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Transl Stroke Res. 2019 Nov 10. doi: 10.1007/s12975-019-00738-3. [Epub ahead of print]

Stroke Severity, and Not Cerebral Infarct Location, Increases the Risk of Infection.

Author information

1
Centre for Inflammatory Diseases, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, 3168, Australia.
2
Department of Anatomy and Neuroscience, School of Biomedical Sciences, The University of Melbourne, Parkville, Victoria, Australia.
3
School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
4
Stroke and Ageing Research Group, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.
5
Department of Medicine (Academic Unit), Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia.
6
Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia.
7
Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, Victoria, Australia.
8
Centre for Inflammatory Diseases, Department of Medicine at Monash Health, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, VIC, 3168, Australia. connie.wong@monash.edu.

Abstract

Infection is a leading cause of death in patients with stroke; however, the impact of cerebral infarct size or location on infectious outcome is unclear. To examine the effect of infarct size on post-stroke infection, we utilised the intraluminal middle-cerebral artery occlusion (MCAO) mouse model of ischemic stroke and adjusted the duration of arterial occlusion. At 1 day following stroke onset, the proportion of mice with infection was significantly greater in mice that had larger infarct sizes. Additionally, the presence of lung infection in these mice with severe strokes extended past 2 days, suggestive of long-term immune impairment. At the acute phase, our data demonstrated an inverse relationship between infarct volume and the number of circulating leukocytes, indicating the elevated risk of infection in more severe stroke is associated with reduced cellularity in peripheral blood, owing predominately to markedly decreased lymphocyte numbers. In addition, the stroke-induced reduction of lymphocyte-to-neutrophil ratio was also evident in the lung of all post-stroke animals. To investigate the effect of infarct location on post-stroke infection, we additionally performed a photothrombotic (PT) model of stroke and using an innovative systematic approach of analysis, we found the location of cerebral infarct does not impact on the susceptibility of post-stroke infection, confirming the greater role of infarct volume over infarct location in the susceptibility to infection. Our experimental findings were validated in a clinical setting and reinforced that stroke severity, and not infarct location, influences the risk of infection after stroke.

KEYWORDS:

Infarct location; Infarct volume; Infection; Stroke

PMID:
31709500
DOI:
10.1007/s12975-019-00738-3

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