Potential Immune Mechanisms Associated with Anemia in Plasmodium vivax Malaria: a Puzzling Question

Abstract

The pathogenesis of malaria is complex, generating a broad spectrum of clinical manifestations. One of the major complications and concerns in malaria is anemia, which is responsible for considerable morbidity in the developing world, especially in children and pregnant women. Despite its enormous health importance, the immunological mechanisms involved in malaria-induced anemia remain incompletely understood. Plasmodium vivax, one of the causative agents of human malaria, is known to induce a strong inflammatory response with a robust production of immune effectors, including cytokines and antibodies. Therefore, it is possible that the extent of the immune response not only may facilitate the parasite killing but also may provoke severe illness, including anemia. In this review, we consider potential immune effectors and their possible involvement in generating this clinical outcome during P. vivax infections.

Effects of IgG and IgM autoantibodies on non-infected erythrocytes is related to ABO blood group in Plasmodium vivax malaria and is associated with anemia

“…Plasmodium vivax is the most widely distributed species that cause malaria in humans, accounting for approximately 74.1% of the cases registered in the Americas in 2017 [1]. One of the major complications of P. vivax infection is anemia [2, 3], which is thought to arise from the destruction of both infected and non-infected RBCs [4]. Recently we have demonstrated that autoantibodies from P. vivax -infected patients are able to opsonize nRBCs, decreasing their deformability and increasing their in vitro phagocytic uptake, which may contribute to vivax malaria-associated anemia [5].…”

Allele-specific antibodies to Plasmodium vivax merozoite surface protein-1: prevalence and inverse relationship to haemoglobin levels during infection

“…A dual role for specific antibodies against P. falciparum or P. vivax infection has been suggested for both immunity and pathogenesis of malaria (reviewed in [32]). Therefore, it was a reasonable hypothesis to investigate whether naturally acquired antibodies against conserved and variant PvMSP-1 proteins were associated with anaemia, a clinical parameter considered to be one of the major complications in P. vivax infections.…”

Vivax-induced thrombocytopenia may be associated with lymphopenia and mild anaemia. Correlation of RBC parameters with WBC and platelet counts – A report of 13 patients with vivax malaria

“…both INF γ and TNF α may induce dyserythropoietic anaemia 10 . In addition, the mechanisms involved in loss of bystander red cells are not clear 11 .…”