Infection after acute ischemic stroke: a manifestation of brain-induced immunodepression.
OBJECTIVE
Infection after experimental focal ischemia may result from brain-induced immunodepression, but it is unsettled whether a similar syndrome occurs in human stroke.


RESULTS
Many patients develop infections shortly after acute stroke regardless of optimal management. Mortality is higher in these patients and the severity of stroke is the strongest determinant of the infectious risk. However, it is controversial whether infections promote neurological worsening or alternatively represent a marker of severe disease. The brain and the immune system are functionally linked through neural and humoral pathways, and decreased immune competence with higher incidence of infections has been demonstrated in several acute neurological conditions. In experimental brain ischemia, infections are associated with the activation of the autonomous nervous system and neuroendocrine pathways, which increase the strength of anti-inflammatory signals. A strong cytokine-mediated anti-inflammatory response was recently observed in stroke patients at higher risk of infection, although infection could not demonstrate an independent association with the progression of the symptoms.


CONCLUSIONS
The appearance of infection in patients with acute stroke obeys in part to immunological mechanisms triggered by acute brain injury. An excessive anti-inflammatory response is a key facilitating factor for the development of infection, and it is likely that this immunological response represents an adaptive mechanism to brain ischemia. Contrarily, it is unclear whether infection contributes independently to poor outcome in human stroke. Overall, a better understanding of the cross-talk between the brain and the immune system might lead to more effective therapies in patients with acute stroke.
Chamorro
Angel
A
Stroke Unit, Hospital Clínic and Institut d'Investigations biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. achamorro@ub.edu
Urra
Xabier
X
Planas
Anna M
AM
D001921:Brain / Q000276:immunology*; D002545:Brain Ischemia / Q000150:complications / Q000276:immunology* / Q000473:pathology; D003141:Communicable Diseases / Q000209:etiology / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D020521:Stroke / Q000150:complications / Q000276:immunology* / Q000473:pathology; D013997:Time Factors