Modulation of cytokine production by intravenous immunoglobulin in patients with enterovirus 71-associated brainstem encephalitis

J Clin Virol. 2006 Sep;37(1):47-52. doi: 10.1016/j.jcv.2006.05.009. Epub 2006 Jul 24.


Background: Several epidemics of enterovirus 71 (EV71) infections occurred in Taiwan since 1998.

Objectives: We performed the study to determine the changes in cytokine profiles associated with administration of intravenous immunoglobulin (IVIG) in patients with EV71-associated brainstem encephalitis complicated by autonomic nervous system (ANS) dysfunction and pulmonary edema.

Study design: Plasma cytokine concentrations (IL-1beta, IL-6, IL-8, IFN-gamma, TNF-alpha, IL-2, IL-4, IL-5, IL-10, and IL-13) were monitored on admission and within 12-24h after administration of IVIG in a cohort of children (n=22) with virologically confirmed EV71 infection, from March 2000 through April 2004.

Result: Plasma levels of IFN-gamma, IL-6, IL-8, IL-10, and IL-13 levels significantly decreased in patients with pulmonary edema after administration of IVIG, P<0.05. Plasma levels of IL-6 and IL-8 were significantly decreased in patients with ANS dysregulation after administration of IVIG, P<0.05. Administration of IVIG was not associated with significant changes in plasma concentration of IL-1beta, IL-2, IL-4, IL-5 IL-10, IL-13 and TNF-alpha in patients with ANS dysregulation.

Conclusions: These findings suggest that IVIG might be considered to have a therapeutic role in EV71-associated brainstem encephalitis. A clinical trial is needed to support this hypothesis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Stem*
  • Child, Preschool
  • Cytokines / biosynthesis*
  • Cytokines / blood
  • Encephalitis, Viral / complications
  • Encephalitis, Viral / immunology*
  • Encephalitis, Viral / therapy
  • Enterovirus A, Human*
  • Enterovirus Infections / complications
  • Enterovirus Infections / immunology*
  • Enterovirus Infections / therapy
  • Female
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage
  • Immunoglobulins, Intravenous / therapeutic use*
  • Infant
  • Male
  • Pulmonary Edema / complications


  • Cytokines
  • Immunoglobulins, Intravenous