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Journal of Clinical Virology
Volume 37, Issue 1, September 2006, Pages 47-52
Modulation of cytokine production by intravenous immunoglobulin in patients with enterovirus 71-associated brainstem encephalitis
Shih-Min Wanga, c, Huan-Yao Leid, Mei-Chih Huange, Ling-Yao Sub, d, Hui-Chen Linb, Chun-Keung Yud, Jung-Lung Wangb and Ching-Chuan Liub, ,
aDepartment of Emergency Medicine, National Cheng Kung University & Hospital, 138 Sheng Li Road, 70428 Tainan, Taiwan
bDepartment of Pediatrics, National Cheng Kung University & Hospital, 138 Sheng Li Road, 70428 Tainan, Taiwan
cInstitute of Clinical Medicine, National Cheng Kung University, 1 Ta-Hsueh Road, 70101 Tainan, Taiwan
dDepartment of Microbiology & Immunology, National Cheng Kung University, 1 Ta-Hsueh Road, 70101 Tainan, Taiwan
eDepartment of Nursing, National Cheng Kung University & Hospital, 138 Sheng Li Road, 70428 Tainan, Taiwan
Received 1 September 2005; revised 16 February 2006; accepted 26 May 2006. Available online 24 July 2006.
Abstract
Background
Several epidemics of enterovirus 71 (EV71) infections occurred in Taiwan since 1998.
Objectives
We performed the study to determine the changes in cytokine profiles associated with administration of intravenous immunoglobulin (IVIG) in patients with EV71-associated brainstem encephalitis complicated by autonomic nervous system (ANS) dysfunction and pulmonary edema.
Study design
Plasma cytokine concentrations (IL-1β, IL-6, IL-8, IFN-γ, TNF-α, IL-2, IL-4, IL-5, IL-10, and IL-13) were monitored on admission and within 12–24 h after administration of IVIG in a cohort of children (n = 22) with virologically confirmed EV71 infection, from March 2000 through April 2004.
Result
Plasma levels of IFN-γ, IL-6, IL-8, IL-10, and IL-13 levels significantly decreased in patients with pulmonary edema after administration of IVIG, P < 0.05. Plasma levels of IL-6 and IL-8 were significantly decreased in patients with ANS dysregulation after administration of IVIG, P < 0.05. Administration of IVIG was not associated with significant changes in plasma concentration of IL-1β, IL-2, IL-4, IL-5 IL-10, IL-13 and TNF-α in patients with ANS dysregulation.
Conclusions
These findings suggest that IVIG might be considered to have a therapeutic role in EV71-associated brainstem encephalitis. A clinical trial is needed to support this hypothesis.
Keywords: Cytokine; Enterovirus 71; IVIG; Pulmonary edema
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