Levels of cytokines and cytokine inhibitors in the neutropenic patient with alpha-hemolytic streptococcus shock syndrome.
The pathogenesis of alpha-hemolytic streptococcus shock syndrome (SS), a life-threatening complication in neutropenic patients following aggressive chemotherapy that is caused by viridans streptococci, is unknown. We measured serum concentrations of proinflammatory and antiinflammatory cytokines and T cell activation markers in two patients with lethal alpha-hemolytic streptococcus SS. The results were compared with those for controls, two neutropenic patients with uncomplicated bacteremia due to gram-positive organisms and four patients with neutropenia and bacteremia due to gram-negative organisms (two of whom had lethal septic shock). In patients with alpha-hemolytic streptococcus SS, levels of interleukin (IL) 1 were undetectable, levels of tumor necrosis factor (TNF) alpha were only slightly elevated, and IL-6 was the only proinflammatory cytokine that was found in high concentrations and had a late peak level at the time of clinical deterioration. IL-6 levels were much higher in patients with alpha-hemolytic streptococcus SS than in controls with uncomplicated bacteremia due to gram-positive organisms but were comparable with those in controls with bacteremia due to gram-negative organisms. Soluble TNF receptor fragments and IL-1 receptor antagonist apparently were not protective despite high serum concentrations.
Section of Infectious Diseases and Clinical Immunology, University Hospital and Medical Center, Ulm, Germany.
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D000328:Adult; D016470:Bacteremia / Q000276:immunology; D064420:Drug-Related Side Effects and Adverse Reactions; D016905:Gram-Negative Bacterial Infections / Q000276:immunology; D016908:Gram-Positive Bacterial Infections / Q000276:immunology; D006801:Humans; D007371:Interferon-gamma / Q000032:analysis; D007375:Interleukin-1 / Q000032:analysis*; D015850:Interleukin-6 / Q000032:analysis*; D008213:Lymphocyte Activation; D008297:Male; D009503:Neutropenia / Q000382:microbiology; D017472:Receptors, Interleukin-1 / Q000032:analysis / Q000037:antagonists & inhibitors; D018124:Receptors, Tumor Necrosis Factor / Q000032:analysis; D012772:Shock, Septic / Q000097:blood / Q000276:immunology*; D013290:Streptococcal Infections / Q000097:blood / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D007375:Interleukin-1; D015850:Interleukin-6; D017472:Receptors, Interleukin-1; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma