Comparison of the serum cytokine levels before and after adrenocorticotropic hormone (ACTH) therapy in patients with infantile spasm.

PURPOSE: Infantile spasm is an age-dependent epileptic syndrome seen in infancy or early childhood. Although studies have investigated the epilepsy-cytokine relationship, there has been insufficient research into the relation between cytokines and infantile spasm. The purpose of this study was to examine the role of cytokines in the pathogenesis of infantile spasm by investigating cytokine levels before and 1month after adrenocorticotropic hormone (ACTH) therapy in patients diagnosed with the condition. METHOD: Twenty patients aged between 1month and 2years and diagnosed with infantile spasm at the Karadeniz Technical University Medical Faculty Department of Child Health and Diseases Pediatric Neurology Clinic, Turkey, and 20 healthy children were included in the study. Patients received 11 doses of ACTH on 2days a week. Levels of TNF-alpha and IL-2, the main cytokines involved in inflammation and recently associated with infantile spasm, and of IL-1beta, IL-6 and IL-17A, associated with epileptic seizures, and serum levels of the IL-17A activator IL-23 were investigated in all patients at the start of treatment and 1month after completion of treatment. RESULTS: No statistically significant difference was observed between pre- and post-treatment patient group and control group IL-1beta, IL-2, IL-23 or TNF-alpha levels. Pre-treatment IL-6 and IL-17A levels were significantly higher in the untreated patient group compared to the healthy control group (p<0.001 and p=0.002). CONCLUSION: Our study supports the recent idea that IL-6 and IL-17A are cytokines involved in the pathogenesis of infantile spasm.

[Investigation of Pneumocystis jirovecii in Respiratory Samples of Immunocompromised Patients with PCR, IFA and Giemsa Staining Methods]. / Immün Yetmezligi Olan Hastalarin Solunum Yolu Örneklerinde PCR, IFA ve Giemsa Boyama Yöntemleriyle Pneumocyctis jirovecii'nin Arastirilmasi

Pneumocystis jirovecii is an important opportunistic agent leading to pneumonia in immunocompromised patients. In this study, the presence of P.jirovecii were investigated by using Giemsa stain, indirect fluorescent antibody (IFA) test and two different nested polymerase chain reaction (nPCR) assays in respiratory samples obtained from 50 immunocompromised patients presenting with respiratory symptoms. The target genes used for nested PCR were mitochondrial large subunit ribosomal RNA (MtLSUrRNA) and internal transcribed spacer (ITS) region. P.jirovecii was detected in 7 (14%) and 11 (22%) respiratory samples by IFA and PCR, respectively, although all samples were negative with Giemsa stain. As a result, IFA and PCR were found to be rapid and reliable tests for the diagnosis of P.jirovecii infections and they should better be used together for accurate diagnosis.