Cytokine storm

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 1, 2016
StartDiseasesCytokine storm

Cytokine storms are rare occurrences in which a person's immune system essentially turns against them. The body begins to create far too many cells devoted to fighting disease, and it quickly becomes a harmful or even fatal situation as organs begin to fail. Cytokine storms have been linked to a number of famous flu outbreaks.

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Definition & Facts

A cytokine storm is a condition in which the body creates too many cytokines, which in turn activate too many immune cells. Doing so causes a slew of harmful health issues including a buildup of fluid in the lungs and organ failure. Cytokine storms are more likely to occur in young, healthy people who have a strong immune system.

Cytokine storms involve the excessive production of cytokines, which are small proteins that play a role in a variety of functions, including regulating inflammatory responses. The overproduction of cytokines causes the release of T-cells and macrophages. These elements are beneficial to the body in small doses but can have devastating effects in large numbers.

Cytokine storms have been linked to flu epidemics. There was a breakout of the "Spanish" flu in 1918 that killed millions of healthy young adults. In 2003, the SARS epidemic was also linked to cytokine storms. Some believe that cytokine storms played a role in the swine influenza (H1N1 flu) outbreak of 2009. 

Symptoms & Complaints

The symptoms of a cytokine storm at the outset are quite similar to the symptoms one might display when they have a flu. They will run a high grade fever, they will be nauseous and they might be prone to vomiting.

The patient will likely sleep a lot and feel fatigued when awake. Their faces will be red and they might take on a swollen appearance. Many patients get severe headaches and begin to feel pain in their lungs and shortness of breath. As the condition worsens, the patient's blood pressure will drop and their hearts will race.

Cytokine storms can occur in different areas of the body and produce different harmful effects. For example, if a person were to have a cytokine storm in their lungs, the cytokines will cause the creation of too much fluid and immune cells. The fluid will block the airways and literally make breathing difficult or impossible.

As a cytokine storm spreads, the body is working under the assumption that it is fighting an illness and will allocate resources to the process. That means that organs might actually shut down. The body will then try to repair those organs through the process of fibrosis, which can lead to permanent organ damage. 

Causes

Cytokine storms can happen as a result of many different conditions. The most common disorders linked to this condition are GVHD (Graft-versus-host disease), ARDS (acute respiratory distress syndrome), bird flu, sepsis, systemic inflammatory response syndrome, and chickenpox.

It is suspected that certain medications might make a person more prone to cytokine storms. Severe lung infections can lead to cytokine storms, as can a variety of other kinds of infections including infections in the gastrointestinal tract or the central nervous system. Genetic factors likely play a role in why certain people are more susceptible to cytokine storms.

Diagnosis & Tests

A cytokine storm can be difficult to diagnose at the outset. In the beginning, the symptoms mimic a fever or infection. Because these storms usually affect people with strong immune systems, they won't have much of a medical history to provide any clues.

Most physicians will likely order a blood test. The results of that test will show that the patient is losing lymphocytes and monocytes, which should clue the doctor in on what is going on. From there, the patient will have difficulty breathing and will be given corticosteroids to ease the inflammation process. The most obvious indicator of a cytokine storm is sepsis, as it is often either the cause or symptom of cytokine storm.

Treatment & Therapy

There are a number of methods used to treat cytokine storms which involves reducing the overactive inflammatory response and treating the underlying infection. Sometimes a physician will prescribe OX40 immunoglobulin or TNF-alpha blockers. Other doctors use corticosteroids, prednisone or nonsteroidal anti-inflammatory drugs, although their effectiveness is questioned by a portion of the medical community.

There are vaccines that protect the body both from influenza strains and cytokine storms. Oseltamivir is both a treatment and a preventative medication that is best to take it within two days of the the appearance of symptoms. Certain flu strains are resistant to this drug, including the bird flu. Antibiotics are used to combat bacterial infections that have triggered cytokine storms.

Prevention & Prophylaxis

When there is an outbreak like the swine flu or the bird flu, people need to take extra precautions to avoid contact with the strain. If flu symptoms become present, a doctor needs to be contacted immediately. Cytokine storms are deadly, but they can be fought off in the early stages.