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Plasma cytokines in paediatric typhoidal salmonellosis: correlation with clinical course and outcome
Z A Bhutta1, N Mansoorali, R Hussain
1Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan.
Insights
Elevated levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) are common in children with multidrug-resistant typhoid. Higher baseline IL-6 levels correlated with increased treatment failure rates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Multidrug-resistant typhoid poses a significant challenge in pediatric care.
- Understanding the role of inflammatory markers like IL-6 and TNF-alpha is crucial for managing severe infections.
Purpose of the Study:
- To investigate the clinical profile, outcomes, and plasma cytokine levels (IL-6 and TNF-alpha) in children with multidrug-resistant typhoid.
- To correlate these cytokine levels with disease severity and treatment response.
Main Methods:
- A cohort of 38 children with culture-proven multidrug-resistant typhoid were studied.
- Plasma IL-6 and TNF-alpha concentrations were measured serially during 14-day treatment with ceftriaxone or cefixime.
- Clinical severity was assessed using a typhoid morbidity score.
Main Results:
- Over 50% of children exhibited elevated IL-6 and TNF-alpha levels, correlating with clinical severity.
- Cytokine levels significantly decreased within 7 days of therapy initiation.
- A higher failure rate was observed in children with baseline IL-6 >400 pg/ml.
Conclusions:
- Plasma cytokine activity, particularly IL-6, is frequently elevated in pediatric typhoidal salmonellosis.
- IL-6 levels correlate with disease severity and predict treatment outcomes in children.
- Monitoring IL-6 may aid in assessing illness severity and guiding treatment in pediatric typhoid cases.
Abstract:
We evaluated the clinical profile, outcome and serial plasma interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) concentrations in 38 consecutive children (aged 6 months-14 years) admitted with culture-proven multidrug-resistant typhoid. All children received therapy for 14 days with either i.v. ceftriaxone or oral cefixime, with comparable outcome. Concentrations of IL-6 and TNF-alpha were significantly elevated in over 50% of the cases and correlated with clinical severity of illness as quantitated by the typhoid morbidity score. Sequential measurements revealed a significant decrease in IL-6 and TNF-alpha concentrations within 7 days of initiation of therapy (P<0.05). While no clear relationship was seen with time-to-defervescence, the failure rate was significantly higher in children with baseline serum IL-6 values >400 pg/ml (P<0.05). Our data suggest that plasma cytokine activity is frequently elevated in children with typhoidal salmonellosis, and IL-6 concentrations show a correlation with clinical severity and recovery from the illness.