Immune suppression and isolated severe head injury: a significant clinical problem

Boddie, David; Currie, David G.; Eremin, O.; Heys, Steven Darryll

doi:10.1080/02688690310001611198

Cited by 36 publications

(19 citation statements)

References 44 publications

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“…This should precede donation if the positive result is known prior to procurement. Regardless, the IGRA testing results alone should not influence suitability for donation, but may be used to guide follow up assessments or TB therapy in the recipient d. Literature suggests that cell-mediated immunity is depressed following head injury (36,37). Therefore, persons with head injury may not respond to mitogen.…”

Section: Epidemiologymentioning

confidence: 99%

Diagnosis and Management of Tuberculosis in Transplant Donors: A Donor-Derived Infections Consensus Conference Report

Morris

Daly

Blumberg

et al. 2012

American Journal of Transplantation

126

147

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Mycobacterium tuberculosis is a ubiquitous organism that infects one-third of the world's population. In previous decades, access to organ transplantation was restricted to academic medical centers in more developed, low tuberculosis (TB) incidence countries. Globalization, changing immigration patterns, and the expansion of sophisticated medical procedures to medium and high TB incidence countries have made tuberculosis an increasingly important posttransplant infectious disease. Tuberculosis is now one of the most common bacterial causes of solid-organ transplant donor-derived infection reported in transplant recipients in the United States. Recognition of latent or undiagnosed active TB in the potential organ donor is critical to prevent emergence of disease in the recipient posttransplant. Donor-derived tuberculosis after transplantation is associated with significant morbidity and mortality, which can best be prevented through careful screening and targeted treatment. To address this growing challenge and provide recommendations, an expert international working group was assembled including specialists in transplant infectious diseases, transplant surgery, organ procurement and TB epidemiology, diagnostics and management. This working group reviewed the currently available data to formulate consensus recommendations for screening and management of TB in organ donors.

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Section: Epidemiologymentioning

confidence: 99%

Diagnosis and Management of Tuberculosis in Transplant Donors: A Donor-Derived Infections Consensus Conference Report

Morris

Daly

Blumberg

et al. 2012

American Journal of Transplantation

126

147

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“…It is also well-known that immunological function may be impaired in the early phase after TBI, as well in as trauma in general, due to a complex multifactorial effect of suppression of T-cell mediated immune function, and changes in soluble mediators, such as an increase in PGE 2 biosynthesis, and reductions in the levels of the key immunoregulatory cytokines IL-2 and IFN-g (Boddie et al, 2003;Quattrocchi et al, 1990Quattrocchi et al, , 1991aQuattrocchi et al, ,b, 1992. The administration of any medication that might induce further immunological suppression should therefore be undertaken with caution, in order to avoid any additional or synergistic suppression of immune function after severe TBI.…”

Section: Effects Of Csa On Blood Counts and Incidence Of Infectionmentioning

confidence: 99%

Safety and Tolerability of Cyclosporin A in Severe Traumatic Brain Injury Patients: Results from a Prospective Randomized Trial

Mazzeo

Brophy

Gilman

et al. 2009

Journal of Neurotrauma

100

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Cyclosporin A (CsA) has recently been proposed for use in the early phase after traumatic brain injury (TBI), for its ability to preserve mitochondrial integrity in experimental brain injury models, and thereby provide improved behavioral outcomes as well as significant histological protection. The aim of this prospective, randomized, double-blind, dual-center, placebo-controlled trial was to evaluate the safety, tolerability, and pharmacokinetics of a single intravenous infusion of CsA in patients with severe TBI. Fifty adult severe TBI patients were enrolled over a 22-month period. Within 12 h of the injury patients received 5 mg=kg of CsA infused over 24 h, or placebo. Blood urea nitrogen (BUN), creatinine, hemoglobin, platelets, white blood cell count (WBC), and a hepatic panel were monitored on admission, and at 12, 24, 36, and 48 h, and on days 4 and 7. Potential adverse events (AEs) were also recorded. Neurological outcome was recorded at 3 and 6 months after injury. This study revealed only transient differences in BUN levels at 24 and 48 h and for WBC counts at 24 h between the CsA and placebo patients. These modest differences were not clinically significant in that they did not negatively impact on patient course. Both BUN and creatinine values, markers of renal function, remained within their normal limits over the entire monitoring period. There were no significant differences in other mean laboratory values, or in the incidence of AEs at any other measured time point. Also, no significant difference was demonstrated for neurological outcome. Based on these results, we report a good safety profile of CsA infusion when given at the chosen dose of 5 mg=kg, infused over 24 h, during the early phase after severe head injury in humans, with the aim of neuroprotection.

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“…Brain injury, for example, has long been known to severely impair host defense, most likely through neurohormonal mechanisms. 25,26 Last, in the case of illnesses related to infection, it appears that some pathogens may promote immune suppression in the host more than others. Secondary infection with Staphylococcus aureus, for example, was associated with dramatically increased risks for immune suppression developing in a cohort of critically ill children with influenza when compared with children co-infected with other organisms.…”

Section: Illness-related Factorsmentioning

confidence: 99%

Critical Illness–Induced Immune Suppression: Current State of the Science

Greathouse

Hall

2016

American Journal of Critical Care

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Critical illness comprises a heterogeneous group of serious medical conditions that typically involve an initial proinflammatory process. A compensatory anti-inflammatory response may occur that, if severe and persistent, places the patient at high risk for adverse outcomes including secondary infection and death. Monitoring strategies can identify these patients through measurement of innate and adaptive immune function. Reductions in monocyte HLA-DR expression, reduced cytokine production capacity, increased inhibitory cell surface molecule expression, and lymphopenia have all been associated with this immunesuppressed state. Intriguing data suggest that critical illness-induced immune suppression may be reversible with agents such as interferon-γ, granulocyte macrophage colony-stimulating factor, interleukin 7, or anti-programmed death-1 therapy. Future approaches for characterization of patient-specific immune derangements and individualized treatment could revolutionize how we recognize and prevent complications in critically ill patients.

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Immune suppression and isolated severe head injury: a significant clinical problem

Cited by 36 publications

References 44 publications

Diagnosis and Management of Tuberculosis in Transplant Donors: A Donor-Derived Infections Consensus Conference Report

Diagnosis and Management of Tuberculosis in Transplant Donors: A Donor-Derived Infections Consensus Conference Report

Safety and Tolerability of Cyclosporin A in Severe Traumatic Brain Injury Patients: Results from a Prospective Randomized Trial

Critical Illness–Induced Immune Suppression: Current State of the Science

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