Odnos koncentracije proinflamatornih citokina u serumu i kliničkih, parazitoloških i hematoloških promena u toku importovane malarije

Abstract

REZIME: Malarija je multisistemska, potencijalno letalna bolest uzrokovana parazitima roda Plasmodium. Dokazano je da kod malarije oslobadanje proinflamatornih citokina produkuje sistemski, inflamatorni odgovor i da su njihove koncentracije povecane, posebno kod teških formi. Smatra se da su citokini odgovorni za pojavu temperature, povracanja, proliva, mialgija, trombocitopenije, imunospupresije, koagulopatije i neuroloških manifestacija. U Klinici za infektivne i tropske bolesti u periodu 2000- 2010. godine je leceno 103 bolesnika sa importovanom malarijom. U ukupnom uzorku bolesnika odredivani su najznacajniji klinicki i laboratorijski parametri, sa posebnim osvrtom na stepen parazitemije.U prospektivnom delu istraživanja koje je ukljucivalo 34 bolesnika uzeti su citokini: TNF- i IL-6. Najvažniji cilj disertacije je da se odredi nivo citokina TNF- i IL-6 u dve faze: pre i posle terapije, i ustanovi njihova korelacija sa klinickim, parazitološkim i hematološkim parametrima. Prema kriterijumima SZO za teške forme malarije formirana je grupa od 22 bolesnika i odredivane su njihove najucestalije komplikacije, kao i razlike u odnosu na ukupan uzorak bolesnika. Ustanovljeno je da su u prvoj fazi povišeni nivoi citokina TNF- i IL-6, i da postoji njihova jaka medusobna korelacija, kao i korelacija sa stepenom parazitemije, povišenim vrednostima d-dimera i laktata, leukopenijom i trombocitopenijom. Sem toga, utvrdeno je da je znacajno veci broj bolesnika imao falciparum malariju, parazitemiju manju od 5%, da nije uzimao hemoprofilaksu, a trombocitopenija je bila najcešca laboratorijska abnormalnost. Bolesnici sa hiperparazitemijom imali su znacajno vece vrednosti bilirubina i cešcu pojavu neuroloških komplikacija, dok su kod teških formi malarije ustanovljene znacajno više vrednosti TNF- i niže vrednosti trombocita.

ABSTRACT: Malaria is a multisystemic, potentially lethal disease caused by parasites of the genus Plasmodium. It has been proven that the release of proinflammatory cytokines in malaria produces systemic inflammatory response and that their concentrations are increased, especially in severe forms. It is considered that the cytokines are responsible for the occurrence of fever, vomiting, diarrhea, myalgia, thrombocytopenia, immunosuppression, coagulopathy and neurological manifestations. At the Clinic of Infectious and Tropical Diseases, 103 patients with imported malaria were treated during the period 2000-2010. The most important clinical and laboratory parameters were determined in the total sample of patients, with special reference to the degree of parasitemia. In the prospective part of the study that included 34 patients, the cytokines TNF- and IL-6 have been taken. The main aim of the doctorate is to determine the levels of cytokines TNF- and IL-6 in two phases: before and after treatment, and to establish their correlation with clinical, parasitological and hematological parameters. According to the WHO criteria for severe forms of malaria, a group of 22 patients was formed, and their most common complications were determined, as well as the comparasion to the total sample of patients. It was confirmed that in the first phase, the levels of cytokines TNF and IL-6 are elevated and that there is their strong mutual correlation and correlation with the degree of parasitemia,elevated d-dimer and lactate levels, leukopenia and thrombocytopenia. In addition, it was found that a significantly greater number of these patients had falciparum malaria, as well as parasitemia less than 5%, that they did not take chemoprophylaxis, and the thrombocytopenia was the most common laboratory abnormality. Patients with hyperparasitemia had significantly higher values of bilirubin and more frequent occurrence of neurological complications, while in severe forms of malaria has been found significantly higher levels of TNF- and the lower number of thrombocytes.