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Prolonged macrophage activation and persistent anaemia in children with complicated malaria

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

Document Type: Research Article


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: January 1, 1998


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