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Background: Data on complications in children with seasonal influenza virus infection are limited. We initiated a nation-wide three-year surveillance of children who were admitted to a paediatric intensive care unit (PICU) with severe seasonal influenza. Methods: From October 2005 to July 2008, active surveillance was performed using an established reporting system for rare diseases (ESPED) including all paediatric hospitals in Germany. Cases to be reported were hospitalized children < 17 years of age with laboratory-confirmed influenza treated in a PICU or dying in hospital. Results: Twenty severe influenza-associated cases were reported from 14 PICUs during three pre-pandemic influenza seasons (2005-2008). The median age of the patients (12 males/8 females) was 7.5 years (range 0.1-15 years). None had received vaccination against influenza. In 14 (70%) patients, the infection had been caused by influenza A and in five (25%) by influenza B; in one child (5%) the influenza type was not reported. Patients spent a median of 19 (IQR 12-38) days in the hospital and a median of 11 days (IQR 6-18 days) in the PICU; 10 (50%) needed mechanical ventilation. Most frequent diagnoses were influenza-associated pneumonia (60%), bronchitis / bronchiolitis (30%), encephalitis / encephalopathy (25%), secondary bacterial pneumonia (25%), and ARDS (25%). Eleven (55%) children had chronic underlying medical conditions, including 8 (40%) with chronic pulmonary diseases. Two influenza A- associated deaths were reported: i) an 8-year old boy with pneumococcal encephalopathy following influenza infection died from cerebral edema, ii) a 14-year-old boy with asthma bronchiale, cardiac malformation and Addison’s disease died from cardiac and respiratory failure. For nine (45%) patients, possibly permanent sequelae were reported (3 neurological, 3 pulmonary, 3 other sequelae). Conclusions: Influenza-associated pneumonia and secondary bacterial infections are relevant complications of seasonal influenza in Germany. The incidence of severe influenza cases in PICUs was relatively low. This may be either due to the weak to moderate seasonal influenza activity during the years 2005 to 2008 or due to underdiagnosis of influenza by physicians. Fifty % of the observed severe cases might have been prevented by following the recommendations for vaccination of risk groups in Germany.
Visualization of type I immunity using bicistronic IFN-gamma reporter mice in vitro and in vivo
(2006)
IFN-γ is the signature cytokine of Th1 and CD8+ effector cells generated in type I immune responses against pathogens, such as Influenza virus, Sendai virus and the intracellular protozoan parasite Toxoplasma gondii. Understanding the regulation of IFN-γ is critical for the manipulation of immune responses, prevention of immunopathology and for vaccine design. In the present thesis, IFN-γ expression by CD4+ and CD8+ T cells was characterized in detail and the requirement of IFN-γ receptor mediated functions for IFN-γ expression was assessed. Bicistronic IFN-γ-eYFP reporter mice, which allow direct identification and isolation of live IFN-γ expressing cells, were used to visualize IFN-γ expression in vitro and in vivo after infection with the afore mentioned pathogens. Expression of the IFN-γ-eYFP reporter by CD4+ and CD8+ T cells was broadly heterogeneous in vitro and in vivo after infection. Increased expression of the reporter correlated positively with the abundance of IFN-γ transcripts and IFN-γ protein production upon stimulation. eYFP reporter brightness reflected the potential for IFN-γ production, but actual secretion was largely dependent on antigenic stimulation. Increased expression of the reporter also correlated with enhanced secretion of additional proinflammatory cytokines and chemokines and cell surface expression of markers that indicate recent activation. Highly eYFP fluorescent cells were generally more differentiated and their anatomical distribution was restricted to certain tissues. The anatomical restriction depended on the pathogen. IFN-γ expressing CD4+ and CD8+ T cells were generated in IFN-γ receptor deficient reporter mice after infection with Sendai virus or Toxoplasma gondii. However, in the absence of IFN-γ receptor mediated functions, the frequency and brightness of the eYFP reporter expression was altered. Dual BM chimeric mice, reconstituted with wild-type and IFN-γ receptor deficient reporter BM, revealed a T cell-intrinsic requirement for the IFN-γ receptor for optimal IFN-γ expression. Reporter fluorescence intensities were regulated independently of IFN-γ receptor mediated functions. Finally, we propose a model for IFN-γ expression by CD4+ and CD8+ T cells. 2. SUMMARY 10 In summary, the expression of IFN-γ is differentially regulated in CD4+ and CD8+ T cells and after viral or protozoan infections. Additionally, the role of IFN-γ receptor mediated functions for the expression of IFN-γ was determined.