title: Macrophage migration inhibitory factor is associated with mortality in cerebral malaria patients in India.
abstract: BACKGROUND
  Macrophage migration inhibitory factor (MIF) is a multifunctional cytokine implicated in the pathogenesis of a number of human diseases including inflammatory neurological diseases. Its role in the pathogenesis of cerebral malaria is unknown. Cerebral malaria is a life-threatening complication of falciparum malaria with approximately 20%-30% of patients dying despite appropriate anti-malarial treatment. The reason for this cerebral malaria mortality is still unknown although host proinflammatory factors have been shown to be evidently important. The current study investigated the role of circulating MIF in the pathogenesis and outcomes of cerebral malaria.
  
  
  RESULTS
  Three categories of subjects contributed to this study: healthy controls subjects, mild malaria patients, and cerebral malaria patients. The cerebral malaria patients were further grouped into cerebral malaria survivors and cerebral malaria non-survivors. MIF levels in the peripheral blood plasma, obtained at the time of enrollment, were measured using standard ELISA methods. In logistic regression on cerebral malaria patients, log MIF levels were found to be significantly associated with fatal outcome (odds ratio 4.0; 95%CI 1.6, 9.8; p = 0.003). In multinomial logistic regression log MIF levels were found to be significantly associated with patient category (p = 0.004).
  
  
  CONCLUSIONS
  This study suggests that elevated levels of MIF in the peripheral blood of cerebral malaria patients may be associated with fatal outcomes.
authors.affiliation: National Institute of Malaria Research, Regional Medical Research Center for Tribals, Indian Council of Medical Research, Jabalpur, India. vidhanjain78@yahoo.com
authors.forename: Vidhan
authors.initials: V
authors.lastname: Jain
authors.forename: Shannon
authors.initials: S
authors.lastname: McClintock
authors.forename: Avinash C
authors.initials: AC
authors.lastname: Nagpal
authors.forename: Aditya P
authors.initials: AP
authors.lastname: Dash
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Stiles
authors.forename: Venkatachalam
authors.initials: V
authors.lastname: Udhayakumar
authors.forename: Neeru
authors.initials: N
authors.lastname: Singh
authors.forename: Naomi W
authors.initials: NW
authors.lastname: Lucchi