Authors: Biemba G.¹; Gordeuk V.R.²; Thuma P.E.³; Mabeza G.F.¹; Weiss G.⁴

Source: Tropical Medicine & International Health, Volume 3, Number 1, January 1998 , pp. 60-65(6)

Publisher: Wiley-Blackwell

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.

Keywords: malaria; anaemia; neopterin; interleukin-4; Zambia

Document Type: Research article

DOI: http://dx.doi.org/10.1046/j.1365-3156.1998.00168.x

Affiliations: 1: Macha Mission Hospital, Choma, Zambia , 2: Department of Medicine, The George Washington University Medical Center, Washington, DC, USA , 3: Department of Pediatrics, Hershey Medical Center, Penn State University, Hershey, PA, USA , 4: Department of Internal Medicine, University of Innsbruck, Innsbruck, Austria

Publication date: 1998-01-01

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