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Post-stroke immunodepression and infection : an emerging concept

Emsley, Hedley C. A. and Hopkins, Stephen J. (2010) Post-stroke immunodepression and infection : an emerging concept. Infectious Disorders - Drug Targets, 10 (2). pp. 91-97. ISSN 1871-5265

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Abstract

Infections occur commonly following stroke and adversely influence outcome. Dysphagia, greater stroke severity and increasing age are associated with post-stroke infection, but post-stroke immunodepression is now recognised as an independent factor associated with increased susceptibility. Counter-regulatory responses, triggered by the proinflammatory response to stroke, appear to effect systemic immunodepression via suppression of both innate and adaptive immune responses. Experimental and clinical studies have identified a range of anti-inflammatory and immunosuppressive changes, including reduced mononuclear phagocyte and natural killer cell function, induction of antiinflammatory cytokines, apoptotic lymphocyte loss and altered T lymphocyte activity. A range of mechanisms has been proposed, including hypothalamo-pituitary-adrenal axis (HPAA) and sympathetic nervous system (SNS) activation. The post-stroke balance of pro- and anti-inflammatory mechanisms may be aimed at restricting the extent of inflammation and contributing to the restoration of immune homeostasis. However, severe inflammation in the brain may trigger major systemic, counter-inflammatory responses that ultimately compromise immune mechanisms required to combat pathogens. Although key pathways have been identified, the extent to which the various elements of post-stroke immunodepression are clinically relevant remains to be discovered. The identification of markers of immunodepression in the early post-stroke phase may prove useful for identifying patients that may have increased susceptibility to infection. It also seems likely that post-stroke immunodepression will need to be taken into account where stroke treatments impact upon inflammatory and immune pathways.

Item Type: Journal Article
Journal or Publication Title: Infectious Disorders - Drug Targets
Uncontrolled Keywords: Immunodepression ; Post-stroke infection ; Stroke
Subjects:
Departments: Faculty of Health and Medicine > Medicine
ID Code: 84782
Deposited By: ep_importer_pure
Deposited On: 21 Feb 2017 10:28
Refereed?: Yes
Published?: Published
Last Modified: 15 May 2018 05:50
Identification Number:
URI: http://eprints.lancs.ac.uk/id/eprint/84782

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