[Prognostic value of cytokines and HLA markers in patients with cerebral malaria in Senegal].
41 patients senegalese patients suffering from clinically defined severe malaria were studied in the intensive medical care unit of the Hôpital Principal in Dakar, Senegal. All of these individuals lived in Dakar, an area of low and seasonal Plasmodium falciparum transmission. In this study, we aim to determine in one hand, the cytokine levels of TNF-alpha, TNF-alpha sRI, TNF-alpha sRII, IL-2 sR, IL-6, IL-6 sR, and IL-10 to evaluate their prognostic value in the course of the disease; in the other hand, the influence of the HLA-DR alleles in the susceptibility to get severe malaria. At the day of admission (day 0) and 3 days later, one or two blood samples were collected for each patient to assess different biological parameters. Plasma samples were tested for cytokines cited above by ELISA (Medegenix EASIA kits) and DNA samples for HLA-DR by PCR-SSP genotyping. The concentrations of all the cytokines and/or their receptors were significantly increased at day 0 in the patients who died (TNF-alpha = 455 +/- 480 pg/ml, IL6 = 511 +/- 396 pg/ml) and decreased rapidly in the patients who survived from the disease (TNF-alpha = 354 +/- 629 pg/ml, IL6 = 453 +/- 706 pg/ml). A fatal issue seems likely related to the age of patients (20 +/- 12 years for surviving patients and 31 +/- 16 years for patients who died) and the kinetic of the cytokines. Significant differences were observed (pc < 0.001) between patients with severe malaria and a control group for the following HLA alleles: DR3, DR10 and DR13. The HLA-DR13 allele was found positively and highly associated with severe malaria.
Dieye
A
A
Immunogénétique Moléculaire, Institut Pasteur de Dakar, Sénégal.
Ndiaye
M
M
Thiam
A
A
Ndiaye
R
R
Diaw
M L
ML
Angel
G
G
Seignot
P
P
Roussilhon
C
C
Sarthou
J L
JL
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D018450:Disease Progression; D006684:HLA-DR Antigens / Q000097:blood*; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000097:blood* / Q000276:immunology* / Q000401:mortality; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012675:Senegal / Q000453:epidemiology; D012680:Sensitivity and Specificity; D016019:Survival Analysis
D015415:Biomarkers; D016207:Cytokines; D006684:HLA-DR Antigens