| Summary: | Malaria still remains a major health problem in tropical and sub-tropical areas
in the world, including Indonesia (particularly in the Eastern Region, including
East Kalimantan). Severe (complicated) malaria is found in 2 � 10 % of individual
infected with Plasmodium falciparum with high mortality rate of 10 � 50 %.
Erythrocyte invasion by Plasmodium is the the cental and beginning of malaria
pathogenesis, which is followed by parasite sequestration in microvascular of
vital organs (cytoadherence and rosetting) resulting in tissue hypoxia, and
immune responses involving various effector cells and pro-inflammatory
cytokines and anti-inflammatory cytokines presented as local and systemic
inflammation that can cause multiple organ impairments and death. The aims of
this study were to evaluate immune responses which included the dynamics of
pro-inflammatory cytokines (TNF-�, IFN-�) and anti-inflammatory cytokine
(IL-10) responses and their correlations with clinical manifestations in severe
malaria patients in East Kalimantan.
It was conducted an analytic prospective study in 23 severe falciparum malaria
and 26 uncomplicated falciparum malaria patients at A. Wahab Sjahranie General
Hospital Samarinda from August 2011 to March 2014. In this study data
evaluated included origin place of patients, place of stay/ work, previous malaria
infection, serial levels of TNF-�, IFN-�, IL-10, parasite counts, GCS, total
bilirubin, creatinine since the first day of admission until the fifth day.
This study showed that in severe malaria patients it was found significant
increases of TNF-�, IFN-�, IL-10 levels, namely 2 � 16-folds (average 5-folds),
2 � 35-folds (average 9-folds), 2 � 87-folds (average 58-folds) above baseline
respectively, which decreased rapidly after anti-malarial treatment.TNF-�, IFN-��
IL-10 levels in severe malaria group were significantly higher than those of
uncomplicated malaria group (p < 0.05). TNF-�, IFN-� levels and IFN-�/IL-10
ratio were negatively-correlated with GCS, positively-correlated with total
bilirubin level and serum creatinine level. IL-10 level was positively-correlated
with total bilirubin level. The strongest correlation was seen between IFN-� level
and total bilirubin level (r = 0.73
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