Serum cytokine profiles in patients withPlasmodium vivaxmalaria: a comparison between those who presented with and without thrombocytopenia

Abstract

One of the peculiar features of Plasmodium vivax malaria in South Korea is the surprisingly high frequency of thrombocytopenia. The mechanism by which this malaria-related thrombocytopenia develops and its role in the pathology and progress of human infection with P. vivax have not yet been completely understood. In the present study, the serum cytokine profiles of cases of P. vivax malaria who presented with thrombocytopenia were compared with those of similar cases who did not have thrombocytopenia at presentation. The subjects were the 94 consecutive cases of P. vivax malaria who presented at five hospitals in South Korea (all near the Demilitarized Zone) between May 2000 and October 2002, 47 of whom had thrombocytopenia at presentation. When mean values and (S.E.) were compared, the thrombocytopenic patients were found not only to be generally older than the non-thrombocytopenic [25.3 (1.1) v. 21.3 (0.18) years; P < 0.001] but also to have presented with higher serum concentrations of aspartate aminotransferase [77.6 (16.6) v. 32.3 (7.4) U/litre; P < 0.0001], alanine aminotransferase [96.7 (19.0) v. 44.7 (12.0) U/litre; P = 0.0001], interleukin-1 [49.9 (7.4) v. 23.7 (5.1) pg/ml; P < 0.001], interleukin-6 [174.9 (26.4) v. 57.3 (14.6) pg/ml; P = 0.001], interleukin-10 [308.2 (39.6) v. 137.9 (23.1) pg/ml; P < 0.002] and transforming growth factor-beta [1134.3 (387.5) v. 416.6 (183.8) pg/ml; P < 0.0001], and higher levels of parasitaemia [4345.7 (966.6) v. 1443.8 (222.7) parasites/microl; P = 0.03). The non-thrombocytopenic patients, however, had relatively high total leucocyte counts [5.8 (0.24) v. 5.4 (0.66) leucocytes/nl; P = 0.03]. The thrombocytopenia associated with P. vivax malaria in South Korea therefore appears to be associated with elevated serum concentrations of both pro- and anti-inflammatory cytokines. To define the role of each cytokine in the development of thrombocytopenia during the course of acute P. vivax malaria, further prospective studies are needed.

The role of platelets in the pathogenesis of cerebral malaria

“…Thrombocytopenia has also been shown to be associated with asymptomatic malaria infection [26]. Thrombocytopenia also occurs with P. vivax infection [27] and P. berghei in mice [28]. While thrombocytopenia has been associated with outcome in cerebral malaria, the role of platelets is somewhat controversial [22,[29][30][31][32].…”

Severe thrombocytopenia with bleeding manifestations in two children secondary to Plasmodium vivax

“…The proposed mechanisms are platelet antibody production [7], proinflammatory and anti-inflammatory cytokine production [8], oxidative stress [9], splenic pooling and shortened platelet life span [10].…”

Human Host-Derived Cytokines Associated with Plasmodium vivax Transmission from Acute Malaria Patients to Anopheles darlingi Mosquitoes in the Peruvian Amazon

“…Cell-mediated immunity, with surrogate markers including pro-inflammatory cytokines, has been shown to play a role in controlling malaria parasitemia 11,12 and symptom severity, [13][14][15][16] and to likely impact transmission. [17][18][19] Interferon-gamma (IFN-γ), produced by Th1 and natural killer cells, is involved in activation of macrophage and iNOS and is an important signal in fighting intracellular infections.…”