Twelve patients with leptospirosis were enrolled in a study to evaluate whether a correlation exists between disease severity and plasma levels of TNF-alpha and IL-10 as determined by enzyme-linked immunoassay. Six patients had less severe disease by analysis of liver, kidney and lung involvement, and 6 patients had severe disease, 2 of whom died. The results of the study confirm an association between high levels of TNF-alpha and poor outcome in leptospirosis. Levels of IL-10 were in a similar range in the 10 surviving and the 2 non-surviving patients. The ratio of IL-10/TNF-a correlated with disease severity in that a high ratio was associated with less severe disease and survival. The possibility is raised that treatment approaches to change this cytokine profile may be more effective in this type of inflammatory condition than it has been in bacterial sepsis.
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