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Abstract
BackgroundThe clinical symptoms, cellular immune response, and serum cytokine homeostasis during falciparum malaria among children living in endemic regions depend on the parasite densities. This study aims to evaluate the CD4+ and CD8+ T cells, leucocytes subpopulations, IL-6, IL-10 and biomarkers of oxidative stress among children infected with varying grades of malaria attending the University of Abuja Teaching Hospital and National Hospital, Abuja, Nigeria.Materials and methodsThis case-control study involved blood samples collected from 165 children (between 5 and 12 years). This comprised 45 children with mild malaria, 40 each with moderate, severe malaria and apparently healthy (control). Serum cytokines, ferritin, malonaldehyde (MDA), ascorbate, α-tocopherol levels were determined by Enzyme-Linked ImmunoSorbent Assay (ELISA). Leucocytes differentials and CD4+/CD8+ T cells counts were enumerated by automated hematology analyzer and flow cytometry, respectively.ResultsAll malarial children had only Plasmodium falciparum. The male to female ratio of children with mild malaria was 1.5:1 (mean ± SD age of 8.5 ± 1.9 years). However, other groups had 1:1 male to female ratio and mean ages of 9.2 ± 2.3, 9.8 ± 2.2, 8.5 ± 1.5 for children with moderate, severe malaria and control, respectively. There was a positive but not significant association of neutrophils and monocytes with the 3 grades of malaria parasitemia (p>0.05). There was a negative and significant correlation between severe malaria and lymphocyte count (p = 0.048; r = −0.647). However, there was positive and significant correlation between eosinophil with moderate (p = 0.03; r = 0.994) and severe malaria (p = 0.006; r = 0.825). There was a significant decline in serum ascorbate with increased malaria density (p<0.0001). However, there was no difference in the serum α-tocopherol concentration within the 4 groups of children (p = 0.182). Serum ferritin and MDA significantly elevated with an increase in malaria density (p<0.0001). There was a significant decline in CD4+ T and CD8+ T cells counts with an increase in malaria densities (p<0.0001). Serum IL-10 and IL-6 significantly elevated with increased malaria density (p<0.0001).ConclusionBased on these findings, severe malaria was significantly associated with declined CD4+ and CD8+ T cell counts, upregulation of IL-6, and high serum levels of oxidative stress biomarkers.
Highlights
The World Health Organization (WHO) affirms that malaria constitutes a global health threat with 228 million cases and 405,000 deaths in 2018 [1]
There was a significant decline in CD4þ T and CD8þ T cells counts with an increase in malaria densities (p0.0001)
There was a total of 165 participants12 years which comprised of four groups; viz, 45 children with mild malaria, 40 with moderate and 40 with severe malaria and 40 ageand gender-matched apparently healthy children which served as control
Summary
The World Health Organization (WHO) affirms that malaria constitutes a global health threat with 228 million cases and 405,000 deaths in 2018 [1]. The African sub-region accounted for approximately 93% of the global burden of malaria and 67% of malaria mortality occurred in children under five years [1e3]. In Nigeria, the rise in the persistence of malaria endemicity has been linked to the poverty and well-being of the populace [3]. Complications such as hypoglycemia, impaired consciousness, anemia, and respiratory distress increase the risk of mortality in children afflicted with severe malaria. The clinical symptoms, cellular immune response, and serum cytokine homeostasis during falciparum malaria among children living in endemic regions depend on the parasite densities. This study aims to evaluate the CD4þ and CD8þ T cells, leucocytes subpopulations, IL-6, IL-10 and biomarkers of oxidative stress among children infected with varying grades of malaria attending the University of Abuja Teaching Hospital and National Hospital, Abuja, Nigeria
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