To investigate differences in cytokine production between influenza A and B.
thirty one patients with influenza A and 16 with influenza B were enrolled in this study. We measured soluble tumor necrosis factor receptor (sTNFR) 1, interleukin (IL)-6, interferon (IFN)-gamma and IL-4 concentrations in serum obtained from all patients during the acute and convalescence phases of their illnesses.
the sTNFR1 and IL-6 serum concentrations of patients with influenza A and B were equivalently elevated in the acute phase of their illness. However, the acute phase concentrations of IFN-gamma and IL-4 were significantly higher in patients with influenza A than in patients with influenza B. The concentration of all cytokines in influenza A and sTNFR1 in influenza B significantly decreased from the acute to convalescent phase. Plotted from the onset of symptoms it appeared that all of the cytokines peaked within 24h after onset.
the production pattern of the inflammatory cytokines - TNF and IL-6 - were the same between influenza A and B. However, a Th2 predominant cytokine pattern was induced after natural influenza virus A infection, notably IL-4 that differed from that to influenza B.
[Show abstract][Hide abstract] ABSTRACT: To our knowledge, no rigorously designed clinical trials have evaluated the relation between vitamin D and physician-diagnosed seasonal influenza.
We investigated the effect of vitamin D supplements on the incidence of seasonal influenza A in schoolchildren.
From December 2008 through March 2009, we conducted a randomized, double-blind, placebo-controlled trial comparing vitamin D(3) supplements (1200 IU/d) with placebo in schoolchildren. The primary outcome was the incidence of influenza A, diagnosed with influenza antigen testing with a nasopharyngeal swab specimen.
Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D(3) group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P = 0.04]. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements (RR: 0.36; 95% CI: 0.17, 0.79; P = 0.006) and who started nursery school after age 3 y (RR: 0.36; 95% CI: 0.17, 0.78; P = 0.005). In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D(3) compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73; P = 0.006).
This study suggests that vitamin D(3) supplementation during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren. This trial was registered at https://center.umin.ac.jp as UMIN000001373.
American Journal of Clinical Nutrition 03/2010; 91(5):1255-60. DOI:10.3945/ajcn.2009.29094 · 6.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute pneumonitis with acute lung injury is a cause of significant mortality related to the 2009 pH1N1 influenza A virus. Widespread lung inflammation and increased pulmonary vascular permeability has been noted on autopsy. Also, many of these patients present with significant hemodynamic compromise suggesting systemic cytokine release. Therefore, attenuating circulating cytokines, and other mediators, by blood purification techniques is a theoretically attractive strategy. We report the use therapeutic plasma exchange in three children with 2009 H1N1 related acute lung injury with severe hemodynamic compromise that had failed conventional therapeutic interventions.
Pediatric intensive care unit in a university children's hospital.
Three children, aged 8, 11, and 17 yrs, with acute respiratory distress syndrome and hemodynamic compromise related to the 2009 pH1N1 influenza A virus documented by polymerase chair reaction. All patients were on mechanical ventilation and inhaled nitric oxide, and one patient was on extracorporeal membrane oxygenation. Therapeutic plasma exchange was used as a rescue strategy.
Each patient received three exchanges of 35-40 mL/kg on consecutive days.
All three patients had dramatic reduction in pediatric logistic organ dysfunction scores, oxygen requirements, and vasopressor requirements after two exchanges. All survived with good functional recovery.
In this small series of patients with H1N1/acute respiratory distress syndrome and hemodynamic compromise, therapeutic plasma exchange appeared to benefit as a method of mitigating the associated cytokine storm. The procedure was well tolerated with no reported side effects. All three patients survived, defying the predicted mortality. Because these procedures used the filtration exchange method, it was performed in a timely fashion by intensive care unit personnel and on equipment already available in the intensive care unit for renal support.
This very limited case series suggest there may be a role for therapeutic plasma exchange as a rescue therapy in severe shock and acute lung injury related to pH1N1 that has not responded to traditional therapy.
Pediatric Critical Care Medicine 06/2010; 12(2):e87-9. DOI:10.1097/PCC.0b013e3181e2a569 · 2.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Procalcitonin (PCT) is synthesized by a large number of tissues and organs in response to invasion by pathogenic bacteria, fungi, and some parasites. Current PCT assays are rapid, specific, and of sufficient sensitivity to detect increases in PCT serum levels within 4 to 6 h of initiation of infection. Clinically, PCT levels may help in decisions regarding the need for empirical antibiotic therapy, "source control" of infection, and duration of antibiotic therapy. The addition of PCT levels to bacterial culture and viral detection results can assist with the separation of colonization and invasion by pathogenic bacteria.
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