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To what extent do severe viral infections, e.g., influenza, result in a catabolic state such that cytokines like tumor necrosis factor, interleukin (IL)-2, and IL-6 cause bone marrow suppression, elevated liver aminotransferases, and rapid weight loss?
—Joseph Chersky, MD, Beverly Hills, Calif.

Influenza, like most viruses, is capable of stimulating the production of cytokines. These mediators play major roles in innate as well as adaptive immunity. Influenza A has been reported to modulate more than 15 separate cytokines. Despite tremendous advances in cytokine biology, we know little of the specific clinical effects produced by each of these cytokines acting alone and together. It seems reasonable that the clinical signs described, while nonspecific, could in part be invoked via cell signaling modulated by a cytokine storm.
—R. Steven Tharratt, MD, MPVM (109-13)

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