Relevant Cytokines in the Management of Community-Acquired Pneumonia

Abstract

Community-acquired pneumonia (CAP) is the leading cause of infectious death in the world. Immune dysregulation during acute lung infection plays a role in lung injury and the systemic inflammatory response. Cytokines seem to be major players in severe lung infection cases. Here, we present a review of published papers in the last 3 years regarding this topic. The cytokine response during pneumonia is different in bacterial vs viral infections; some of these cytokines correlate with clinical severity scales such as CURB65 or SOFA. Treatment focused in the cytokine environment is an interesting area that could impact the prognosis of CAP. Some of the agents that have been studied as co-adjuvant therapy are corticosteroids, macrolides, and linezolid, but anyone of those have shown a clear or proven efficacy or have been recommended as a part of the standard of care for CAP. More studies designed to define the role of immunomodulatory agents, such as co-adjuvant therapy in pneumonia, are needed.

Interleukin-5, interleukin-6, interferon induced protein-10, procalcitonin and C-reactive protein among mechanically ventilated severe community-acquired viral and bacterial pneumonia patients

“…In pneumococcal pneumonia, higher interleukin-1 receptor antagonist (IL-1RA), IL-6, IL-8, IL-10, and TNF-α concentrations have been found compared to patients with non-pneumococcal etiology [8][9][10]. CAP patients with gram-negative etiology, Enterobacteriaceae have been shown in higher IL-8 and Klebsiella pneumoniae in higher IL-10 levels compared to other etiologies [11,12]. In influenza pneumonia, IL-6, IL-8, IL-17, and transforming growth factor (TGF)-β1 have been shown to be elevated in an acute phase of the disease [13,14].…”

“…Children with respiratory syncytial virus (RSV) pneumonia have presented high serum levels of IL-4, IL-10, and interferon gamma (IFN-γ) [14,15]. However, the precise role of cytokines and the relationship between serum cytokine levels and microbiological etiology among mechanically ventilated SCAP patients is unclear [10,11].…”

Cytokine responses, microbial aetiology and short‐term outcome in community‐acquired pneumonia

“…Moreover, recent studies of patients with CAP have suggested that different micro‐organisms exhibit diverse inflammatory responses, with distinctive cytokine activation patterns . However, the impact of various pathogens associated with CAP, especially respiratory viruses as well as polymicrobial infections, on cytokine production is insufficiently addressed . Better understanding of differences in immune responses in CAP may improve disease severity assessment, diagnostic efficiency and ultimately clinical outcome in these patients.…”

Time to Blood Culture Positivity as a Predictor of Clinical Outcomes and Severity in Adults with Bacteremic Pneumococcal Pneumonia

“…Interestingly, the first finding of our study is related to the pathogenesis of pneumococcal infection. Patients with blood cultures with rapid growth of pneumococcus could be due to a dysregulation in the host innate immune response, shown by the low number of circulating leukocytes and a high inflammatory response measured by high levels of C-reactive protein [23][24][25][26][27].…”