Comparison of the levels of some hemostatic and inflammatory markers between tuberculosis patients with and without malaria at pretreatment, intensive, and continuation phase treatment.

Background: Tuberculosis and malaria (TB/MP) co-infection generates severe pathology that affects the levels of cytokines and hemostatic parameters than either disease. Anti-TB treatment regimen involves phases of different drug cocktails that may additionally modulate the levels of inflammatory cytokines and hemostatic parameters. This study investigated the variations in the levels of hemostatic and inflammatory markers when compared between TB patients with and without malaria at pretreatment, intensive, and continuation phase treatment. Method: In this cross-sectional study, 180 patients were recruited comprising; 35 TB-only and 25 TB/malaria patients at pretreatment, 36 TB-only and 24 TB/malaria patients at intensive phase treatment, and 27 TB-only and 33 TB/malaria patients at continuation phase therapy. P-selectin (P-SEL), platelet-activating factor (PAF), platelet factor-4, GP IIb/IIIa complex, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-10, IL-6, IL-2, transforming growth factor (TGF)-ß, and thrombopoietin (TPO) were assayed using enzyme-linked immunosorbent assays. Mann-Whitney test and Spearman's rank correlation were applied for statistical test. Results: At pretreatment, the median levels of IL-6 and IL-10 were significantly lowered, while P-selectin (P-SEL), GP IIb/IIIa, and PAF were significantly increased in TB/malaria patients compared to TB patients without malaria. At intensive treatment, TNF-α, IL-6, and IL-2 were significantly higher, while IL-10 and PAF were significantly reduced in TB/malaria patients compared with TB patients without malaria. At continuation phase treatment, TNF-α, IL-6, TGF-ß, PF4, GP IIb/IIIa, and TPO were significantly reduced, while P-SEL was significantly increased in TB/malaria patients compared with TB patients without malaria. Conclusion: Differences in the levels of inflammatory cytokines and hemostatic markers between TB patients co-infected with malaria and nonmalaria-infected TB patients vary with anti-TB treatment.

Variations in the leukocyte and cytokine profiles between placental and maternal circulation in pregnancy-associated malaria.

BACKGROUND: Activation of immune cells by malaria infection induces the secretion of cytokines and the synthesis of other inflammatory mediators. This study compared the cytokine levels and leukocyte count between malaria-infected peripheral and placental blood of pregnant women before delivery and postpartum. The cytokines assessed include interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin-4 (IL-4), interleukin-6 (IL-6) and interleukin-10 (IL-10). MATERIALS AND METHODS: The subjects comprised 144 malaria-infected pregnant women and 60 malaria-infected women at post-partum stage (for placental blood collection). Others were 60 malaria-uninfected pregnant women and 40 malaria-uninfected women at postpartum stage (for placental blood collection). Forty malaria-infected and 40 malaria-uninfected nonpregnant women served as control subjects. The test groups were asymptomatic, and the control groups were apparently healthy subjects. All were aged between 17 and 44 years. Ethical approval for the study was obtained at Abia State University Teaching Hospital and Living Word Mission Hospital, Aba. Informed consent was obtained from the participants. Blood samples were aseptically collected initially from the maternal peripheral circulation and from the placenta on delivery, and tested for HIV and malaria using standard methods. IFN-γ, TNF-α, IL-4, IL-6 and IL-10 were measured by enzyme-linked immunosorbent assay technique. Kruskal-Wallis test was used for comparison of the groups. RESULTS: IFN-γ was significantly higher in the peripheral than in placental blood (P=0.001). IL-4 and IL-10 were significantly lower in the peripheral than in placental blood (P=0.001 and P=0.004, respectively). The total leukocytes, neutrophils and lymphocyte counts were significantly higher in the placenta than in peripheral blood (P=0.001), and the mixed differential count was significantly higher in the placenta than in peripheral blood (P=0.012). CONCLUSION: This study has shown that the cytokine levels and leukocyte counts may differ between the peripheral and placental blood of the same women. Therefore, measurement of parameters in the peripheral circulation may not always reflect the levels in the placental blood for the assessment of immune cellular response at the materno-fetal interface.

Evaluation of some haemostatic parameters in falciparum malaria and HIV co-infection.

BACKGROUND: Studies from sub-Saharan Africa where malaria is endemic have observed high incidences of malaria and HIV co-infection. It has long been accepted that malaria causes alterations in haemostatic parameters and that HIV is associated with a wide range of haematological changes. We assessed the effect of the overlap of these infections on routine haemostatic parameters. METHOD: The study involved 337 subjects grouped according to their HIV and malaria status: Group 1 'Asymptomatic HIV seropositive, Plasmodium falciparum positive' (n = 61); Group 2 'Asymptomatic HIV seropositive, P. falciparum negative' (n = 73); Group 3 'Symptomatic HIV seropositive, P. falciparum positive' (n = 49); Group 4 'Symptomatic HIV positive P. falciparum negative' (n = 56); Group 5 'Control HIV negative, P. falciparum positive' (n = 52) and Group 6 'Control HIV negative, P. falciparum negative' (n = 46). Blood samples were taken for HIV testing, diagnosis of falciparum malaria and malaria parasite density counts. Citrated samples were used within one hour of collection for prothrombin time (PT) and activated partial thromboplastin time (APTT). CD4+ T cell counts, platelet count and haematocrit (Hct) were also performed. RESULTS: Our results demonstrate greater alterations in APTT, PT and platelet count with prolongation of APTT, PT and lower platelet counts in HIV and malaria co-infection. In spite of this, the co-infected subjects with mild to moderate parasitaemia did not show a bleeding tendency; however, the risk is higher in severe malaria. CONCLUSION: These results suggest that co-infected subjects with severe malaria have a higher risk of bleeding and would require greater monitoring.