Cytokine Activation Patterns and Biomarkers Are Influenced by Microorganisms in Community-Acquired Pneumonia

Menéndez, Rosário; Sahuquillo-Arce, José Miguel; Reyes, Soledad; Martínez, Raquel; Polverino, Eva; Cillóniz, Catia; Córdoba, Juan; Montull, Beatriz; Torres, Antoni

doi:10.1378/chest.11-1446

Cited by 97 publications

(92 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, it is not currently widely available in routine laboratory analysis because access to flow cytometry is required. PCT is also well-known and utilized as a useful biomarker related to the severity of bacterial infections and sepsis (24) and may be increased during Legionella infection (20,25,26) as also seen in the present case. However, it should be noted that PCT may not be upregulated during viral or mycobacterial infections, unlike neutrophil CD64.…”

Section: Discussionsupporting

confidence: 68%

“…However, to the best of our knowledge, no previous reports of Legionella infection in RA patients receiving TCZ (in recent PubMed search results) exist. Menéndez et al reported that serum IL-6, as well as TNF-α levels in patients with Legionella pneumonia, were higher among patients with community-acquired pneumonia other than Legionella pneumonia (20). In vitro, induction and expression of IL-6 derived from lung epithelial cells increased after invasion of human alveolar cells by Legionella pneumophila, thus indicating that IL-6 is required for normal defense against infection by this organism in the lung (21).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Fatal Complication of <i>Legionella pneumophila</i> Pneumonia in a Tocilizumab-treated Rheumatoid Arthritis Patient

et al. 2015

View full text Add to dashboard Cite

We herein report a fatal case of Legionella pneumophila pneumonia in a tocilizumab-treated rheumatoid arthritis patient who was in a state of shock on admission but remained afebrile even during severe pneumonia. Legionella antigen was detected in the urine and neutrophil CD64 expression was highly elevated. Despite undergoing intensive treatment, the patient developed sepsis and died 12 days after admission. An autopsy indicated that while the Legionella infection had almost been controlled, a subarachnoid hemorrhage was the ultimate cause of death.

show abstract

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Fatal Complication of <i>Legionella pneumophila</i> Pneumonia in a Tocilizumab-treated Rheumatoid Arthritis Patient

et al. 2015

View full text Add to dashboard Cite

show abstract

“…If not regulated tightly, the inflammatory response can become excessive and may progress into sepsis and, ultimately, multiple organ dysfunction syndrome (MODS). The nature and magnitude of the inflammatory response are determined by host characteristics, the nature of the causative microorganisms, and antibiotic treatment (10).…”

mentioning

confidence: 99%

Dexamethasone Downregulates the Systemic Cytokine Response in Patients with Community-Acquired Pneumonia

Remmelts

Meijvis

Biesma

et al. 2012

Clin Vaccine Immunol

View full text Add to dashboard Cite

hThe influence of adjunctive corticosteroids on the cytokine response in community-acquired pneumonia (CAP) is largely unknown. In this study, we analyzed the effect of dexamethasone on the cytokine response in patients with CAP and evaluated whether this effect is dependent on the causative microorganism. We hypothesized that dexamethasone has a larger effect on the cytokine response in patients with pneumococcal pneumonia than in patients with pneumonia caused by an atypical bacterium. A total of 304 hospitalized, nonimmunocompromised patients with CAP were randomized to an adjunctive 4-day course of 5 mg dexamethasone once a day (n ‫؍‬ 151) or a placebo (n ‫؍‬ 153). Serum concentrations of interleukin-1 receptor antagonist (IL-1Ra), IL-6, IL-8, IL-10, IL-17, tumor necrosis factor alpha (TNF-␣), gamma interferon (IFN-␥), macrophage inflammatory protein-1 alpha (MIP-1␣), and monocyte chemotactic protein-1 (MCP-1) were measured on days 0, 1, 2, and 4 and at a control visit. Overall, the concentrations of IL-6 (P < 0.01), IL-8 (P < 0.01), MCP-1 (P < 0.01), and TNF-␣ (P < 0.01) were significantly lower on day 2 in the dexamethasone group than in the placebo group. In patients with pneumococcal pneumonia (n ‫؍‬ 72), both treatment groups showed a rapid decrease of cytokine concentrations; only the concentration of TNF-␣ (P ‫؍‬ 0.05) was significantly lower in the dexamethasone group on day 2. In patients with CAP caused by an atypical pathogen (Legionella pneumophila, Chlamydophila species, Coxiella burnetii, or Mycoplasma pneumoniae; n ‫؍‬ 58), IL-1Ra (P < 0.01), IL-6 (P < 0.01), and MCP-1 (P ‫؍‬ 0.03) decreased more rapidly in the dexamethasone group than in the placebo group. In conclusion, dexamethasone downregulates the cytokine response during CAP. This effect seems to be dependent on the causative microorganism. This study provides insight into which patients with CAP might benefit most from adjunctive dexamethasone.

show abstract

“…The growing pressure of multidrug-resistant bacteria in the ICU environment, combined with considerations regarding cost and limitation of drug toxicity and interactions [26,27], offered the perfect opportunity for a new appraisal of this biomarker, which had somehow failed to fulfill its promises. It is considered to be useful because of favorable kinetics [28] and a high negative predictive value [17,[29][30][31].…”

Section: Core Textmentioning

confidence: 99%

Procalcitonin for Antibiotic Treatment in Intensive Care Unit Patients

Layios¹,

Lambermont

2013

Curr Infect Dis Rep

View full text Add to dashboard Cite

Procalcitonin (PCT), a 116-aminoacids prohormone, has been substantially studied over the last 2 decades in the field of sepsis. Disappointingly low sensitivity values led to the abandonment of the concept of it as a diagnostic tool and then to its being considered more as a prognostic marker with a good correlation with severe infection. Later on, growing concerns about multidrug-resistant bacteria in the ICU environment and about the cost and side effects of antibiotics suggested that PCT might prove to be a valuable asset in stewardship programs. Numerous but hardly comparable randomized controlled trials assessing either initiation or deescalation in ICU patients have been published. Stewardship encompassing PCT should focus on the latter, because of the high negative predictive value of this biomarker. However, there still would be safety concerns if a systematic implementation of PCT were to be considered in daily stewardship programs in the ICU, especially in extrathoracic sepsis.

show abstract

Cytokine Activation Patterns and Biomarkers Are Influenced by Microorganisms in Community-Acquired Pneumonia

Abstract: Different inflammatory patterns elicited by different microorganisms may provide a useful tool for diagnosis. Recognizing these patterns provides additional information that may facilitate a broader understanding of host inflammatory response to microorganisms.

Cited by 97 publications

References 26 publications

Fatal Complication of <i>Legionella pneumophila</i> Pneumonia in a Tocilizumab-treated Rheumatoid Arthritis Patient

Fatal Complication of <i>Legionella pneumophila</i> Pneumonia in a Tocilizumab-treated Rheumatoid Arthritis Patient

Dexamethasone Downregulates the Systemic Cytokine Response in Patients with Community-Acquired Pneumonia

Procalcitonin for Antibiotic Treatment in Intensive Care Unit Patients

Contact Info

Product

Resources

About