PROGNOSTIC VALUE OF CYTOKINES IN SEVERE A DULT AND CHILDHOOD MALARIA IN A SEASONAL ENDEMIC ARE IN AFRICA

Objectives: The present study was conducted in West Africa in a region where malaria exists as a seasonal endemic disease. The aim was to co mpare clinical and biological aspects of adult severe falciparum malar ia with those found in children and to appreciate the role of cytokine s a prognostic markers. Thirty-one patients fulfilling the WHO criteri a of severe malaria were included. Methods: Fifteen children (8 boys a nd 7 girls; mean age: 7.9 +/- 3.7 years) were compared with an adult g roup of 16 patients (9 men and 7 women; mean age: 31.1 +/- 14.5 years) . The number of severe criteria and most of the biological features (g lycaemia, parasitaemia, haemoglobin levels, platelet count) were simil ar in both groups. As regards immunological findings, serum levels of IgM and IgG were significantly increased in the adult group. Serum lev els of TNF alpha, IL-6 and IL-2SR were similar (255.2 +/- 375.3 versus 298.4 +/- 254.1 pg/ml for TNF alpha, 534.6 +/- 642.7 versus 609.5 +/- 1217.0 pg/ml for IL-6, 253.1 +/- 120.5 versus 297.6 +/- 142.2 pg/ml f or IL-2SR). Each of these cytokines correlated with the others and wer e also correlated to parasitaemia. Three children and two adults died during the course of the study. At admission a significant died during the course of the study. At admission a significant difference was ob served between serum levels of TNF alpha (p < 0.01), IL-6 (p < 0.001) and IL-2SR (p < 0.05) in patients who were later survivors or non-surv ivors. Conclusion: This study confirms the prognostic significance of serum levels of TNF alpha, IL-6 and IL-2SR in severe malaria.