The systemic inflammatory response syndrome

Werneck

Rev. Soc. Bras. Med. Trop.

et al. 2010

119

Introduction: The objective of the study is to identify the main risk factors for death by New World visceral leishmaniasis and establish a coherent pathogenic substrate of severe disease based on clinical findings. Methods: Seventy-six deceased inpatients and 320 successfully treated inpatients with VL were studied in a case control study. Results: Bacterial infection and bleeding were mutually exclusive events leading to death. Five risk factors were unique for death by bacterial infection (malnutrition, pulmonary rales, severe anemia, severe absolute neutropenia and higher neutrophil count), while another six were unique for death by bleeding (jaundice, severe relative neutropenia, severe thrombocytopenia, liver injury, kidney failure, higher bone marrow parasite load). Bacterial infection, bleeding, severe anemia, diarrhea, dyspnea, edema, jaundice and bone marrow parasite load were the main syndromes of visceral leishmaniasis among successfully treated patients. Conclusions: The data support the idea that bacterial infections are due to immune paralysis. Broad organ and system involvement is plausibly due to the high production of proinflammatory cytokines, whose actions fit well with visceral leishmaniasis. The syndromes and causative mediators are typical of a slowly developing systemic inflammatory response syndrome. Keywords: Visceral leishmaniasis. Kala-azar. Severe inflammatory response syndrome. AIDS. Bleeding. RESUMO Introdução: O objetivo do estudo foi identificar os principais fatores de risco para morte na leishmaniose visceral do Novo Mundo e estabelecer um substrato patogênico baseado nos achados clínicos coerente para doença grave. Métodos: Em um estudo caso-controle, foram estudados 76 pacientes internados que faleceram e 320 pacientes internados tratados com sucesso. Resultados: Infecção bacteriana e sangramento foram eventos que levaram à morte, mutuamente exclusivos. Cinco fatores de risco foram únicos para morte por infecção bacteriana (desnutrição, estertores pulmonares, anemia grave, neutropenia absoluta grave e número de leucócitos aumentados), enquanto outros seis foram exclusivos para morte por sangramento (icterícia, neutropenia relativa grave, trombocitopenia grave, lesão hepática, insuficiência renal, maior carga de parasitas na medula óssea). Entre os pacientes tratados com sucesso, as principais síndromes de leishmaniose visceral foram infecções bacterianas, sangramento, anemia grave, diarreia, dispneia, edema, icterícia e carga de parasitas na medula óssea. Conclusões: Os dados apoiam a ideia de que as infecções bacterianas são secundárias a imunoparalisia. O amplo envolvimento de órgãos e sistemas é de forma plausível devido a elevada produção de citocinas pró-inflamatórias, cujas ações se encaixam com a leishmaniose visceral. As síndromes e os mediadores causais são típicos da síndrome de resposta inflamatória sistêmica, desenrolando-se lentamente. Palavras-chaves: Leishmaniose visceral. Calazar. Síndrome da resposta inflamatória sistêmica. AIDS. Sangramento.

Section: Discussionmentioning

confidence: 99%

Is severe visceral leishmaniasis a systemic inflammatory response syndrome? A case control study

Werneck

Rev. Soc. Bras. Med. Trop.

et al. 2010

119

“…Strongly elevated levels of proinflammatory cytokines, particularly TNF-␣ , IL-1 ␤ , and IL-6 can be detected in patients with systemic inflammatory response, sepsis and acute respiratory distress syndrome [1,3,20] . Furthermore, the cytokine levels correlate closely with the severity of the inflammatory disease [21][22][23] .…”

Section: Discussionmentioning

confidence: 99%

Isoflurane Inhalation after Induction of Endotoxemia in Rats Attenuates the Systemic Cytokine Response

Flondor

Hofstetter²,

Boost³

et al. 2007

Eur Surg Res

Background/Aims: Volatile anesthetics are frequently utilized in clinical routine. Isoflurane has been shown to attenuate the response to inflammatory stimuli such as lipopolysaccharide (LPS) when administered before induction of endotoxemia. We aimed therefore to evaluate the effect of isoflurane after administration of LPS on the cytokine release as a therapeutic option. Materials and Methods:21 male Sprague-Dawley rats were randomly assigned to the following groups: animals that received LPS (5 mg/kg, i.v.) without further intervention (LPS group), animals that received continuous inhalation of 1 minimum alveolar concentration (MAC) isoflurane 15 min after administration of LPS (Iso group) and no specific intervention (sham group). Four hours following LPS injection, plasma levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6 and IL-10 were determined. Furthermore, nitrite release from cultured alveolar macrophages was analyzed. Results: Inhalation of isoflurane after induction of endotoxemia attenuated the release of TNF-α (–52%, p < 0.05) and IL-1β (–39%, p < 0.05) as compared to the LPS group, while IL-6 and IL-10 levels were not significantly altered. Nitrite release was significantly increased in the Iso group as compared to the LPS group (+115%, p < 0.05). Conclusion: Inhalation of 1 MAC isoflurane after induction of endotoxemia in rats attenuates the systemic release of proinflammatory cytokines and concurrently enhances the production of nitrite in cultured alveolar macrophages.

Acta Med. (Hradec Kralove, Czech Repub.)

“…Unrestrained forms of SIRS, which have evaded the network of regulatory mechanisms, develop into exaggerated clinical presentation with deeply pronounced symptoms that have been enumerated above. Ultimately, they can progress into some of the life-threatening manifestations, referred to as the multiple organ dysfunction syndrome (MODS) or the multiple organ failure syndrome (MOFS) (33).…”

Section: Introductionmentioning

confidence: 99%

The Inflammatory Response in Cardiac Surgery. An Up-to-date Overview with the Emphasis on the Role of Heat Shock Proteins (HSPs) 60 and 70

Kuneš

Lonský

Mandak

et al. 2007

Summary: Cardiac surgical operations are associated with the development of a systemic inflammatory response syndrome (SIRS). In most cases, the inflammatory response is apparent only in its subclinical form. In some cases, however, it can become clinically manifest or even life-threatening. This review article presents some new data regarding its biological importance, along with an insight into the recently discovered role played by heat shock proteins 60 and 70.