Cerebral malaria in children: serum and cerebrospinal fluid TNF-alpha and TGF-beta levels and their relationship to clinical outcome.
This was a prospective study conducted at the Moi Teaching and Referral Hospital, Eldoret, Kenya. Twenty-three children admitted to the hospital with cerebral (CM) and 10 children with non-cerebral malaria (NCM) were studied. The aim of the study was to establish and compare levels of tumour necrosis factor (TNF-alpha) and transforming growth factor (TGF-beta1) in these children. Serum and cerebrospinal fluid (CSF) cytokine levels were assayed using ELISA kits. In serum, TGF-beta1 and TNF-alpha decreased over 5 days after admission to the hospital in both groups of patients with CM and NCM. In the CSF of cerebral cases the levels of TNF-alpha and TGF-beta1 were low and inversely related. Children in deeper coma had lower levels in serum of TGF-beta and higher levels of TNF-alpha than those in lighter levels of coma. The serum TNF-alpha levels in CM children were the same irrespective of the duration of illness before admission, but children with NCM who had been sick for a shorter duration before admission tended to have higher serum levels of TNF-alpha and higher levels of TGF-beta than those with a longer duration of illness before admission. In conclusion, this study shows that TNF-alpha and TGF-beta1 may not be useful in predicting the outcome for CM. They may, however, be useful in detecting children at risk of developing deep coma. TNF-alpha and TGF-beta levels were inversely related both in serum and CSF.
Esamai
Fabian
F
Department of Child Health and Pediatrics, Faculty of Health Sciences, Moi University, Eldoret, Kenya. mufhs@net2000ke.com
Ernerudh
Jan
J
Janols
Helena
H
Welin
Susanne
S
Ekerfelt
Christina
C
Mining
Simeon
S
Forsberg
Pia
P
D000962:Antimalarials / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003196:Computer Graphics; D016207:Cytokines / Q000097:blood / Q000134:cerebrospinal fluid; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007223:Infant; D008233:Lymphotoxin-alpha / Q000097:blood* / Q000134:cerebrospinal fluid*; D016779:Malaria, Cerebral / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000188:drug therapy; D008297:Male; D011446:Prospective Studies; D011803:Quinine / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis* / Q000134:cerebrospinal fluid*
D000962:Antimalarials; D016207:Cytokines; D008233:Lymphotoxin-alpha; D014409:Tumor Necrosis Factor-alpha; D011803:Quinine