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. 2013 Feb;73(2):187-93.
doi: 10.1038/pr.2012.163. Epub 2012 Nov 19.

CD4+ T-cell counts and interleukin-8 and CCL-5 plasma concentrations discriminate disease severity in children with RSV infection

Hanne K Brand  1 , Gerben Ferwerda, Frank Preijers, Ronald de Groot, Chris Neeleman, Frank J T Staal, Adilia Warris, Peter W M Hermans
Affiliations

CD4+ T-cell counts and interleukin-8 and CCL-5 plasma concentrations discriminate disease severity in children with RSV infection

Hanne K Brand et al. Pediatr Res. 2013 Feb.

Abstract

Background: Current tools to predict the severity of respiratory syncytial virus (RSV) infection might be improved by including immunological parameters. We hypothesized that a combination of inflammatory markers would differentiate between severe and mild disease in RSV-infected children.

Methods: Blood and nasopharyngeal samples from 52 RSV-infected children were collected during acute infection and after recovery. Retrospectively, patients were categorized into three groups based on disease severity: mild (no supportive treatment), moderate (supplemental oxygen and/or nasogastric feeding), and severe (mechanical ventilation). Clinical data, number of flow-defined leukocyte subsets, and cytokine concentrations were compared.

Results: Children with severe RSV infection were characterized by young age; lymphocytopenia; increased interleukin (IL)-8, granulocyte colony-stimulating factor (G-CSF), and IL-6 concentrations; and decreased chemokine (C-C motif) ligand (CCL-5) concentrations in plasma. The combination of plasma levels of IL-8 and CCL-5, and CD4+ T-cell counts, with cutoff values of 67 pg/ml, 13 ng/ml, and 2.3 × 10(6)/ml, respectively, discriminated severe from mild RSV infection with 82% sensitivity and 96% specificity.

Conclusion: This study demonstrates that the combination of CD4+ T-cell counts and IL-8 and CCL-5 plasma concentrations correlates with disease severity in RSV-infected children. In addition to clinical features, these immunological markers may be used to assess severity of RSV infection and guide clinical management.

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Figures

Figure 1
Figure 1
Absolute cell counts of leukocyte subsets in blood from children with an RSV infection categorized by disease severity. Cell counts of (a) granulocytes, (b) monocytes, (c) B cells, (d) NK cells, (e) CD4+ T cells, and (f) CD8+ T cells are expressed as 106 cells/ml. Data are plotted as medians with the 25th–75th percentile range. Mann–Whitney U-tests were performed, **P < 0.01. NK, natural killer; RSV, respiratory syncytial virus.
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