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Clinical significance of IL-5 and VEGF in BALF with Mycoplasma pneumoniae pneumonia
Posters / Paediatric Respiratory Reviews 13S1 (2012) S51–S85
definite at last. After an anti-tuberculosis treatment for nearly one year, the girl had nearly recovered. Conclusion: Sometimes disseminated tuberculosis may be atypical. If a child with multisystem damage, infectious diseases, especially TB, always need to be taken into consideration in China. A further careful etiology search is necessary. C11-205 Immune reconstitution syndrome (IRIS) in a child with disseminated tuberculosis I.D. Ba1 , G. Lapierre2 , D. Berub ´ e´ 2 , M.F. Buteau2 , J.E. Marcotte2 , S. Jacob1 , M. Ba1 , P.M. Faye1 . 1 Albert Royer Children Hospital (Dakar-Senegal) Pediatrics, Dakar, Senegal; 2 Montreal University Ste-Justine University Hospital Center, Montreal, Canada IRIS is a paradoxical reaction initially described in HIV-infected patient after initiation of antiretroviral therapy (ART). Incidence is estimated between 12 to 19% in children starting ART. TB associated IRIS is characterized by a clinical worsening after the start of ART in patients receiving Tb treatment. It can also be diagnosed as a new presentation of Tb that is “unmasked” in the weeks following initiation of ART and exclusion of other causes that could explain a deterioration (such as antimicrobial drug resistance, drug hypersensitivity reaction, or another opportunistic infection). IRIS in association with tuberculosis in non-HIV patients has not been reported in the literature. We report the case of an HIV negative 8 years-old malnourished girl of Haitian origin who developed an IRIS and dilated cardiomyopathy during her treatment for severe disseminated TB (lungs, mediastinal lymph nodes, spleen, liver and kidneys). An antibiotic treatment consisting of Rifampine, Izoniacid, Pyrazinamide and Ethambutol (RIPE) for the initial 2 months followed by months 10 of RI was begun against a drug sensitive mycobacterium tuberculosis strain retrieved in gastric aspirates and urine. The child appeared stable for the 2 first weeks of treatment but her fever kept going. In fact, fever (39–40°C) and rigors persisted on a daily basis with diffuse bone pains, elevated transaminases over the next 5 months together with an initial progression of the chest infiltrates. Sequential abdominal CT and Gallium scans demonstrated a progressive involvement of liver (enlarged liver with multiple nodules), spleen, kidneys, bone marrow and abdomen lymph nodes between 2 weeks and 5 months. An extensive search for other infections turned back negative and a complete immunological work-up was considered normal. At the end of those 5 months, fever vanished and she gradually improved. Chest and abdominal imaging also eventually improved. We concluded from an extensive review of the literature that this case highlights a paradoxical immune mediated reaction similar to the previously described IRIS in HIV infected patients but this time to Mycobacterium Tuberculosis during an appropriate antibiotic treatment. Such an IRIS resulted in an apparent clinical deterioration but turned out not being a failure to treatment. In the future, early recognition of an IRIS in tuberculosis might prevent unnecessary changes in anti-TB regimen. C12-230 Clinical significance of IL-5 and VEGF in BALF with Mycoplasma pneumoniae pneumonia H.J. Cheng1 , H.M. Qiao1 , L. Liu1 , H. Sun2 , J.R. Lu1 , J.Z. Lii1 . 1 Hospital of Jilin University, Changchun, China; 2 Taizhou People’s Hospital pediatrics, Taizhou, China Keywords: MPP, IL-5, VEGF, BALF, Children
Background: Mycoplasma pneumonia (MP) is a common cause of pneumonia in children. Until now the mechanism of mycoplasma pneumoniae pneumonia (MPP) has not been clarified, some studies confirmed cellular immunity involved in the pathogenesis of MPP, and cytokines play an important role. Main role of IL-5 is to activate a series of eosinophil response that could induce eosinophil
S61
progenitor cell growth and differentiation. VEGF plays an important role in airway inflammation and airway remodeling. When MP infected the body, the level of IL-5 and VEGF increased that can mediate immune responses and immune injury. Objectives: To study the levels and roles of the cytokines IL-5 and VEGF in Bronchoalveolar lavage fluid (BALF) and serum in children with MPP, to indicate their effect on the pathogenesis of MPP and the relation between breathing disease and MPP. Methods: The object of this study is enrolled children with MPP in our department. Select the patients during the same period of bronchial foreign body, airway malformations, chronic cough in the hospital as the control group. The level of IL-5 and VEGF in BALF and serum are measured with wheezing and no wheezing of MPP children in acute and remission stage by doubleantibody sandwich enzyme-linked immunosorbent assay (ELISA) respectively. Results: 1. The level of IL-5 and VEGF in BALF and serum in acute stage were significantly higher than those at the remission phase in children with MPP (P < 0.01). 2. There was no significant difference between the remission stage and the control group (P >0.05). 3. The level of IL-5 and VEGF in BALF and serum in the wheezing group patients with MPP were higher than those no wheezing group (P < 0.01). Conclusions: 1. The level of IL-5 and VEGF in BALF and serum in acute stage children with MPP were higher than those in the remission stage and the control group, There was no statistically significant difference between the remission stage and the control group. It suggests that IL-5 and VEGF are involved in the pathogenesis of MPP. 2. The level of IL-5 and VEGF in BALF and serum in the wheezing group patients were higher than those in no wheezing group. It suggests that IL-5 and VEGF are closely related with the occurrence of wheezing. 3. The levels of IL-5 and VEGF in BALF were in accordance with it in serum, and the cytokine concentration in BALF was higher than that in serum, both positive related. C13-231 The effect of TNF-a, IL-12 and CysLTs on the pathogenesis of MPP in children H.J. Cheng1 , J.N. Yin1 , L. Liu1 , H.M. Qiao1 , J.R. Lu1 . 1 Hospital of Jilin University, Changchun, China Keywords: CysLTs; IL-12; TNF-a; Children; Mycoplasma pneumoniae pneumonia
Objective: To approach the effect of TNF-a, IL-12 and CysLTs on the pathogenesis of MPP, we detected the levels of these three cytokines in the blood serum of the children with MPP in the acute and convalescence stages. Method: The levels of TNF-a, IL-12 and CysLTs in the blood serum of 40 children with MPP in acute stage, 23 in convalescence stage, 20 children with bacterial pneumonia and 20 healthy children were respectively detected by ELISA method, and the group difference of each cytokine was compared. Results: The level of CysLTs in the blood serum of the group in the acute stage was higher than the one in the healthy group, and the one in the convalescence stage was in the downtrend but still higher than the one in the healthy group. The levels of IL-12 in the blood serum of the groups in the acute and convalescence stages were lower than the one in the healthy group. Compared with the one in the healthy group, the levels of TNF-a in the blood serum of the groups in the acute and convalescence stages had no significant differences. Conclusion: The changes of CysLTs and IL-12 in the blood serum maybe one of the reasons of the MPP immunological damage.
definite at last. After an anti-tuberculosis treatment for nearly one year, the girl had nearly recovered. Conclusion: Sometimes disseminated tuberculosis may be atypical. If a child with multisystem damage, infectious diseases, especially TB, always need to be taken into consideration in China. A further careful etiology search is necessary. C11-205 Immune reconstitution syndrome (IRIS) in a child with disseminated tuberculosis I.D. Ba1 , G. Lapierre2 , D. Berub ´ e´ 2 , M.F. Buteau2 , J.E. Marcotte2 , S. Jacob1 , M. Ba1 , P.M. Faye1 . 1 Albert Royer Children Hospital (Dakar-Senegal) Pediatrics, Dakar, Senegal; 2 Montreal University Ste-Justine University Hospital Center, Montreal, Canada IRIS is a paradoxical reaction initially described in HIV-infected patient after initiation of antiretroviral therapy (ART). Incidence is estimated between 12 to 19% in children starting ART. TB associated IRIS is characterized by a clinical worsening after the start of ART in patients receiving Tb treatment. It can also be diagnosed as a new presentation of Tb that is “unmasked” in the weeks following initiation of ART and exclusion of other causes that could explain a deterioration (such as antimicrobial drug resistance, drug hypersensitivity reaction, or another opportunistic infection). IRIS in association with tuberculosis in non-HIV patients has not been reported in the literature. We report the case of an HIV negative 8 years-old malnourished girl of Haitian origin who developed an IRIS and dilated cardiomyopathy during her treatment for severe disseminated TB (lungs, mediastinal lymph nodes, spleen, liver and kidneys). An antibiotic treatment consisting of Rifampine, Izoniacid, Pyrazinamide and Ethambutol (RIPE) for the initial 2 months followed by months 10 of RI was begun against a drug sensitive mycobacterium tuberculosis strain retrieved in gastric aspirates and urine. The child appeared stable for the 2 first weeks of treatment but her fever kept going. In fact, fever (39–40°C) and rigors persisted on a daily basis with diffuse bone pains, elevated transaminases over the next 5 months together with an initial progression of the chest infiltrates. Sequential abdominal CT and Gallium scans demonstrated a progressive involvement of liver (enlarged liver with multiple nodules), spleen, kidneys, bone marrow and abdomen lymph nodes between 2 weeks and 5 months. An extensive search for other infections turned back negative and a complete immunological work-up was considered normal. At the end of those 5 months, fever vanished and she gradually improved. Chest and abdominal imaging also eventually improved. We concluded from an extensive review of the literature that this case highlights a paradoxical immune mediated reaction similar to the previously described IRIS in HIV infected patients but this time to Mycobacterium Tuberculosis during an appropriate antibiotic treatment. Such an IRIS resulted in an apparent clinical deterioration but turned out not being a failure to treatment. In the future, early recognition of an IRIS in tuberculosis might prevent unnecessary changes in anti-TB regimen. C12-230 Clinical significance of IL-5 and VEGF in BALF with Mycoplasma pneumoniae pneumonia H.J. Cheng1 , H.M. Qiao1 , L. Liu1 , H. Sun2 , J.R. Lu1 , J.Z. Lii1 . 1 Hospital of Jilin University, Changchun, China; 2 Taizhou People’s Hospital pediatrics, Taizhou, China Keywords: MPP, IL-5, VEGF, BALF, Children
Background: Mycoplasma pneumonia (MP) is a common cause of pneumonia in children. Until now the mechanism of mycoplasma pneumoniae pneumonia (MPP) has not been clarified, some studies confirmed cellular immunity involved in the pathogenesis of MPP, and cytokines play an important role. Main role of IL-5 is to activate a series of eosinophil response that could induce eosinophil
S61
progenitor cell growth and differentiation. VEGF plays an important role in airway inflammation and airway remodeling. When MP infected the body, the level of IL-5 and VEGF increased that can mediate immune responses and immune injury. Objectives: To study the levels and roles of the cytokines IL-5 and VEGF in Bronchoalveolar lavage fluid (BALF) and serum in children with MPP, to indicate their effect on the pathogenesis of MPP and the relation between breathing disease and MPP. Methods: The object of this study is enrolled children with MPP in our department. Select the patients during the same period of bronchial foreign body, airway malformations, chronic cough in the hospital as the control group. The level of IL-5 and VEGF in BALF and serum are measured with wheezing and no wheezing of MPP children in acute and remission stage by doubleantibody sandwich enzyme-linked immunosorbent assay (ELISA) respectively. Results: 1. The level of IL-5 and VEGF in BALF and serum in acute stage were significantly higher than those at the remission phase in children with MPP (P < 0.01). 2. There was no significant difference between the remission stage and the control group (P >0.05). 3. The level of IL-5 and VEGF in BALF and serum in the wheezing group patients with MPP were higher than those no wheezing group (P < 0.01). Conclusions: 1. The level of IL-5 and VEGF in BALF and serum in acute stage children with MPP were higher than those in the remission stage and the control group, There was no statistically significant difference between the remission stage and the control group. It suggests that IL-5 and VEGF are involved in the pathogenesis of MPP. 2. The level of IL-5 and VEGF in BALF and serum in the wheezing group patients were higher than those in no wheezing group. It suggests that IL-5 and VEGF are closely related with the occurrence of wheezing. 3. The levels of IL-5 and VEGF in BALF were in accordance with it in serum, and the cytokine concentration in BALF was higher than that in serum, both positive related. C13-231 The effect of TNF-a, IL-12 and CysLTs on the pathogenesis of MPP in children H.J. Cheng1 , J.N. Yin1 , L. Liu1 , H.M. Qiao1 , J.R. Lu1 . 1 Hospital of Jilin University, Changchun, China Keywords: CysLTs; IL-12; TNF-a; Children; Mycoplasma pneumoniae pneumonia
Objective: To approach the effect of TNF-a, IL-12 and CysLTs on the pathogenesis of MPP, we detected the levels of these three cytokines in the blood serum of the children with MPP in the acute and convalescence stages. Method: The levels of TNF-a, IL-12 and CysLTs in the blood serum of 40 children with MPP in acute stage, 23 in convalescence stage, 20 children with bacterial pneumonia and 20 healthy children were respectively detected by ELISA method, and the group difference of each cytokine was compared. Results: The level of CysLTs in the blood serum of the group in the acute stage was higher than the one in the healthy group, and the one in the convalescence stage was in the downtrend but still higher than the one in the healthy group. The levels of IL-12 in the blood serum of the groups in the acute and convalescence stages were lower than the one in the healthy group. Compared with the one in the healthy group, the levels of TNF-a in the blood serum of the groups in the acute and convalescence stages had no significant differences. Conclusion: The changes of CysLTs and IL-12 in the blood serum maybe one of the reasons of the MPP immunological damage.