CORRELATION BETWEEN SERUM TNF-ALPHA AND IL6 LEVELS AND SEVERITY OF GROUP-A STREPTOCOCCAL INFECTIONS

The multiorgan failure syndrome caused by group A streptococci (GAS) d esignated streptococcal toxic shock syndrome (STSS) is believed to be mediated by cytokines induced by superantigens. In order to study the relationship between superantigen production, cytokine levels in patie nt sera, and clinical GAS manifestation we examined acute-phase sera a nd strains from 25 patients with GAS bacteremia. The patients had vari ous disease manifestations, including STSS (44%), erysipelas (28%), se pticemia (24%), wound infections (16%), and pneumonia (12%). Serotype T1M1 dominated, representing 56% of the isolates, but also strains of other serotypes were identified. The strains were found to produce the streptococcal pyrogenic exotoxins (Spe) A, B, and F, as determined by immune-blot analyses. There was no difference in amounts of toxin pro duced between strains isolated from patients with different manifestat ions of disease. Levels of TNF alpha, IL1 alpha, IL6, IL8, and IFN gam ma, in acute-phase sera were determined by use of ELISA and RIA assays . The analyses showed higher levels of IL6 in sera from patients with STSS than in sera from patients with bacteremia without shock. TNF alp ha was elevated in sera from patients with STSS, as compared to sera f rom patients with uncomplicated pharyngotonsillitis. No increase in th e levels of IL1 alpha, IL8, and IFN gamma could be found in the patien t sera and there was no difference in the level of those cytokines bet ween the various patient categories.