UMass Chan Medical School Faculty Publications


Cytokine markers as predictors of type of respiratory infection in patients during the influenza season

UMMS Affiliation

Department of Medicine, Division of Infectious Diseases and Immunology; Laboratory of Nucleic Acid Vaccines; Department of Emergency Medicine

Publication Date


Document Type



Cytokines; Respiratory Tract Infections; Influenza, Human


Bacterial Infections and Mycoses | Emergency Medicine | Immunology and Infectious Disease | Infectious Disease | Respiratory Tract Diseases | Virus Diseases


OBJECTIVE: The objective of this study is to characterize the cytokine response among patients presenting with an influenza-like illness who are infected with the influenza virus, a bacterial pneumonia, or another viral infection. We hypothesize that there are differences in proinflammatory and anti-inflammatory cytokines in relation to cytokines associated with the humoral response during viral and bacterial respiratory infections.

METHODS: We enrolled adults who presented to an urban academic emergency department during the 2008 to 2011 influenza seasons with symptoms of fever and a cough. Subjects had nasal aspirates tested by viral culture, and peripheral blood drawn to quantify cytokine concentrations. Cytokine concentrations were compared between groups using the Wilcoxon rank sum test, and receiver operating characteristic curves were calculated.

RESULTS: A total of 80 patients were enrolled: 40 with influenza infection, 14 patients with a bacterial pneumonia as determined by infiltrate on chest x-ray, and 26 patients negative for influenza infection and infiltrate. There were differences between the bacterial pneumonia group, and all other viral infections grouped together with regard to interleukin (IL) 4 (2.66 vs 16.77 pg/mL, P < .001), IL-5 (20.57 vs 57.57 pg/mL, P = .006), IL-6 (403.06 vs 52.69 pg/mL, P < .001), granulocyte macrophage colony-stimulating factor (18.26 vs 66.80 pg/mL, P < .001), and interferon gamma (0.0 vs 830.36 pg/mL, P < .001). Interleukin 10 concentrations were elevated in patients with influenza (88.69 pg/mL) compared with all other groups combined (39.19 pg/mL; P = .003).

CONCLUSION: Cytokines IL-4, IL-5, IL-6, granulocyte macrophage colony-stimulating factor, and interferon gamma may serve as distinct markers of bacterial infection in patients with an influenza-like illness, whereas IL-10 is uniquely elevated in influenza patients.

DOI of Published Version



Am J Emerg Med. 2013 May;31(5):816-21. doi: 10.1016/j.ajem.2013.01.030. Link to article on publisher's site


Co-author Rachel Buglione-Corbett is a student in the MD/PhD program in the Graduate School of Biomedical Sciences (GSBS) at UMass Medical School.

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

The American journal of emergency medicine

PubMed ID