Background Human metapneumovirus (HMPV) is an important cause of respiratory tract infections in young children. Early innate immune response to HMPV is focused on induction of antiviral interferons (IFNs) and other pro-inflammatory cytokines that are critical for the formation of adaptive immune responses. To evaluate the predictive value of Th1/Th2 cytokines which include IL-2, IL-4, IL-6, IL-10, INF-γ and TNF-α in pneumonia caused by HMPV. Methods A retrospective study was performed among 59 pneumonia pediatric patients with HMPV infection and 33 healthy children as the control cohort, which was detected by the immunofluorescence assay, and the Th1/Th2 cytokines were measured by flow cytometry. 131 children infected with Influenza virus A (IVA) and 41 children infected with influenza virus B (IVB) were detected by RT-PCR assay in throat swabs. Results When compared with the healthy children, children who were infected with HMPV pneumonia had a significantly lower level of IL-2 (p < 0.001) and higher levels of IL-4 (p < 0.001), IL-6 (p = 0.001), IL-10 (p < 0.001), and IFN-γ (p < 0.001). Compared with patients diagnosed with IVA or IVB infection, HMPV-positive patients had significantly higher levels of IL-4 (p < 0.001 and < 0.001), IFN-γ (p < 0.001 and < 0.001), and TNF-α (p < 0.001 and 0.016). Moreover, compared with IVA patients, HMPV-positive patients had a significantly lower level of IL-6 (p = 0.033). Finally, when comparing cytokine levels among the patients with HMPV pneumonia, IL-6 and TNF-α levels were found to be significantly higher in the severe group than the mild group (p = 0.027 and 0.049). The IL-6 and TNF-α were used to differentiate between mild symptoms and severe symptoms in children diagnosed with HMPV pneumonia with an AUC of 0.678 (95% CI 0.526–0.829) and 0.658 (95% CI 0.506–0.809), respectively. Conclusion Our study indicated that difference in cytokine trends depending on the virus species. The levels of IL-4, TNF-α and IFN-γ were significantly distinguished in children infected with HMPV versus IVA and IVB. IL-6 and TNF-α may be helpful in assessing the severity and prognosis of HMPV infection.
Background: Human metapneumovirus (HMPV) is an important cause of respiratory tract infections in young children. To evaluate the predicitive value of Th1/Th2 cytokines which include IL-2, IL-4, IL-6, IL-10, INF-γ and TNF-α in pneumonia caused by HMPV. Methods: A retrospective study was performed among 59 pneumonia pediatric patients with HMPV infection and 33 healthy children as the control cohort, which was detected by the immunofluorescence assay, and the Th1/Th2 cytokines were measured by flow cytometry. Results: When compared with the healthy children, children who were infected with HMPV pneumonia had a significantly lower level of IL-2 (p<0.001) and higher levels of IL-4 ((p<0.001), IL-6 (p=0.001), IL-10 (p<0.001), and IFN-γ (p<0.001). Compared with patients diagnosed with influenza virus A (IVA) or influenza virus B (IVB) infections, HMPV-positive patients had significantly higher levels of IL-4 (p<0.001 and <0.001), IFN-γ (p<0.001 and <0.001), and TNF-α (p<0.001 and 0.016). Moreover, compared with IVA patients, HMPV-positive patients had a significantly lower level of IL-6 (p=0.033). Finally, when comparing cytokine levels among the patients with HMPV pneumonia, IL-6 and TNF-α levels were found to be significantly higher in the severe group than the mild group (p=0.027 and 0.049). The IL-6 and TNF-α were used to differentiate between mild and severe symptoms in children diagnosed with HMPV pneumonia with an AUC of 0.678 (95% CI, 0.526-0.829) and 0.658 (95% CI, 0.506-0.809), respectively.Conclusions: Our study indicates that IL-2, IL-4, IL-6, IL-10, and IFN-γ may be a reference for auxiliary diagnose HMPV pneumonia in children. IL-4, TNF-α, and IFN-γ may serve as biomarkers to distinguish HMPV from IVA and IVB, whereas IL-6 may be able to differentiate between HMPV and IVA. IL-6 and TNF-α may be used to assessment of severity and prognosis of HMPV infection.
We report a case of a 3-year-old boy diagnosed with CAEBV infection followed by pancreatic mass and recurrent pancreatitis. Due to the difficult clinical course of this patient's illness and complex diagnosis making, specialists from various departments were consulted. The multidisciplinary approach was crucial for the correct identification of the etiology of pancreatitis and pancreatic mass and selecting the most suitable treatment option. We present the following case in accordance with the CARE reporting checklist (available at
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