Anemia and interleukin-10, tumor necrosis factor alpha, and erythropoietinlevels among children with acute, uncomplicated Plasmodium falciparum malaria

Anemia is an important complication of malaria, and its pathogenesis is not well understood. To gain insight into potential age-related relationships between tumor necrosis factor alpha (TNF-alpha), interleukin 10 (IL-10), er ythropoietin, and anemia during acute malaria, 273 children of ages 12 to 1 20 months presenting with acute, uncomplicated malaria in Kampala, Uganda, were monitored at enrollment and 3 and 7 days later. Younger children had h igher geometric mean erythropoietin, TNF-alpha, and alpha (1)-acid glycopro tein (AGP) concentrations than older children. Univariate regression analys is revealed that age, log(10) erythropoietin levels, IL-10/TNF-alpha ratio, and AGP levels were each significantly associated with hemoglobin levels a t baseline. Hemoglobin concentrations were inversely correlated with the lo g(10) erythropoietin level at all three visits. For the older age groups, h igher levels of TNF-alpha were significantly associated with higher IL-10 l evels at all three visits, but this relationship was significant only at ba seline for younger children. These data suggest that younger children do no t maintain IL-10 production in response to the inflammatory process, and th is mechanism may contribute to the more severe anemia found in younger chil dren. Acute malaria is an illness whose incidence and severity are largely age dependent. Further studies are needed to understand the relationships b etween age-related immune responses to malaria and their role in the pathog enesis of malarial anemia.