| Author | Costa, Dorcas Lamounier | |
| Author | Rocha, Regina L | |
| Author | Carvalho, Rayssa Maria de Araujo | |
| Author | Lima Neto, Adelino S | |
| Author | Harhay, Michael O | |
| Author | Costa, Carlos Henrique Nery | |
| Author | Barral Netto, Manoel | |
| Author | Barral, Aldina Maria Prado | |
| Access date | 2013-11-25T18:51:32Z | |
| Available date | 2013-11-25T18:51:32Z | |
| Document date | 2013 | |
| Citation | COSTA, D. et al. Serum cytokines associated with severity and complications of kala-azar. Pathogens and Global Health, v.107, p.78-87, 2013. | pt_BR |
| URI | https://www.arca.fiocruz.br/handle/icict/7260 | |
| Language | eng | pt_BR |
| Publisher | W. S. Maney & Son Ltd | pt_BR |
| Rights | open access | pt_BR |
| Title | Serum cytokines associated with severity and complications of kala-azar | pt_BR |
| Type | Article | pt_BR |
| DOI | 10.1179/2047773213Y.0000000078 | |
| Abstract | Objectives: Recent clinical data suggest that severe kala-azar (or visceral leishmaniasis) is an exaggerated
innate immune response mediated by inflammatory cytokines, leading to a systemic inflammatory
syndrome similar to what is observed in malaria, sepsis and other diseases. We tested this hypothesis by
measuring serum cytokines in individuals with kala-azar.
Methods: We compared patients with severe kala-azar (i.e. hemorrhagic manifestations, n538) with
patients without evidence of hemorrhage (n596). We conducted a detailed clinical and laboratory
evaluation, measuring serum IL-1beta, IL-6, IL-8, IL-10, IL-12, interferon-gamma, and TNF-alpha, and
markers of disseminated intravascular coagulation (DIC).
Results: Infants had higher levels of inflammatory cytokines, while HIV-infected patients had lower
concentrations of IL-10 and interferon-gamma. Higher levels of IL-6, interferon-gamma, and IL-8 were
found among deceased patients. IL-8 and interferon-gamma were independently associated with bleeding.
Several cytokines were associated with different signs of severe clinical and laboratory manifestations,
including DIC. IL-6 was highly positively and independently associated with IL-1beta, IL-8, IL-10, and
negatively associated with TNF-alpha. IL-1beta and TNF-alpha were also highly independently associated
with disease severity.
Conclusion: In its severe form, kala-azar, a neglected tropical disease, initiates a systemic inflammatory
response that leads to DIC and other manifestations. Children may have higher risk of death due to the more
intense cytokine release. The data supports the notion that IL-6 is the central cytokine that is associated with
lethal disease, but interferon-gamma, IL1beta, IL-8, and TNF-alpha are also involved with disease severity.
Inhibition of IL-6 is a potential target of adjuvant therapy for severe or pediatric forms of this disease. | pt_BR |
| Affilliation | Federal University of Piauí. Maternal and Childhood Department. Piauí, Brasil / Institute of Tropical Medicine ‘Natan Portella’. Laboratory of Leishmaniasis. Piauí, Brasil | pt_BR |
| Affilliation | Federal University of Minas Gerais. Department of Pediatrics. Minas Gerais, BH, Brasil | pt_BR |
| Affilliation | Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Laboratorio de Imunoparasitologia. Salvador, BA, Brasil | pt_BR |
| Affilliation | Institute of Tropical Medicine ‘Natan Portella’. Laboratory of Leishmaniasis. Piauí, Brasil. / Federal University of Minas Gerais. Department of Community Medicine. Minas Gerais, BH, Brasil | pt_BR |
| Affilliation | Federal University of Minas Gerais. Department of Community Medicine. Minas Gerais, BH, Brasil | pt_BR |
| Affilliation | Institute of Tropical Medicine ‘Natan Portella’. Laboratory of Leishmaniasis. Piauí, Brasil. / Federal University of Minas Gerais. Department of Community Medicine. Minas Gerais, BH, Brasil | pt_BR |
| Affilliation | Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Laboratório de Imunoregulação. Salvador, Bahia, Brasil | pt_BR |
| Affilliation | Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Laboratório de Imunoparasitologia. Salvador, BA, Brasil | pt_BR |
| Subject | Cytokines | pt_BR |
| Subject | Kala-azar | pt_BR |
| Subject | Leishmania infantum | pt_BR |
| Subject | Disseminated intravascular coagulation | pt_BR |
| Subject | Systemic inflammatory response | pt_BR |
