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Lactate levels in severe malarial anaemia are associated with haemozoin-containing neutrophils and low levels of IL-12.

Casals-Pascual C, Kai O, Lowe B, English M, Williams TN, Maitland K, Newton CR, Peshu N, Roberts DJ - Malar. J. (2006)

Bottom Line: Hyperlactataemia is often associated with a poor outcome in severe malaria in African children.The same associations were measured in non-severe malaria controls (N = 60).Parasite density was associated with lactate levels on admission (r = 0.56, P < 0.005).

View Article: PubMed Central - HTML - PubMed

Affiliation: Nuffield Department of Clinical Laboratory Sciences and National Blood Service Oxford Centre, Oxford, OX3 9DU, UK. ccasals@mrc.gm <ccasals@mrc.gm>

ABSTRACT

Background: Hyperlactataemia is often associated with a poor outcome in severe malaria in African children. To unravel the complex pathophysiology of this condition the relationship between plasma lactate levels, parasite density, pro- and anti-inflammatory cytokines, and haemozoin-containing leucocytes was studied in children with severe falciparum malarial anaemia.

Methods: Twenty-six children with a primary diagnosis of severe malarial anaemia with any asexual Plasmodium falciparum parasite density and Hb < 5 g/dL were studied and the association of plasma lactate levels and haemozoin-containing leucocytes, parasite density, pro- and anti-inflammatory cytokines was measured. The same associations were measured in non-severe malaria controls (N = 60).

Results: Parasite density was associated with lactate levels on admission (r = 0.56, P < 0.005). Moreover, haemozoin-containing neutrophils and IL-12 were strongly associated with plasma lactate levels, independently of parasite density (r = 0.60, P = 0.003 and r = -0.46, P = 0.02, respectively). These associations were not found in controls with uncomplicated malarial anaemia.

Conclusion: These data suggest that blood stage parasites, haemozoin and low levels of IL-12 may be associated with the development of hyperlactataemia in severe malarial anaemia.

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Plasma lactate concentration and parasite density in children with acute malaria and severe anaemia (a) and non-severe anaemia (b). Parasite density is plotted on a loge scale. Dotted line represents regression line and R2 is the coefficient of determination.
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Figure 1: Plasma lactate concentration and parasite density in children with acute malaria and severe anaemia (a) and non-severe anaemia (b). Parasite density is plotted on a loge scale. Dotted line represents regression line and R2 is the coefficient of determination.

Mentions: It was hypothesized that lactate levels in children with severe anaemia were associated with measures of parasite burden and with the prevailing cytokine levels. Indeed, lactate levels were associated with parasite density (R2 = 0.53, P < 0.001) and with absolute numbers of HCNs (r = 0.60, P = 0.003) (Figure 1a and 2a). However, the same associations were not found in children with uncomplicated malarial anaemia (Figure 1b). Severe anaemia was associated with significantly higher plasma lactate levels and the median (IQR) plasma lactate was significantly higher (P = 0.01) in children with SMA and respiratory distress (8.8 [IQR 8.2–11.4] mM) than those without respiratory distress (3.5 [IQR 2.1–6.1] mM) (P = 0.01).


Lactate levels in severe malarial anaemia are associated with haemozoin-containing neutrophils and low levels of IL-12.

Casals-Pascual C, Kai O, Lowe B, English M, Williams TN, Maitland K, Newton CR, Peshu N, Roberts DJ - Malar. J. (2006)

Plasma lactate concentration and parasite density in children with acute malaria and severe anaemia (a) and non-severe anaemia (b). Parasite density is plotted on a loge scale. Dotted line represents regression line and R2 is the coefficient of determination.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1636645&req=5

Figure 1: Plasma lactate concentration and parasite density in children with acute malaria and severe anaemia (a) and non-severe anaemia (b). Parasite density is plotted on a loge scale. Dotted line represents regression line and R2 is the coefficient of determination.
Mentions: It was hypothesized that lactate levels in children with severe anaemia were associated with measures of parasite burden and with the prevailing cytokine levels. Indeed, lactate levels were associated with parasite density (R2 = 0.53, P < 0.001) and with absolute numbers of HCNs (r = 0.60, P = 0.003) (Figure 1a and 2a). However, the same associations were not found in children with uncomplicated malarial anaemia (Figure 1b). Severe anaemia was associated with significantly higher plasma lactate levels and the median (IQR) plasma lactate was significantly higher (P = 0.01) in children with SMA and respiratory distress (8.8 [IQR 8.2–11.4] mM) than those without respiratory distress (3.5 [IQR 2.1–6.1] mM) (P = 0.01).

Bottom Line: Hyperlactataemia is often associated with a poor outcome in severe malaria in African children.The same associations were measured in non-severe malaria controls (N = 60).Parasite density was associated with lactate levels on admission (r = 0.56, P < 0.005).

View Article: PubMed Central - HTML - PubMed

Affiliation: Nuffield Department of Clinical Laboratory Sciences and National Blood Service Oxford Centre, Oxford, OX3 9DU, UK. ccasals@mrc.gm <ccasals@mrc.gm>

ABSTRACT

Background: Hyperlactataemia is often associated with a poor outcome in severe malaria in African children. To unravel the complex pathophysiology of this condition the relationship between plasma lactate levels, parasite density, pro- and anti-inflammatory cytokines, and haemozoin-containing leucocytes was studied in children with severe falciparum malarial anaemia.

Methods: Twenty-six children with a primary diagnosis of severe malarial anaemia with any asexual Plasmodium falciparum parasite density and Hb < 5 g/dL were studied and the association of plasma lactate levels and haemozoin-containing leucocytes, parasite density, pro- and anti-inflammatory cytokines was measured. The same associations were measured in non-severe malaria controls (N = 60).

Results: Parasite density was associated with lactate levels on admission (r = 0.56, P < 0.005). Moreover, haemozoin-containing neutrophils and IL-12 were strongly associated with plasma lactate levels, independently of parasite density (r = 0.60, P = 0.003 and r = -0.46, P = 0.02, respectively). These associations were not found in controls with uncomplicated malarial anaemia.

Conclusion: These data suggest that blood stage parasites, haemozoin and low levels of IL-12 may be associated with the development of hyperlactataemia in severe malarial anaemia.

Show MeSH
Related in: MedlinePlus