Document Detail


Association of profoundly impaired immune competence in H1N1v-infected patients with a severe or fatal clinical course.
MedLine Citation:
PMID:  20670171     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pandemic A/H1N1v influenza is characterized by a mild clinical course. However, a small subset of patients develops a rapidly progressive course caused by primary viral pneumonia or secondary bacterial infections that, in many cases, lead to death due to respiratory failure. The aim of the present study was to analyze the involvement of the immune response in the clinical presentation of H1N1v influenza. METHODS: The differentiation and functional capability of T cells from H1N1v-infected patients presenting with either mild disease (n=22) or severe or fatal disease (n=6) were compared. Moreover, plasma cytokines and chemokines were quantified. RESULTS: T cells from H1N1v-infected patients presenting with a severe clinical course resulted in impaired effector cell differentiation and failed to respond to mitogenic stimulation. T cell anergy was strictly associated with a severe acute phase of infection, but T cells could be restored in patients able to recover. Of interest, massive expression of CD95 marker was found on anergic T cells, suggesting an apoptosis-related mechanism. Finally, lower plasma levels of interferon-alpha and monocyte chemoattractant protein-1 were found in patients with a worse clinical course of influenza, suggesting impaired production of these cytokines. CONCLUSIONS: Our results show a strict association between host immune competence and the severity of the clinical course of H1N1v infection. By monitoring host functional response, patients with an enhanced risk of developing influenza-associated severe complications could be identified in a timely manner.
Authors:
Chiara Agrati; Cristiana Gioia; Eleonora Lalle; Eleonora Cimini; Concetta Castilletti; Orlando Armignacco; Francesco Nicola Lauria; Federica Ferraro; Mario Antonini; Giuseppe Ippolito; Maria Rosaria Capobianchi; Federico Martini
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of infectious diseases     Volume:  202     ISSN:  1537-6613     ISO Abbreviation:  J. Infect. Dis.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-05     Completed Date:  2010-09-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0413675     Medline TA:  J Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  681-9     Citation Subset:  AIM; IM    
Affiliation:
National Institute for Infectious Diseases Lazzaro Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico, Via Portuense 292, Rome, Italy. agrati@inmi.it
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antigens, CD95 / metabolism
Cell Differentiation
Child
Child, Preschool
Female
Humans
Influenza A Virus, H1N1 Subtype / immunology,  pathogenicity*
Influenza, Human / immunology*,  mortality,  physiopathology*,  virology
Interferon-alpha / blood
Male
Middle Aged
Severity of Illness Index
T-Lymphocytes / immunology*,  pathology*
Young Adult
Chemical
Reg. No./Substance:
0/Antigens, CD95; 0/Interferon-alpha

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