Circulating interleukin-6 and tumor necrosis factor receptor-1 predict resistance to therapy of typhoidal salmonellosis

Abstract

Background: Typhoid fever, a food-borne disease caused by salmonella species, is a worldwide prevalent disease. In endemic areas, children are at highest risk owing to weaning from passively acquired maternal antibody and lack of acquired immunity. Several studies have been done to clarify the pathogenesis and underlying immune aspects of typhoid fever. Objective: Study the changes of some proinflammatory cytokines in plasma of children with typhoid fever. Study design: Thirty consecutive children admitted to Zagazig Fever Hospital with proven diagnosis of typhoid fever were included in the study. They were 20 males and 10 females, of ages ranging from 3 to 13 years. In addition, 10 age and sex matched healthy children served as a control group. A verbal consent was obtained from parent(s) of each child before inclusion to the study. All children were subjected to history taking, clinical examination, and routine investigations (CBC, ESR, CRP, Widal test and stool culture), as well as determination of serum interleukin-6 (IL-6) and tumor necrosis factor receptor-1 (TNF-R1), before and 5 days after start of treatment (for patients). Results: Twenty patients (66.7%) were responsive to therapy and 10 patients (33.3%) were resistant. Toxic look, constipation, high fever, splenomegaly, increased CRP and ESR were significantly presented in patients who displayed resistance to drug therapy. Both IL-6 and TNF-R1 plasma levels were significantly higher in patients than in control children, and in resistant cases than in responsive cases (before and 5 days after treatment). ESR and S. typhi H agglutination titre correlated significantly with plasma levels of IL-6 and TNF-R1, whereas S. typhi O agglutination titre and total leucocytic count did not. Conclusion: patients with typhoid fever resistant to combined therapy with chloramphenicol and co-trimoxazole have higher plasma levels of IL-6 and TNF-R1. Toxic look, constipation and splenomegaly may be considered as indicators of drug resistance.

Keywords: salmonellosis - resistance to therapy – cytokines

Egypt J Pediatr Allergy Immunol 2010; 8(2): 55-59