PLASMA ENDOTOXIN, PLASMA AND STOOL PRO AND AND INFLAMMATORY CYTOKINES AND STOOL SHIGA TOXIN IN PATIENTS WITH SHIGELLOSIS

Abstract

F13 We measured on admission, day 3 and 5, and 3 weeks after discharge plasma concentrations of endotoxin (ETX), granulocyte colony stimulating factor(GCSF), granulocyte-macrophage colony stimulating factor (GM-CSF), tumor necrosis factor a (TNF-a), interleukin 6 (IL 6), interleukin I-receptor antagonist (IL-I RA), tumor necrosis factor binding protein (TNF-BP): stool concentrations of G-CSF, GM CSF, TNFa, IL-6, IL I RA; and stool Shiga toxin (STX) in 157 patients (pts) with shigellosis and 103 pts with watery diarrhoea. Twenty six (17%) of the shigellosis pts were infected with S. dysenteriae type I (SDI) and developed hemolytic uraemic syndrome (HUS), 36(23%) pts (33 & 3 pts had SDI and S. flexneri infection respectively) with leukemoid reaction (LR) but did not have HUS, 65 (41 %) pts had SDI infection without HUS or LR, and 30 (19%) pts had Shigella infections other than SDI and did not have HUS or LR. Mean peak ETX concentrations were higher in pts with Shigella infection compared to watery diarrhoea (5.00 vs 0.51 unit/ml; P<0.001), pts with HUS had higher mean peak ETX (9.46 vs 4.02 unit/ml; P=0.078) compared to other pts infected with Shigella without HUS. Similarly mean peak plasma concentration of G-CSF (1.83 vs 0.02 pg/ml), GM-CSF (0.38 vs 0 pg/ml), TNF-a (4.32 vs 0.31 pg/ml), IL 6 (0.08 vs 0 pg/ml), IL I RA (4.50 vs 1.71 pg/ml), TNF-BP (1.48 vs 0 pg/ml) were significantly higher in pts infected with Shigella compared to pts with watery diarrhoea. Pts with HUS had significantly higher mean peak plasma GM-CSF (0.74 vs 0.31 pg/ml). TNF-A (7.07 vs 3.74 pg/ml), IL-6 (0.19 vs 0.05 pg/ml), IL-I RA (7.59 vs 3.75 pg/ml), TNF BP (6.48 vs 0.43 pg/ml) compared to pts infected with Shigella but did not developed HUS. Pts infected with SDI infection without HUS or LR had higher mean peak stool G-CSF (2741.17 vs 1551.73 pg/ml; P=0.048), GM-CSF (99.07 vs 64.55 pg/ml; P=0.303), TNF -a(515.77 vs 284.67 pg/ml; P= 0.1 13), IL-6 (420.08 vs 290.43 pg/ml; P= 0.101), IL-I RA (4146.04 vs 3531.96 pg/ml; P=0.299) compared to other Shigella infected pts. Pts with SDI had more frequent SXT detectable in stool. In summary, the plasma concentrations of endotoxin, "pro" and anti inflammatory cytokines were markedly higher in pts with shigellosis who develop HUS compared to those who did not; and stool concentrations of "pro" and anti-inflammatory cytokines were higher in SDI infected pts who did not have HUS or LR compared to other Shigella infected pts.