title: CD4+ T-cell counts and interleukin-8 and CCL-5 plasma concentrations discriminate disease severity in children with RSV infection.
abstract: BACKGROUND
  Current tools to predict the severity of respiratory syncytial virus (RSV) infection might be improved by including immunological parameters. We hypothesized that a combination of inflammatory markers would differentiate between severe and mild disease in RSV-infected children.
  
  
  METHODS
  Blood and nasopharyngeal samples from 52 RSV-infected children were collected during acute infection and after recovery. Retrospectively, patients were categorized into three groups based on disease severity: mild (no supportive treatment), moderate (supplemental oxygen and/or nasogastric feeding), and severe (mechanical ventilation). Clinical data, number of flow-defined leukocyte subsets, and cytokine concentrations were compared.
  
  
  RESULTS
  Children with severe RSV infection were characterized by young age; lymphocytopenia; increased interleukin (IL)-8, granulocyte colony-stimulating factor (G-CSF), and IL-6 concentrations; and decreased chemokine (C-C motif) ligand (CCL-5) concentrations in plasma. The combination of plasma levels of IL-8 and CCL-5, and CD4+ T-cell counts, with cutoff values of 67 pg/ml, 13 ng/ml, and 2.3 × 10(6)/ml, respectively, discriminated severe from mild RSV infection with 82% sensitivity and 96% specificity.
  
  
  CONCLUSIONS
  This study demonstrates that the combination of CD4+ T-cell counts and IL-8 and CCL-5 plasma concentrations correlates with disease severity in RSV-infected children. In addition to clinical features, these immunological markers may be used to assess severity of RSV infection and guide clinical management.
authors.affiliation: Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Hanne K
authors.initials: HK
authors.lastname: Brand
authors.forename: Gerben
authors.initials: G
authors.lastname: Ferwerda
authors.forename: Frank
authors.initials: F
authors.lastname: Preijers
authors.forename: Ronald
authors.initials: R
authors.lastname: de Groot
authors.forename: Chris
authors.initials: C
authors.lastname: Neeleman
authors.forename: Frank J T
authors.initials: FJ
authors.lastname: Staal
authors.forename: Adilia
authors.initials: A
authors.lastname: Warris
authors.forename: Peter W M
authors.initials: PW
authors.lastname: Hermans
mesh_terms: D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001990:Bronchiolitis, Viral / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy / Q000821:virology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology* / Q000821:virology; D018946:Chemokine CCL5 / Q000097:blood*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018836:Inflammation Mediators / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D018357:Respiratory Syncytial Virus Infections / Q000097:blood / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy / Q000821:virology; D018113:Respiratory Syncytial Virus, Human / Q000276:immunology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019562:Viral Load
chemical_list: D015415:Biomarkers; C483024:CCL5 protein, human; C508606:CXCL8 protein, human; D018946:Chemokine CCL5; D018836:Inflammation Mediators; D016209:Interleukin-8