Prognostic value of cytokines in severe adult and childhood malaria in a seasonal endemic area in Africa; [PALUDISME GRAVE EN ZONE D'ENDEMIE SAISONNIERE AFRICAINE. COMPARAISON DES FORMES DE L'ADULTE ET DE L'ENFANT ET VALEUR PRONOSTIQUE DES CYTOKINES]

Objectives: 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 TNFα, IL-6 and IL-2SR were similar (255.2 ± 375.3 versus 298.4 ± 254.1 pg/ml for TNFα, 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 difference was observed between serum levels of TNFα (p < 0.01), IL-6 (p < 0.01) and IL-2SR (p < 0.05) in patients who were later survivors or non-survivors. Conclusion: This study confirms the prognostic significance of serum levels of TNFα, IL-6 and IL-2SR in severe malaria.