Abstract：Objective To preliminarily study the changes in CD4+CD25+ regulatory T cells (Tregs) in children with severe purulent meningitis at the early stage and its possible implications. Methods A retrospective analysis was performed on the clinical data of 39 children with severe purulent meningitis who were admitted to the pediatric intensive care unit from August 2014 to December 2015. According to whether Tregs count was decreased within 12 hours of hospitalization (considering Tregs count <410/mm3 as decreased), they were divided into two groups:decrease group and non-decrease group. The associations between the changes in Tregs cells and the clinical manifestations, laboratory marker levels, and prognosis were analyzed. Results Of the 39 cases, 13 (33%) showed a decrease in the proportion of Tregs cells (<31%) and 18 (46%) showed a decrease in the absolute Tregs cell count (<410/mm3). Four deaths were all in the Tregs decrease group. Compared with the non-decrease group, the decrease group showed a significantly higher proportion of children with a peripheral blood leukocyte count lower than the normal range and a significantly greater increase in the level of serum procalcitonin (P < 0.05). Conclusions Tregs might be suppressed in children with severe purulent meningitis at the early stage. And its suppression could be related to the severer inflammation reaction and higher mortality in those patients.
XU Wei,YIN Miao,HUO Ming-Chao et al. Changes in blood CD4+CD25+ regulatory T cells in children with severe purulent meningitis[J]. CJCP, 2016, 18(9): 821-825.
van de Beek D. Progress and challenges in bacterial meningitis[J]. Lancet, 2012, 380(9854):1623-1624.
[2]
Snelling TL, McIntyre PB. Assessing the effect of meningitis prevention and treatment[J]. Lancet Infect Dis, 2014, 14(9):780-781.
[3]
Briand C, Levy C, Baumie F, et al. Outcomes of bacterial meningitis in children[J]. Med Mal Infect, 2016, 46(4):177-187.
[4]
van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis[J]. N Engl J Med, 2004, 351(18):1849-1859.
[5]
Lucas MJ, Brouwer MC, van de Beek D. Neurological sequelae of bacterial meningitis[J]. J Infect, 2016, 73(1):18-27.
[6]
Chiswick EL, Mella JR, Bernardo J, et al. Acute-phase deaths from murine polymicrobial sepsis are characterized by innate immune suppression rather than exhaustion[J]. J Immunol, 2015, 195(8):3793-802.
[7]
Bone RC. Sir Isaac Newton, sepsis, SIRS, and CARS[J]. Crit Care Med, 1996, 24(7):1125-1128.
[8]
Huo R, Wang L, Wang X, et al. Removal of regulatory T cells prevents secondary chronic infection but increases the mortality of subsequent sub-acute infection in sepsis mice[J]. Oncotarget, 2016, 7(10):10962-10975.
Yadav M, Stephan S, Bluestone JA. Peripherally induced Tregss-role in immune homeostasis and autoimmunity[J]. Front Immunol, 2013, 4:232.
[11]
Markwart R, Condotta SA, Requardt RP, et al. Immunosuppression after sepsis:systemic inflammation and sepsis induce a loss of naïve T-cells but no enduring cell-autonomous defects in T-cell function[J]. PLoS One, 2014, 9(12):e115094.
Takada H, Ishimura M, Takimoto T, et al. Invasive bacterial infection in patients with interleukin-1 receptor-associated Kinase 4 deficiency:case report[J]. Medicine (Baltimore), 2016, 95(4):e2437.
[15]
Savva A, Brouwer MC, Roger T, et al. Calandra functional polymorphisms of macrophage migration inhibitory factor as predictors of morbidity and mortality of pneumococcal meningitis[J]. Proc Natl Acad Sci U S A, 2016, 113(13):3597-3602.
[16]
Elenga N, Sicard S, Cuadro-Alvarez E, et al. Pediatric bacterial meningitis in French Guiana[J]. Med Mal Infect, 2015, 45(11-12):441-445.
[17]
Gensollen T, Iyer SS, Kasper DL, et al. How colonization by microbiota in early life shapes the immune system[J]. Science, 2016, 352(6285):539-544.
[18]
van Vught LA, Klein Klouwenberg PM, Spitoni C, et al. Incidence, risk factors, and attributable mortality of secondary infections in the intensive care unit after admission for sepsis[J]. JAMA, 2016, 315(14):1469-1479.
[19]
Yang WY, Shao Y, Lopez-Pastrana J, et al. Pathological conditions re-shape physiological Tregs into pathological Tregs[J]. Burns Trauma, 2015, 3(1). pii:1.
