Prolonged macrophage activation and persistent anaemia in children with complicated malaria.

Abstract

OBJECTIVE:

To determine if prolonged immune activation may be associated with the persistence of anaemia after treatment for severe malaria, we measured serum concentrations of neopterin and interleukin-4 during one week of antimalarial therapy and determined haemoglobin levels one month later. Neopterin is a clinically valuable marker for monitoring activation of macrophages by gamma-interferon and thus reflects the TH-1 immune response. Interleukin-4 is a major cytokine that tends to be inhibited by TH-1 activity.

METHOD:

The study population consisted of 26 Zambian children < 6 years of age who presented with cerebral malaria to a rural hospital in 1994 and who were treated with quinine for seven days. Six children (23%) were anaemic (haemoglobin < 11 g/dl) one month after completing antimalarial therapy.

RESULTS:

On admission, concentrations of neopterin were markedly elevated in all patients. During the seven days of anti-malarial therapy, neopterin levels remained elevated in the 6 children who proved to have persistent anaemia one month after finishing treatment but declined significantly (P = 0.008) in the 20 children who corrected their haemoglobin levels by that time. Conversely, interleukin-4 levels declined in the children with persistent anaemia (P = 0.043) but not in the other children.

CONCLUSION:

Persistence of the TH-1 mediated immune response and associated activation of macrophages may be involved in the pathogenesis of lingering anaemia after treatment of malaria.

• Authors: G Biemba, V R Gordeuk, P E Thuma, G F Mabeza, G Weiss
• Journal: Tropical medicine & international health : TM & IH (Trop Med Int Health) Vol. 3 Issue 1 Pg. 60-5 (Jan 1998) ISSN: 1360-2276 [Print] England
• PMID: 9484971 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antimalarials
• Hemoglobins
• Interleukin-6
• Interleukin-10
• Interleukin-4
• Neopterin
• Sulfadoxine
• Quinine
• Deferoxamine
• Pyrimethamine

Topics

• Analysis of Variance
• Anemia (complications, immunology)
• Antimalarials (therapeutic use)
• Child, Preschool
• Deferoxamine (therapeutic use)
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Hemoglobins (analysis)
• Humans
• Infant
• Interleukin-10 (blood)
• Interleukin-4 (blood)
• Interleukin-6 (blood)
• Macrophage Activation
• Malaria, Cerebral (complications, drug therapy, immunology)
• Male
• Neopterin (blood)
• Pyrimethamine (therapeutic use)
• Quinine (therapeutic use)
• Retrospective Studies
• Sulfadoxine (therapeutic use)