Modulation of cytokine production by intravenous immunoglobulin in patients with enterovirus 71-associated brainstem encephalitis.
BACKGROUND
Several epidemics of enterovirus 71 (EV71) infections occurred in Taiwan since 1998.


OBJECTIVE
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.


METHODS
Plasma cytokine concentrations (IL-1beta, IL-6, IL-8, IFN-gamma, TNF-alpha, IL-2, IL-4, IL-5, IL-10, and IL-13) were monitored on admission and within 12-24h after administration of IVIG in a cohort of children (n=22) with virologically confirmed EV71 infection, from March 2000 through April 2004.


RESULTS
Plasma levels of IFN-gamma, 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-1beta, IL-2, IL-4, IL-5 IL-10, IL-13 and TNF-alpha 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.
Wang
Shih-Min
SM
Department of Emergency Medicine, National Cheng Kung University & Hospital, 138 Sheng Li Road, 70428 Tainan, Taiwan.
Lei
Huan-Yao
HY
Huang
Mei-Chih
MC
Su
Ling-Yao
LY
Lin
Hui-Chen
HC
Yu
Chun-Keung
CK
Wang
Jung-Lung
JL
Liu
Ching-Chuan
CC
D001933:Brain Stem; D002675:Child, Preschool; D016207:Cytokines / Q000096:biosynthesis* / Q000097:blood; D018792:Encephalitis, Viral / Q000150:complications / Q000276:immunology* / Q000628:therapy; D029821:Enterovirus A, Human; D004769:Enterovirus Infections / Q000150:complications / Q000276:immunology* / Q000628:therapy; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D011654:Pulmonary Edema / Q000150:complications
D016207:Cytokines; D016756:Immunoglobulins, Intravenous