Cytokine dysregulation in the post-Q-fever fatigue syndrome |
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Authors: | Penttila IA; Harris RJ; Storm P; Haynes D; Worswick DA; Marmion BP |
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Institution: | Department of Pathology, Adelaide University, South Australia. |
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Abstract: | The post-Q-fever fatigue syndrome (QFS) (inappropriate fatigue, myalgia and
arthralgia, night sweats, changes in mood and sleep patterns) follows about
20% of laboratory-proven, acute primary Q-fever cases. Cytokine
dysregulation resulting from chronic immune stimulation and modulation by
persistence of Coxiella burnetii cells or their antigens is hypothesized.
We studied cytokine release patterns of peripheral blood mononuclear cells
(PBMC) stimulated with various ligands in short- term culture, from 18
patients with active QFS, and 27 controls: six with resolving QFS, five who
had had acute primary Q-fever without subsequent QFS, eight healthy Q-fever
vaccinees and eight healthy subjects without Q-fever antibody. Conditioned
media (CM) from PBMC stimulated in short-term culture with Q-fever
antigens, PHA or measles antigen (as an unrelated antigen) were assayed for
IL-2, IL-4, IL-5, IL- 6, IL-10 and IFN gamma by AgEIA, and for IL-1 and TNF
alpha/beta by bioassay. Aberrant cytokine release patterns were observed
with PBMC from QFS patients when stimulated with Q-fever antigens: an
accentuated release of IL-6 which was significantly p = 0.01,
non-parametric one- way analysis of variance (ANOVA)] in excess of medians
for all four control groups. With IL-2, the number of responders in the
active QFS group was decreased relative to control groups (Fisher's exact
test, p = 0.01) whereas the number of IFN gamma responders was increased
(Fisher's exact test, p = 0.0008). Significant correlations were observed
between concentrations of IL-6 in CM, total symptom scores, and scores for
other key symptoms.
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