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The cytokine storm during the second (immune) phase is thought to be a major contributory factor for the leptospirosis disease severity. We aim to summarize evidence for cytokine response in leptospirosis at different clinical outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A systematic review was carried out to examine the cytokine response in leptospirosis patients using relevant scientific databases. Reference lists of the selected articles were also screened. Quality of the selected studies was assessed by using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of the 239 articles retrieved in the initial search, 18 studies fulfilled the selection criteria. India and Thailand have produced the highest number of studies (17% each, <jats:italic>n<\/jats:italic>\u2009=\u20093). The majority were comparative cross-sectional studies (72%, <jats:italic>n<\/jats:italic>\u2009=\u200913). Overall the quality of the selected studies was fair regardless of few drawbacks such as reporting of sample size and the lack of adjustment for confounders. Microscopic agglutination test (67% - 12\/18) and enzyme-linked immunosorbent assay (50% - 9\/18) were commonly used for the confirmation of leptospirosis and the measurement of cytokines respectively. IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10 and TNF-\u03b1 levels were found to be significantly higher in severe than in mild leptospirosis. There were equivocal findings on the association between IL-1\u03b2, TNF-\u03b1 and IL-10\/TNF-\u03b1 ratio and disease severity.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Leptospirosis had a wide-range of elevated cytokines. However, prospective studies in-relation to the onset of the symptom are required to better understand the pathophysiology of cytokine response in leptospirosis.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-020-04986-9","type":"journal-article","created":{"date-parts":[[2020,4,7]],"date-time":"2020-04-07T09:04:33Z","timestamp":1586250273000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Cytokine response in human leptospirosis with different clinical outcomes: a systematic review"],"prefix":"10.1186","volume":"20","author":[{"given":"Indika","family":"Senavirathna","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devarajan","family":"Rathish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suneth","family":"Agampodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,4,7]]},"reference":[{"issue":"1","key":"4986_CR1","doi-asserted-by":"publisher","first-page":"e2626","DOI":"10.1371\/journal.pntd.0002626","volume":"8","author":"SB Agampodi","year":"2014","unstructured":"Agampodi SB, Dahanayaka NJ, Bandaranayaka AK, Perera M, Priyankara S, Weerawansa P, Matthias MA, Vinetz JM. 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