Serum inflammatory cytokine levels correlate with hand-foot-mouth disease severity: a nested serial case-control study.
BACKGROUND
Hand-food-mouth disease (HFMD) cases can be fatal. These cases develop rapidly, and it is important to predict the severity of HFMD from mild to fatal and to identify risk factors for mild HFMD. The objective of this study was to correlate the levels of serum inflammatory cytokines with HFMD severity.


METHODS
This study was designed as a nested serial case-control study. The data collected included general information, clinical symptoms and signs, laboratory findings and serum cytokine levels.


RESULTS
The levels of IL-4, IL-6, IL-10, TNF-α and IFN-γ in patients with severe HFMD were significantly higher than in mild patients during the 2nd to 5th day after disease onset. The levels of IL-4, IL-6, IL-10 and IFN-γ increased from the 2nd day to the 4th day and later decreased. The levels of TNF-α were high on the first two days and subsequently decreased. The changes of IL-10, TNF-α and IFN-γ in the controls were similar for all cases. The levels of IL-4, IL-6 and IL-17 in the controls were not significantly different with the progression of HFMD.


CONCLUSIONS
Our findings indicate that the IL-4, IL-6, IL-10, TNF-α and IFN-γ levels correlate with HFMD severity.
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China; Henan Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, Henan, China.
Guangcai
G
Duan
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
Haiyan
H
Yang
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China; Henan Center for Disease Control and Prevention, Zhengzhou, Henan, China.
Lubin
L
Shi
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
Wumei
W
Sun
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
Meili
M
Sui
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
Rongguang
R
Zhang
Children's Hospital of Zhengzhou City, Zhengzhou, Henan, China.
Xinhong
X
Wang
Children's Hospital of Zhengzhou City, Zhengzhou, Henan, China.
Fang
F
Wang
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
Weidong
W
Zhang
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
Yuanlin
Y
Xi
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
Qingtang
Q
Fan
D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index
D015415:Biomarkers; D016207:Cytokines