[Severe malaria in an African seasonal endemic area. Comparison of aspects in adults and children and prognostic value of cytokines].
OBJECTIVE
The present study was conducted in West Africa in a region where malaria exists as a seasonal endemic disease. The aim was to compare clinical and biological aspects of adult severe falciparum malaria with those found in children and to appreciate the role of cytokines a prognostic markers. Thirty-one patients fulfilling the WHO criteria of severe malaria were included.


METHODS
Fifteen children (8 boys and 7 girls; mean age: 7.9 +/- 3.7 years) were compared with an adult group 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 (glycaemia, parasitaemia, haemoglobin levels, platelet count) were similar in both groups. As regards immunological findings, serum levels of IgM and IgG were significantly increased in the adult group. Serum levels 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 for IL-2SR). Each of these cytokines correlated with the others and were 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 observed 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-survivors.


CONCLUSIONS
This study confirms the prognostic significance of serum levels of TNF alpha, IL-6 and IL-2SR in severe malaria.
Saïssy
J M
JM
Service de Réanimation et de Soins intensifs, Hôpital Principal, Dakar, Sénégal.
Cellard-Peyle
F
F
Vitris
M
M
Demazière
J
J
Gaye
M
M
Poli
L
L
Trossaert
M
M
Dieye
A
A
Sarthou
J L
JL
D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016778:Malaria, Falciparum / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015375:Receptors, Interleukin-2 / Q000032:analysis; D012621:Seasons; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D016207:Cytokines; D015850:Interleukin-6; D015375:Receptors, Interleukin-2; D014409:Tumor Necrosis Factor-alpha
Paludisme grave en zone d'endémie saisonnière Africaine. Comparaison des formes de l'adulte et de l'enfant et valeur pronostique des cytokines.