage of bronchial asthma were higher compared with those in remission. The respiratory rate of children in the remission stage was lower compared with those in the acute stage, however, the other indicators were higher. IL-17, IL-27, and FeNO levels positively correlated with the respiratory rate and were negatively correlated with inspiratory time, expiratory time, peak time, and time to reach peak tidal expiratory flow/total expiratory time (TPTEF/TE; all p < 0.05). Conclusion: IL-17 and IL-27 levels are associated with the incidence and the development of bronchial asthma in children, and could be useful diagnostic markers. They may also effectively improve the specificity of FeNO for diagnosing the extent of lung injury in children.
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Affiliation(s)
- Zheng Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing City, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing City, China
| | - Chao Niu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing City, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing City, China
| | - Linyan Ying
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing City, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing City, China
| | - Qiao Zhang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing City, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing City, China
| | - Meiling Long
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing City, China
| | - Zhou Fu
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing City, China
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