Bacterial enteric pathogens and serum interleukin-6 levels in children with acute diarrhea

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Herlina Herlina
Jeanette Irene Manoppo
Adrian Umboh


Background Acute diarrhea is currently one of the major causes of morbidity and mortality in developing countries. A wide range of enteric pathogens, including bacteria, is responsible for the pathogenesis of acute infectious diarrhea. Recent studies have shown an increase in acute phase proteins, such as serum interleukin-6 (IL-6) levels, in patients with acute bacterial gastroenteritis. Thus, IL-6 may be a useful marker to differentiate bacterial from non-bacterial enteric pathogens.
Objective To assess for a correlation between bacterial enteric pathogens and serum IL-6 levels in children with acute diarrhea.
Methods We conducted a cross-sectional study from November 2013 to March 2014 in two hospitals in Manado. Subjects were children aged 1-5 years with acute diarrhea and good nutritional status. Subjects’ provided stool samples for bacterial culture and microscopic examination, as well as blood specimens for serum IL-6 measurements. Data was analyzed by linear regression and Pearson’s correlation tests for a correlation between bacterial enteric pathogens and serum IL-6 levels.
Results In children with acute diarrhea, those with bacterial enteric pathogens had significantly higher mean serum IL-6 than those with non-bacterial enteric pathogens (r = 0.938; P < 0.001).
Conclusion Serum IL-6 levels are significantly more elevated in children with acute diarrhea and bacterial enteric pathogens. Therefore, serum IL-6 may be a useful marker for early identification of bacterial gastroenteritis in children aged 1-5 years. [Paediatr Indones. 2016;56:144-8.].

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How to Cite
Herlina H, Manoppo J, Umboh A. Bacterial enteric pathogens and serum interleukin-6 levels in children with acute diarrhea. PI [Internet]. 1Jul.2016 [cited 19Aug.2019];56(3):144-. Available from:
Pediatric Gastrohepatology
Received 2016-08-18
Accepted 2016-08-18
Published 2016-07-01


1. Subagyo B, Santoso NB. Diare akut. In: Juffrie M, Soenarto SSY, Oswari H, Arief S, Rosalina I, Mulyani NS, editors. Buku ajar gastroenterologi-hepatologi. 1st ed. Jakarta: IDAI; 2010. p. 87-120.
2. Nguyen TV, Le Van P, Le Huy C, Weintraub A. Diarrhea caused by rotavirus in children less than 5 years of age in Hanoi, Vietnam. J Clin Microbiol. 2004;42:5745-50.
3. Oyofo BA, Subekti D, Tjaniadi P, Machpud N, Komalarini S, Setiawan B, et al. Enteropathogens associated with acute diarrhea in community and hospital patients in Jakarta, Indonesia. FEMS Immunol Med Microbiol. 2002;34:139-46.
4. Farthing M, Lindberg G, Dite P, Khalif I, Lindo ES, Ramakrishna BS, et al. World Gastroenterology Organisation Practice Guidelines: acute diarrhea. Milwaukee: World Gastroenterology Organisation; 2008. p. 1-29.
5. Ahs JW, Tao W, Lofgren J, Forsberg BC. Diarrheal diseases in low- and middle-income countries: incidence, prevention and management. Open Infect Dis J. 2010;4:113-24.
6. Yeung CY, Lee HC, Lin SP, Fang SB, Jiang CB, Huang FY, et al. Serum cytokines in differentiating between viral and bacterial enterocolitis. Ann Trop Paediatr. 2004;24:337-43.
7. Stadnyk AW. Intestinal epithelial cells as a source of inflammatory cytokines and chemokines. Can J Gastroenterol. 2002;16:241-6.
8. Hodges K, Gill R. Infectious diarrhea: cellular and molecular mechanisms. Gut Microbes. 2010;1:4-21.
9. Hessle CC, Andersson B, Worl AE. Gram-positive and gram-negative bacteria elicit different patterns of pro-inflammatory cytokines in human monocytes. Cytokine. 2005;30:311-8.
10. Lin CH, Hsieh CC, Chen SJ, Wu TC, Chung RL, Tang RB. The diagnostic value of serum interleukins 6 and 8 in children with acute gastroenteritis. J Pediatr Gastroenterol Nutr. 2006;43:25-9.
11. Boga JA, Melon S, Nicieza I, Diego I, Villar M, Parra F, et al. Etiology of sporadic cases of pediatric acute gastroenteritis in Asturias, Spain, and genotyping and characterization of norovirus strains involved. J Clin Microbiol. 2004;42:2668-74.
12. Johargy A, Ghazi H, Mumenah A. Frequency of viral, bacterial and parasitic enteropathogens among young children with acute diarrhoea in Saudi Arabia. J Park Med Assoc. 2010;60:456.
13. Hsu TR, Chen SJ, Wu TC, Chung RL, Tang RB. Tumor necrosis factor-α and interleukin-10 in viral and bacterial gastroenteritis in children. J Chin Med Assoc. 2005;68:250-3.
14. Zherebtsova N, Valishin DA, Mavziutov AR. Proinflammatory cytokines in children with acute enteric infections caused by enterobacteria. Zh Mikrobiol Epidemiol Immunobiol. 2007;3:48-52.
15. Stoycheva MS, Murdjeva MA. Correlation between serum levels of interleukin-1β, interleukin-1RA, interleukin-6, interleukin-10, interleukin-12, tumor necrosis factor-α, and interferon-γ with some clinical and laboratory parameters in patients with salmonellosis. Biotechnol Biotechnol Eq. 2005;19:143-6.
16. Rana SV, Sharma S, Sinha SK, Parsad KK, Malik A, Singh K. Pro-inflammatory and anti-inflammatory cytokine response in diarrhoea-predominant irritable bowel syndrome patients. Trop Gastroenterol. 2012;33:251-6.
17. Pritts T, Hungness E, Wang Q, Robb B, Hershko D, Hasselgren PO. Mucosal and enterocyte IL-6 production during sepsis and endotoxemia--role of transcription factors and regulation by the stress response. Am J Surg. 2002;183:372-83.
18. Diniz-Santos DR, Santana JS, Barretto JR, Andrade MG, Silva LR. Epidemiological and microbiological aspects of acute bacterial diarrhea in children from Salvador, Bahia, Brazil. Braz J Infect Dis. 2005;9:77-83.
19. Chen SM, Ku MS, Lee MY, Tsai JD, Sheu JN. Diagnostic performance of serum interleukin-6 and interleukin-10 levels and clinical predictors in children with rotavirus and norovirus gastroenteritis. Cytokine. 2012;59:299-304.
20. Vaisman N, Leibovitz E, Dagan R, Barak V. The involvement of IL-6 and IL-8 in acute invasive gastroenteritis of children. Cytokine. 2003;22:194-7.
21. Pavare J, Grope I, Kalnins I, Gardovska D. High-mobility group box-1 protein, lipopolysacharide-binding protein, interleukin-6 and C-reactive protein in children with community acquired infections and bacteraemia: a prospective study. BMC Infect Dis. 2010:10;28.
22. Chen SM, Lin CP, Tsai JD, Chao YH, Sheu JN. The significance of serum and fecal levels of interleukin-6 and interleukin-8 in hospitalized children with acute rotavirus and norovirus gastroenteritis. Pediatr Neonatol. 2014;55:120-6.