Artigo de Periódico
Severe Plasmodium vivax malaria exhibits marked inflammatory imbalance
Fecha
2010Registro en:
1475-2875
v. 9, n. 13
Autor
Andrade, Bruno Bezerril
Reis Filho, Antonio
Souza Neto, Sebastião Martins
Clarêncio, Jorge
Camargo, Luís Marcelo Aranha
Barral, Aldina Maria Prado
Barral-Netto, Manoel
Andrade, Bruno Bezerril
Reis Filho, Antonio
Souza Neto, Sebastião Martins
Clarêncio, Jorge
Camargo, Luís Marcelo Aranha
Barral, Aldina Maria Prado
Barral-Netto, Manoel
Institución
Resumen
Background: Despite clinical descriptions of severe vivax malaria cases having been reported, data regarding
immunological and inflammatory patterns are scarce. In this report, the inflammatory and immunological status of
both mild and severe vivax malaria cases are compared in order to explore immunopathological events in this
disease.
Methods and Results: Active and passive malaria case detections were performed during 2007 in Buritis,
Rondônia, in the Brazilian Amazon. A total of 219 participants enrolled the study. Study individuals were classified
according to the presence of Plasmodium vivax infection within four groups: non-infected (n = 90), asymptomatic
(n = 60), mild (n = 50) and severe vivax infection (n = 19). A diagnosis of malaria was made by microscopy and
molecular assays. Since at present no clear criteria define severe vivax malaria, this study adapted the consensual
criteria from falciparum malaria. Patients with severe P. vivax infection were younger, had lived for shorter time in
the endemic area, and recalled having experienced less previous malaria episodes than individuals with no malaria
infection and with mild or asymptomatic infection. Strong linear trends were identified regarding increasing
plasma levels of C reactive protein (CRP), serum creatinine, bilirubins and the graduation of disease severity. Plasma
levels of tumour necrosis factor (TNF), interferon-gamma(IFN-gamma) and also IFN-gamma/interleukin-10 ratios
were increased and exhibited a linear trend with gradual augmentation of disease severity. Both laboratory
parameters of organ dysfunction and inflammatory cytokines were reduced during anti-parasite therapy in those
patients with severe disease.
Conclusion: Different clinical presentations of vivax malaria infection present strong association with activation of
pro-inflammatory responses and cytokine imbalance. These findings are of utmost importance to improve current
knowledge about physiopathological concepts of this serious widespread disease.