Alterations in cytokines and haematological parameters during the acute and convalescent phases of Plasmodium falciparum and Plasmodium vivax infections.

Paulo Renato Zuquim Antas,Dalma Maria Banic,Fátima Santos,Arlete Baldez,Josué da Costa Lima-Junior,Rodrigo Nunes Rodrigues-da-Silva,Bruna de Paula Fonseca e Fonseca,Joseli de Oliveira-Ferreira,Fabio Luiz Storer

doi:10.1590/0074-0276140275

Abstract

Haematological and cytokine alterations in malaria are a broad and controversial subject in the literature. However, few studies have simultaneously evaluated various cytokines in a single patient group during the acute and convalescent phases of infection. The aim of this study was to sequentially characterise alterations in haematological patters and circulating plasma cytokine and chemokine levels in patients infected with Plasmodium vivax or Plasmodium falciparum from a Brazilian endemic area during the acute and convalescent phases of infection. During the acute phase, thrombocytopaenia, eosinopaenia, lymphopaenia and an increased number of band cells were observed in the majority of the patients. During the convalescent phase, the haematologic parameters returned to normal. During the acute phase, P. vivax and P. falciparum patients had significantly higher interleukin (IL)-6, IL-8, IL-17, interferon-γ, tumour necrosis factor (TNF)-α, macrophage inflammatory protein-1β and granulocyte-colony stimulating factor levels than controls and maintained high levels during the convalescent phase. IL-10 was detected at high concentrations during the acute phase, but returned to normal levels during the convalescent phase. Plasma IL-10 concentration was positively correlated with parasitaemia in P. vivax and P. falciparum-infected patients. The same was true for the TNF-α concentration in P. falciparum-infected patients. Finally, the haematological and cytokine profiles were similar between uncomplicated P. falciparum and P. vivax infections.

Highlights

Haematological and cytokine alterations in malaria are a broad and controversial subject in the literature
Another study in the same area showed a significant increase in the concentrations of tumour necrosis factor (TNF)-α, IFN-γ, migration inhibitory factor and monocyte chemotactic protein (MCP)-1 in patients with P. vivax and P. falciparum, whereas IL-10 was observed in only P. vivax-infected patients (Fernandes et al 2008)
There were no differences in mean age, time of residence in the endemic area and number of past malaria episodes between P. vivax (n = 47) and P. falciparum (n = 24) infected patients

Summary

Introduction

Haematological and cytokine alterations in malaria are a broad and controversial subject in the literature. A significant number of cytokines and chemokines have been associated with severe disease, in particular IL-1β (Brown et al 1999), IL-2 (Ramharter et al 2003), IL-6 (Kern et al 1989, el-Nashar et al 2002), interferon (IFN)-γ (Day et al 1999, Ramharter et al 2003), TNF-α (Kern et al 1989, Kwiatkowski et al 1990, el-Nashar et al 2002, Ramharter et al 2003), IL-4 (Kumaratilake & Ferrante 1992, Eisenhut 2010), IL-10 (Day et al 1999, Othoro et al 1999, Ramharter et al 2003) and macrophage inflammatory protein (MIP)-1β (Ochiel et al 2005), whereas low levels of regulatory cytokines, such as TGF-β and IL-10, have been correlated with acute malaria (Peyron et al 1994, Hansen & Schofield 2010). In the group of patients with severe malaria, P. vivax parasitaemia had several positive interactions with inflammatory mediators such as TNF-α, IFN-γ and IL-10 (Mendonça et al 2013)

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Conclusion