The Significance of Serum and Fecal Levels of Interleukin-6 and Interleukin-8 in Hospitalized Children with Acute Rotavirus and Norovirus Gastroenteritis

Abstract

Rotavirus and norovirus are the most common known causes of viral gastroenteritis in children. This study examined the association between serum interleukin 6 (IL-6) and interleukin 8 (IL-8) levels and disease severity in the acute phase of rotavirus and norovirus gastroenteritis in children, and it also explored the role of fecal cytokine levels in children with viral and bacterial gastroenteritis. This prospective study enrolled patients aged 4 months to 14 years admitted with acute gastroenteritis in a tertiary care center. Peripheral blood samples were collected for IL-6 and IL-8 assays within the first 3 days of diarrhea. Stool samples were obtained from the patients in the first 24 hours after admission. Serum IL-6 and IL-8 were measured in children with viral (n=66) and bacterial(n=23) infections, and in healthy controls (n=10). In the acute phase of gastroenteritis, a moderately positive correlation was found between serum IL-6 levels and disease severity (rs=0.41, p<0.01). Serum IL-8 levels correlated with the duration of fever (rs=0.28, p=0.03). Fecal IL-6 levels correlated with the maximum number of daily bowel movements (rs=0.35, p<0.05). Rotavirus infection induced significantly higher serum IL-8 levels than norovirus infection (p<0.05). Receiver operating characteristic (ROC) curve analysis showed that absolute neutrophil count (ANC), maximum body temperature (BT), and Vesikari score were significant predictors in discriminating rotavirus from norovirus gastroenteritis. IL-6 and IL-8 are involved in the pathogenesis of acute gastroenteritis in both rotavirus and norovirus. An ANC of less than 9000/mm(3), maximum BT of less than 38.2°C, and Vesikari score of less than 14 at the end of the course are potential predictors of norovirus infection in children compared with rotavirus gastroenteritis.