CYTOKINES IN ADENOVIRAL DISEASE IN CHILDREN - ASSOCIATION OF INTERLEUKIN-6, INTERLEUKIN-8, AND TUMOR-NECROSIS-FACTOR-ALPHA LEVELS WITH CLINICAL OUTCOME

To explore the pathogenic mechanisms involved in adenovirus infection, we evaluated total levels of immunoglobulins, antiadenovirus antibodi es, adenovirus-specific circulating immune complexes, and cytokines in serum samples obtained from 38 hospitalized children with adenovirus infection. According to their clinical findings and outcome, the infec tions were classified as follows: (1) moderate (group I, n = 10), (2) severe (group II, n = 12), and (3) fatal (group III, n = 16). About 60 % of the children had elevated IgM levels. IgG-containing adenovirus-s pecific circulating immune complexes were initially detected in 7 of 1 6 group III patients, 4 of whom had low serum levels of the third comp onent of complement. A decrease in initial antiadenovirus lgG antibodi es was observed in 3 of 10 patients in group III. Serum interleukin-6 was not detected in group I (none of 10), but was present in group II (7 of 12, p = 0.016) and group III (13 of 16, p <0.001). Interleukin-8 was detected in all groups; values in fatal cases were significantly higher than in surviving children. Tumor necrosis factor alpha was not observed in group I (none of 10) and was uncommon in group 11 (2 of 1 2) but was frequently detected in group III (9 of 15, p = 0.01). Inter leukin-1 and interleukin-4 were rarely detected in serum samples. Incr eased concentrations of interleukin-6, interleukin-8, and tumor necros is factor alpha were associated with hypoperfusion, febrile peaks, ton ic-clonic seizures, and septic shock. In 5 of 10 patients in groups II and III, autoantibodies specific for smooth muscle were found. Our fi ndings indicate that high serum values for interleukin-6, interleukin- 8, and tumor necrosis factor alpha are associated with severity of ade novirus infection.