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Severe Plasmodium vivax malaria exhibits marked inflammatory imbalance.

Andrade BB, Reis-Filho A, Souza-Neto SM, Clarêncio J, Camargo LM, Barral A, Barral-Netto M - Malar. J. (2010)

Bottom Line: Plasma levels of tumour necrosis factor (TNF), interferon-gamma(IFN-gamma) and also IFN-gamma/interleukin-10 ratios were increased and exhibited a linear trend with gradual augmentation of disease severity.Both laboratory parameters of organ dysfunction and inflammatory cytokines were reduced during anti-parasite therapy in those patients with severe disease.These findings are of utmost importance to improve current knowledge about physiopathological concepts of this serious widespread disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil.

ABSTRACT

Background: Despite clinical descriptions of severe vivax malaria cases having been reported, data regarding immunological and inflammatory patterns are scarce. In this report, the inflammatory and immunological status of both mild and severe vivax malaria cases are compared in order to explore immunopathological events in this disease.

Methods and results: Active and passive malaria case detections were performed during 2007 in Buritis, Rondônia, in the Brazilian Amazon. A total of 219 participants enrolled the study. Study individuals were classified according to the presence of Plasmodium vivax infection within four groups: non-infected (n = 90), asymptomatic (n = 60), mild (n = 50) and severe vivax infection (n = 19). A diagnosis of malaria was made by microscopy and molecular assays. Since at present no clear criteria define severe vivax malaria, this study adapted the consensual criteria from falciparum malaria. Patients with severe P. vivax infection were younger, had lived for shorter time in the endemic area, and recalled having experienced less previous malaria episodes than individuals with no malaria infection and with mild or asymptomatic infection. Strong linear trends were identified regarding increasing plasma levels of C reactive protein (CRP), serum creatinine, bilirubins and the graduation of disease severity. Plasma levels of tumour necrosis factor (TNF), interferon-gamma(IFN-gamma) and also IFN-gamma/interleukin-10 ratios were increased and exhibited a linear trend with gradual augmentation of disease severity. Both laboratory parameters of organ dysfunction and inflammatory cytokines were reduced during anti-parasite therapy in those patients with severe disease.

Conclusion: Different clinical presentations of vivax malaria infection present strong association with activation of pro-inflammatory responses and cytokine imbalance. These findings are of utmost importance to improve current knowledge about physiopathological concepts of this serious widespread disease.

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Related in: MedlinePlus

Kinetic of organ damage indicators during antimalarial treatment in individuals with severe vivax disease. Plasma levels of (A) CRP, (B) creatinine, (C), ALT and (D) total bilirubin were estimated before treatment (at admission to the Hospital) and after seven days of inhospital care in individuals with severe vivax infection who achieved cure (n = 13). Wilcoxon matched pairs test was performed to calculate the statistical significance. P values are plotted in each graph.
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Figure 3: Kinetic of organ damage indicators during antimalarial treatment in individuals with severe vivax disease. Plasma levels of (A) CRP, (B) creatinine, (C), ALT and (D) total bilirubin were estimated before treatment (at admission to the Hospital) and after seven days of inhospital care in individuals with severe vivax infection who achieved cure (n = 13). Wilcoxon matched pairs test was performed to calculate the statistical significance. P values are plotted in each graph.

Mentions: In thirteen patients, who clinically recovered out of nineteen with severe vivax infection, there was an important reduction in the levels of all laboratory parameters of organ damage screened, including plasma CRP (P = 0.002; Figure 3A), creatinine (P = 0.005; Figure 3B), ALT (P = 0.001; Figure 3C) and total bilirubin (P = 0.016; Figure 3D) during anti-parasite treatment. This observation suggests that clinical recovery resulted from a reduction in systemic inflammatory aggression. Regarding the immune markers of pro-inflammatory responses, an important decrease in both IFN-gamma/IL-10 ratios (P = 0.0005; Figure 4A) and TNF levels (P = 0.001; Figure 4B) was noticed during anti-malarial treatment.


Severe Plasmodium vivax malaria exhibits marked inflammatory imbalance.

Andrade BB, Reis-Filho A, Souza-Neto SM, Clarêncio J, Camargo LM, Barral A, Barral-Netto M - Malar. J. (2010)

Kinetic of organ damage indicators during antimalarial treatment in individuals with severe vivax disease. Plasma levels of (A) CRP, (B) creatinine, (C), ALT and (D) total bilirubin were estimated before treatment (at admission to the Hospital) and after seven days of inhospital care in individuals with severe vivax infection who achieved cure (n = 13). Wilcoxon matched pairs test was performed to calculate the statistical significance. P values are plotted in each graph.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2837053&req=5

Figure 3: Kinetic of organ damage indicators during antimalarial treatment in individuals with severe vivax disease. Plasma levels of (A) CRP, (B) creatinine, (C), ALT and (D) total bilirubin were estimated before treatment (at admission to the Hospital) and after seven days of inhospital care in individuals with severe vivax infection who achieved cure (n = 13). Wilcoxon matched pairs test was performed to calculate the statistical significance. P values are plotted in each graph.
Mentions: In thirteen patients, who clinically recovered out of nineteen with severe vivax infection, there was an important reduction in the levels of all laboratory parameters of organ damage screened, including plasma CRP (P = 0.002; Figure 3A), creatinine (P = 0.005; Figure 3B), ALT (P = 0.001; Figure 3C) and total bilirubin (P = 0.016; Figure 3D) during anti-parasite treatment. This observation suggests that clinical recovery resulted from a reduction in systemic inflammatory aggression. Regarding the immune markers of pro-inflammatory responses, an important decrease in both IFN-gamma/IL-10 ratios (P = 0.0005; Figure 4A) and TNF levels (P = 0.001; Figure 4B) was noticed during anti-malarial treatment.

Bottom Line: Plasma levels of tumour necrosis factor (TNF), interferon-gamma(IFN-gamma) and also IFN-gamma/interleukin-10 ratios were increased and exhibited a linear trend with gradual augmentation of disease severity.Both laboratory parameters of organ dysfunction and inflammatory cytokines were reduced during anti-parasite therapy in those patients with severe disease.These findings are of utmost importance to improve current knowledge about physiopathological concepts of this serious widespread disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil.

ABSTRACT

Background: Despite clinical descriptions of severe vivax malaria cases having been reported, data regarding immunological and inflammatory patterns are scarce. In this report, the inflammatory and immunological status of both mild and severe vivax malaria cases are compared in order to explore immunopathological events in this disease.

Methods and results: Active and passive malaria case detections were performed during 2007 in Buritis, Rondônia, in the Brazilian Amazon. A total of 219 participants enrolled the study. Study individuals were classified according to the presence of Plasmodium vivax infection within four groups: non-infected (n = 90), asymptomatic (n = 60), mild (n = 50) and severe vivax infection (n = 19). A diagnosis of malaria was made by microscopy and molecular assays. Since at present no clear criteria define severe vivax malaria, this study adapted the consensual criteria from falciparum malaria. Patients with severe P. vivax infection were younger, had lived for shorter time in the endemic area, and recalled having experienced less previous malaria episodes than individuals with no malaria infection and with mild or asymptomatic infection. Strong linear trends were identified regarding increasing plasma levels of C reactive protein (CRP), serum creatinine, bilirubins and the graduation of disease severity. Plasma levels of tumour necrosis factor (TNF), interferon-gamma(IFN-gamma) and also IFN-gamma/interleukin-10 ratios were increased and exhibited a linear trend with gradual augmentation of disease severity. Both laboratory parameters of organ dysfunction and inflammatory cytokines were reduced during anti-parasite therapy in those patients with severe disease.

Conclusion: Different clinical presentations of vivax malaria infection present strong association with activation of pro-inflammatory responses and cytokine imbalance. These findings are of utmost importance to improve current knowledge about physiopathological concepts of this serious widespread disease.

Show MeSH
Related in: MedlinePlus