Markers of inflammation in children with severe malarial anaemia

OBJECTIVE To investigate if severe malarial anaemia is associated with a sp ecific immune response pattern, we determined serum levels of neopterin (a marker of activation of macrophages by interferon-gamma) and of the anti-in flammatory cytokines, interleukins 4 and 10. METHODS Zambian children < 6 years of age presenting to a rural hospital wi th cerebral malaria were studied. Twenty-one children with admission haemog lobin concentrations less than or equal to 5 g/dl were classified as having severe anaemia and 40 with haemoglobin concentrations greater than or equa l to 7 g/dl served as a control group. RESULTS Logistic regression modelling indicated that a 10-fold rise in seru m neopterin concentrations was associated with a 50-fold increase in the es timated odds of having severe anaemia (P = 0.015), while a 10-fold rise in serum interleukin 4 concentrations was associated with a 10-fold decrease i n the estimated odds of having severe anaemia (P = 0.023). Increasing serum interleukin 10 concentrations, measured in less than half of the subjects, were associated with a nonsignificant reduction in the odds of having seve re anaemia (P = 0.095). CONCLUSION Development of severe malarial anaemia may be directly associate d with serum neopterin concentrations and inversely correlated with serum i nterleukin 4 levels.