title: Prolonged macrophage activation and persistent anaemia in children with complicated malaria.
abstract: OBJECTIVE
  To determine if prolonged immune activation may be associated with the persistence of anaemia after treatment for severe malaria, we measured serum concentrations of neopterin and interleukin-4 during one week of antimalarial therapy and determined haemoglobin levels one month later. Neopterin is a clinically valuable marker for monitoring activation of macrophages by gamma-interferon and thus reflects the TH-1 immune response. Interleukin-4 is a major cytokine that tends to be inhibited by TH-1 activity.
  
  
  METHODS
  The study population consisted of 26 Zambian children < 6 years of age who presented with cerebral malaria to a rural hospital in 1994 and who were treated with quinine for seven days. Six children (23%) were anaemic (haemoglobin < 11 g/dl) one month after completing antimalarial therapy.
  
  
  RESULTS
  On admission, concentrations of neopterin were markedly elevated in all patients. During the seven days of anti-malarial therapy, neopterin levels remained elevated in the 6 children who proved to have persistent anaemia one month after finishing treatment but declined significantly (P = 0.008) in the 20 children who corrected their haemoglobin levels by that time. Conversely, interleukin-4 levels declined in the children with persistent anaemia (P = 0.043) but not in the other children.
  
  
  CONCLUSIONS
  Persistence of the TH-1 mediated immune response and associated activation of macrophages may be involved in the pathogenesis of lingering anaemia after treatment of malaria.
authors.affiliation: Macha Mission Hospital, Choma, Zambia.
authors.forename: G
authors.initials: G
authors.lastname: Biemba
authors.forename: V R
authors.initials: VR
authors.lastname: Gordeuk
authors.forename: P E
authors.initials: PE
authors.lastname: Thuma
authors.forename: G F
authors.initials: GF
authors.lastname: Mabeza
authors.forename: G
authors.initials: G
authors.lastname: Weiss
mesh_terms: D000704:Analysis of Variance; D000740:Anemia / Q000150:complications / Q000276:immunology*; D000962:Antimalarials / Q000627:therapeutic use; D002675:Child, Preschool; D003676:Deferoxamine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D016753:Interleukin-10 / Q000097:blood; D015847:Interleukin-4 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008262:Macrophage Activation; D016779:Malaria, Cerebral / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D008297:Male; D019798:Neopterin / Q000097:blood; D011739:Pyrimethamine / Q000627:therapeutic use; D011803:Quinine / Q000627:therapeutic use; D012189:Retrospective Studies; D013413:Sulfadoxine / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D006454:Hemoglobins; D015850:Interleukin-6; D016753:Interleukin-10; D015847:Interleukin-4; D019798:Neopterin; D013413:Sulfadoxine; D011803:Quinine; D003676:Deferoxamine; D011739:Pyrimethamine