Reduced Parasite Burden in Children with Falciparum Malaria and Bacteremia Coinfections: Role of Mediators of Inflammation

Mediators Inflamm. 2016:2016:4286576. doi: 10.1155/2016/4286576. Epub 2016 Jun 22.

Abstract

Bacteremia and malaria coinfection is a common and life-threatening condition in children residing in sub-Saharan Africa. We previously showed that coinfection with Gram negative (G[-]) enteric Bacilli and Plasmodium falciparum (Pf[+]) was associated with reduced high-density parasitemia (HDP, >10,000 parasites/μL), enhanced respiratory distress, and severe anemia. Since inflammatory mediators are largely unexplored in such coinfections, circulating cytokines were determined in four groups of children (n = 206, aged <3 yrs): healthy; Pf[+] alone; G[-] coinfected; and G[+] coinfected. Staphylococcus aureus and non-Typhi Salmonella were the most frequently isolated G[+] and G[-] organisms, respectively. Coinfected children, particularly those with G[-] pathogens, had lower parasite burden (peripheral and geometric mean parasitemia and HDP). In addition, both coinfected groups had increased IL-4, IL-5, IL-7, IL-12, IL-15, IL-17, IFN-γ, and IFN-α and decreased TNF-α relative to malaria alone. Children with G[-] coinfection had higher IL-1β and IL-1Ra and lower IL-10 than the Pf[+] group and higher IFN-γ than the G[+] group. To determine how the immune response to malaria regulates parasitemia, cytokine production was investigated with a multiple mediation model. Cytokines with the greatest mediational impact on parasitemia were IL-4, IL-10, IL-12, and IFN-γ. Results here suggest that enhanced immune activation, especially in G[-] coinfected children, acts to reduce malaria parasite burden.

MeSH terms

  • Bacteremia / blood
  • Bacteremia / microbiology*
  • Bacteremia / parasitology*
  • Child, Preschool
  • Coinfection / blood*
  • Coinfection / microbiology*
  • Coinfection / parasitology*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Inflammation / blood
  • Inflammation / microbiology
  • Inflammation / parasitology
  • Interferon-alpha / blood
  • Interferon-gamma / blood
  • Interleukin-10 / blood
  • Interleukin-12 / blood
  • Interleukin-15 / blood
  • Interleukin-17 / blood
  • Interleukin-4 / blood
  • Interleukin-5 / blood
  • Interleukin-7 / blood
  • Malaria, Falciparum / blood
  • Malaria, Falciparum / microbiology*
  • Malaria, Falciparum / parasitology*
  • Male
  • Salmonella / pathogenicity
  • Staphylococcus aureus / pathogenicity
  • Tumor Necrosis Factor-alpha / blood

Substances

  • Interferon-alpha
  • Interleukin-15
  • Interleukin-17
  • Interleukin-5
  • Interleukin-7
  • Tumor Necrosis Factor-alpha
  • Interleukin-10
  • Interleukin-12
  • Interleukin-4
  • Interferon-gamma