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Ventura AMRDS, Fernandes AAM, Zanini GM, Pratt-Riccio LR, Sequeira CG, do Monte CRS, Martins-Filho AJ, Machado RLD, Libonati RMF, de Souza JM, Daniel-Ribeiro CT. Clinical and immunological profiles of anaemia in children and adolescents with Plasmodium vivax malaria in the Pará state, Brazilian Amazon. Acta Trop 2018; 181:122-131. [PMID: 29408596 DOI: 10.1016/j.actatropica.2018.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/18/2022]
Abstract
Children and adolescents are at great risk for developing iron deficiency anaemia worldwide. In the tropical areas, malaria and intestinal parasites may also play an important role in anaemia pathogenesis. This study aimed at evaluating clinical and immunological aspects of anaemia in children and adolescents with Plasmodium vivax malaria, in the Pará State, Brazil. A longitudinal study was performed in two Reference Centers for malaria diagnosis in the Brazilian Amazon in children and adolescents with malaria (n = 81), as compared to a control group (n = 40). Patients had blood drawn three times [before treatment (D0), after treatment (D7) and at the first cure control (D30)] and hemogram, autoantibody analysis (anticardiolipin, antibodies against normal RBC membrane components) and cytokine studies (TNF and IL-10) were performed. Stool samples were collected for a parasitological examination. Malaria patients had a 2.7-fold greater chance of anaemia than the control group. At D0, 66.1% of the patients had mild anaemia, 30.5% had moderate and 3.5% had severe anaemia. Positivity to intestinal helminths and/or protozoa at stool examinations had no influence on anaemia. Patients had significantly lower levels of plasmatic TNF than control individuals at D0. Low TNF levels were more prevalent among patients with moderate/severe anaemia than in those with mild anaemia and among anaemic patients than in anaemic controls. TNF levels were positively correlated with the haemoglobin rates and negatively correlated with the interval time elapsed between the onset of symptoms and diagnosis. Both plasma TNF levels and haemoglobin rates increased during the follow-up period. The IL-10 levels were lower in patients than in the controls at day 0 and decreased thereafter up to the end of treatment. Only the anti-anticardiolipin autoantibodies were associated with moderate/severe anaemia and, possibly by reacting with the parasite glycosylphosphatidylinositol (a powerful stimulator of TNF production), may have indirectly contributed to decrease the TNF levels, which could be involved in the malarial vivax anaemia of these children and adolescents. More studies addressing this issue are necessary to confirm these findings and to add more information on the multifactorial pathogenesis of the malarial anaemia.
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Affiliation(s)
- Ana Maria Revoredo da Silva Ventura
- Laboratório de Ensaios Clínicos em Malária, Instituto Evandro Chagas, Ministério da Saúde, Secretaria de Vigilância em Saúde (IEC/MS/SVS), Ananindeua, Pará, Brazil; Serviço de Pediatria - Departamento de Saúde Integrada, Universidade do Estado do Pará (UEPA), Belém, Pará, Brazil.
| | | | - Graziela Maria Zanini
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz (IOC), Fiocruz, Rio de Janeiro, Brazil.
| | - Lilian Rose Pratt-Riccio
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz (IOC), Fiocruz, Rio de Janeiro, Brazil.
| | - Carina Guilhon Sequeira
- Serviço de Pediatria - Departamento de Saúde Integrada, Universidade do Estado do Pará (UEPA), Belém, Pará, Brazil.
| | | | - Arnaldo Jorge Martins-Filho
- Serviço de Patologia Clínica, Instituto Evandro Chagas, Ministério da Saúde, Secretaria de Vigilância em Saúde (IEC/MS/SVS), Ananindeua, Pará, Brazil.
| | - Ricardo Luiz Dantas Machado
- Laboratório de Imunogenética, Instituto Evandro Chagas, Ministério da Saúde, Secretaria de Vigilância em Saúde (IEC/MS/SVS), Ananindeua, Pará, Brazil.
| | | | - José Maria de Souza
- Laboratório de Ensaios Clínicos em Malária, Instituto Evandro Chagas, Ministério da Saúde, Secretaria de Vigilância em Saúde (IEC/MS/SVS), Ananindeua, Pará, Brazil.
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Resende SS, Milagres VG, Chaves DG, Fontes CJF, Carvalho LH, Sousa TN, Brito CFAD. Increased susceptibility of blood type O individuals to develop anemia in Plasmodium vivax infection. INFECTION GENETICS AND EVOLUTION 2017; 50:87-92. [DOI: 10.1016/j.meegid.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
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Potential immune mechanisms associated with anemia in Plasmodium vivax malaria: a puzzling question. Infect Immun 2014; 82:3990-4000. [PMID: 25092911 DOI: 10.1128/iai.01972-14] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The pathogenesis of malaria is complex, generating a broad spectrum of clinical manifestations. One of the major complications and concerns in malaria is anemia, which is responsible for considerable morbidity in the developing world, especially in children and pregnant women. Despite its enormous health importance, the immunological mechanisms involved in malaria-induced anemia remain incompletely understood. Plasmodium vivax, one of the causative agents of human malaria, is known to induce a strong inflammatory response with a robust production of immune effectors, including cytokines and antibodies. Therefore, it is possible that the extent of the immune response not only may facilitate the parasite killing but also may provoke severe illness, including anemia. In this review, we consider potential immune effectors and their possible involvement in generating this clinical outcome during P. vivax infections.
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Rodrigues-da-Silva RN, Lima-Junior JDC, Fonseca BDPFE, Antas PRZ, Baldez A, Storer FL, Santos F, Banic DM, de Oliveira-Ferreira J. Alterations in cytokines and haematological parameters during the acute and convalescent phases of Plasmodium falciparum and Plasmodium vivax infections. Mem Inst Oswaldo Cruz 2014; 109:154-62. [PMID: 24676654 PMCID: PMC4015248 DOI: 10.1590/0074-0276140275] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 12/06/2013] [Indexed: 12/31/2022] Open
Abstract
Haematological and cytokine alterations in malaria are a broad and controversial subject in the literature. However, few studies have simultaneously evaluated various cytokines in a single patient group during the acute and convalescent phases of infection. The aim of this study was to sequentially characterise alterations in haematological patters and circulating plasma cytokine and chemokine levels in patients infected with Plasmodium vivax or Plasmodium falciparum from a Brazilian endemic area during the acute and convalescent phases of infection. During the acute phase, thrombocytopaenia, eosinopaenia, lymphopaenia and an increased number of band cells were observed in the majority of the patients. During the convalescent phase, the haematologic parameters returned to normal. During the acute phase, P. vivax and P. falciparum patients had significantly higher interleukin (IL)-6, IL-8, IL-17, interferon-γ, tumour necrosis factor (TNF)-α, macrophage inflammatory protein-1β and granulocyte-colony stimulating factor levels than controls and maintained high levels during the convalescent phase. IL-10 was detected at high concentrations during the acute phase, but returned to normal levels during the convalescent phase. Plasma IL-10 concentration was positively correlated with parasitaemia in P. vivax and P. falciparum-infected patients. The same was true for the TNF-α concentration in P. falciparum-infected patients. Finally, the haematological and cytokine profiles were similar between uncomplicated P. falciparum and P. vivax infections.
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Affiliation(s)
| | | | | | | | - Arlete Baldez
- Agência de Vigilância em Saúde, Secretaria de Estado da Saúde, Porto Velho, RO, Brasil
| | | | - Fátima Santos
- Odebrecht Energia/Usina Hidrelétrica Santo Antônio, Porto Velho, RO, Brasil
| | - Dalma Maria Banic
- Instituto Oswaldo Cruz, Laboratório de Simulídeos e Oncocercose, Instituto Oswaldo Cruz
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Martins N. Estudo Epidemiológico de Casos de Malária em Gestantes no Estado do Amapá entre 2003 e 2012. BIOTA AMAZÔNIA 2014. [DOI: 10.18561/2179-5746/biotaamazonia.v4n1p22-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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de Carvalho GB, de Carvalho GB. Duffy Blood Group System and the malaria adaptation process in humans. Rev Bras Hematol Hemoter 2013; 33:55-64. [PMID: 23284245 PMCID: PMC3521437 DOI: 10.5581/1516-8484.20110016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 02/04/2011] [Indexed: 11/27/2022] Open
Abstract
Malaria is an acute infectious disease caused by the protozoa of the genus
Plasmodium. The antigens of the Duffy Blood Group System, in addition to
incompatibilities in transfusions and hemolytic disease of the newborn, are of great
interest in medicine due to their association with the invasion of red blood cells by
the parasite Plasmodium vivax. For invasions to occur an interaction between the
parasites and antigens of the Duffy Blood Group System is necessary. In Caucasians
six antigens are produced by the Duffy locus (Fya, Fyb, F3, F4, F5 and F6). It has
been observed that Fy(a-b-) individuals are resistant to Plasmodium knowlesi and P.
vivax infection, because the invasion requires at least one of these antigens. The P.
vivax Duffy Binding Protein (PvDBP) is functionally important in the invasion process
of these parasites in Duffy / DARC positive humans. The proteins or fractions may be
considered, therefore, an important and potential inoculum to be used in immunization
against malaria.
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Lacerda MVG, Mourão MPG, Alexandre MAA, Siqueira AM, Magalhães BML, Martinez-Espinosa FE, Filho FSS, Brasil P, Ventura AMRS, Tada MS, Couto VSCD, Silva AR, Silva RSU, Alecrim MGC. Understanding the clinical spectrum of complicated Plasmodium vivax malaria: a systematic review on the contributions of the Brazilian literature. Malar J 2012; 11:12. [PMID: 22230294 PMCID: PMC3268102 DOI: 10.1186/1475-2875-11-12] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 01/09/2012] [Indexed: 12/12/2022] Open
Abstract
The resurgence of the malaria eradication agenda and the increasing number of severe manifestation reports has contributed to a renewed interested in the Plasmodium vivax infection. It is the most geographically widespread parasite causing human malaria, with around 2.85 billion people living under risk of infection. The Brazilian Amazon region reports more than 50% of the malaria cases in Latin America and since 1990 there is a marked predominance of this species, responsible for 85% of cases in 2009. However, only a few complicated cases of P. vivax have been reported from this region. A systematic review of the Brazilian indexed and non-indexed literature on complicated cases of vivax malaria was performed including published articles, masters' dissertations, doctoral theses and national congresses' abstracts. The following information was retrieved: patient characteristics (demographic, presence of co-morbidities and, whenever possible, associated genetic disorders); description of each major clinical manifestation. As a result, 27 articles, 28 abstracts from scientific events' annals and 13 theses/dissertations were found, only after 1987. Most of the reported information was described in small case series and case reports of patients from all the Amazonian states, and also in travellers from Brazilian non-endemic areas. The more relevant clinical complications were anaemia, thrombocytopaenia, jaundice and acute respiratory distress syndrome, present in all age groups, in addition to other more rare clinical pictures. Complications in pregnant women were also reported. Acute and chronic co-morbidities were frequent, however death was occasional. Clinical atypical cases of malaria are more frequent than published in the indexed literature, probably due to a publication bias. In the Brazilian Amazon (considered to be a low to moderate intensity area of transmission), clinical data are in accordance with the recent findings of severity described in diverse P. vivax endemic areas (especially anaemia in Southeast Asia), however in this region both children and adults are affected. Finally, gaps of knowledge and areas for future research are opportunely pointed out.
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Affiliation(s)
- Marcus V G Lacerda
- Fundação de Medicina Tropical Dr, Heitor Vieira Dourado, Av, Pedro Teixeira, 25, 69040-000, Manaus Amazonas, Brazil.
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Quintero JP, Siqueira AM, Tobón A, Blair S, Moreno A, Arévalo-Herrera M, Lacerda MVG, Valencia SH. Malaria-related anaemia: a Latin American perspective. Mem Inst Oswaldo Cruz 2011; 106 Suppl 1:91-104. [PMID: 21881762 PMCID: PMC4830680 DOI: 10.1590/s0074-02762011000900012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 07/04/2011] [Indexed: 11/22/2022] Open
Abstract
Malaria is the most important parasitic disease worldwide, responsible for an estimated 225 million clinical cases each year. It mainly affects children, pregnant women and non-immune adults who frequently die victims of cerebral manifestations and anaemia. Although the contribution of the American continent to the global malaria burden is only around 1.2 million clinical cases annually, there are 170 million inhabitants living at risk of malaria transmission in this region. On the African continent, where Plasmodium falciparum is the most prevalent human malaria parasite, anaemia is responsible for about half of the malaria-related deaths. Conversely, in Latin America (LA), malaria-related anaemia appears to be uncommon, though there is a limited knowledge about its real prevalence. This may be partially explained by several factors, including that the overall malaria burden in LA is significantly lower than that of Africa, that Plasmodium vivax, the predominant Plasmodium species in the region, appears to display a different clinical spectrus and most likely because better health services in LA prevent the development of severe malaria cases. With the aim of contributing to the understanding of the real importance of malaria-related anaemia in LA, we discuss here a revision of the available literature on the subject and the usefulness of experimental animal models, including New World monkeys, particularly for the study of the mechanisms involved in the pathogenesis of malaria.
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Affiliation(s)
- Juan Pablo Quintero
- Caucaseco Scientific Research Center, Cali, Colômbia
- Centro Latino Americano de Investigación en Malaria, Cali, Colombia
| | - André Machado Siqueira
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, AM, Brasil
- Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | | | | | - Alberto Moreno
- Emory Vaccine Centre, Yerkes National Primate Research Centre, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Myriam Arévalo-Herrera
- Caucaseco Scientific Research Center, Cali, Colômbia
- Centro Latino Americano de Investigación en Malaria, Cali, Colombia
| | | | - Sócrates Herrera Valencia
- Caucaseco Scientific Research Center, Cali, Colômbia
- Centro Latino Americano de Investigación en Malaria, Cali, Colombia
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Fernandes AAM, Carvalho LJDM, Zanini GM, Ventura AMRDS, Souza JM, Cotias PM, Silva-Filho IL, Daniel-Ribeiro CT. Similar cytokine responses and degrees of anemia in patients with Plasmodium falciparum and Plasmodium vivax infections in the Brazilian Amazon region. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2008; 15:650-8. [PMID: 18256207 PMCID: PMC2292669 DOI: 10.1128/cvi.00475-07] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 01/02/2008] [Accepted: 01/29/2008] [Indexed: 11/20/2022]
Abstract
The mechanisms of malarial anemia induction are poorly understood, but cytokines and autoantibodies are considered to play important roles. This work aimed at evaluating the degree of anemia and the plasmatic profile of the cytokines tumor necrosis factor alpha (TNF-alpha), gamma interferon (IFN-gamma), interleukin-12 (IL-12), migration inhibitory factor (MIF), and IL-10 and the monocyte chemotactic protein-1 (MCP-1) chemokine, as well as evaluating the presence of antibodies directed to components of the normal erythrocyte membrane and to cardiolipin in individuals with malaria from the Brazilian Amazon. No difference was observed in the frequency of anemia between patients infected by Plasmodium vivax and those infected by Plasmodium falciparum, and there was no relationship between the levels of parasitemia and the manifestations of anemia in P. vivax and P. falciparum patients. Significant increases in the concentrations of TNF-alpha, IFN-gamma, MIF, and MCP-1 were observed in patients with P. falciparum and P. vivax malaria, whereas the concentrations of IL-10 was increased only in patients with P. vivax infection. Higher concentrations of IL-12 and IL-10 were observed in the P. falciparum anemic patients, while for TNF-alpha this profile was observed in the nonanemic ones. P. vivax-infected and P. falciparum-infected patients with positive immunoglobulin M (IgM) or IgM and IgG responses, respectively, against blood-stage forms of the parasites had significantly lower hemoglobin levels than did those with negative responses. There was no correlation between the presence of anti-erythrocyte and anti-cardiolipin antibodies and the presence or intensity of the anemia. Our data suggest that in areas of low endemicity and unstable transmission of malaria, P. vivax and P. falciparum infections present similar characteristics in terms of the induction of anemia and cytokine responses.
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