IL-10 plasma and bronchoalveolar lavage levels used as markers of candida bronchopneumonia during fungal sepsis

Introduction and aims

Nosocomial bloodstream fungal infections by Candida species in ICU has risen dramatically in the past two decades. In fact, fungal infections in the critically ill patient are difficult to diagnose and are associated with a high mortality rate. The high concentration of some proinflammatory cytokines registered in the serum and in bronchoalveolar lavage (BAL) of patients with severe bronchopneumonia and the different kind of host response during fungal infections are well defined. Our aim is to correlate the IL-10 serum and BAL levels in critically ill patients with confirmed bronchopneumonia associated with candidiasis or bacterial sepsis and to research whether these levels consent to prove the fungal origin of severe pneumonia associated with severe sepsis.

Materials and methods

Involved patients were admitted for more than 48 hours in the ICU. We enrolled 28 patients subdivided into two groups: (group A) 18 patients with severe sepsis with bacterial bronchopneumonia and (group B) 10 patients with sepsis and confirmed candidemia with bronchopneumonia. We registered IL-10 levels in standardized blind nonbronchoscopical bronchoalveolar lavage (b-NB-BAL) and in serum at admission and than 1, 3 and 7 days after treatment. We measured cytokines by an ELISA assay.

Results

At present we have registered 28 patients aged from 51 to 91 years. Data (mean ± SD) are presented in Table 1.

Table 1

Conclusions

The value of IL-10 confirms the results obtained by other authors on mice. In humans this correlation could be explained by the suppressive effects of high levels of IL-10 on mononuclear phagocyte activity against candida and methicillin-resistant Staphylococcus aureus. In candidiasis with severe bronchopneumonia the precocious increase of IL-10 levels, both in bronchial and in serum, represents confirmation of fungal sepsis and a negative predictive value in order to predict the development of multiorgan failure and death.