Odnos koncentracije proinflamatornih citokina u serumu i kliničkih, parazitoloških i hematoloških promena u toku importovane malarije
The relation between concentration of the proinflamatory cytokines in serum and clinical, parasitological and hematological changes during the imported malaria
Doktorand
Poluga, Jasmina L.Mentor
Pavlović, MiloradČlanovi komisije
Pelemiš, MijomirPekmezović, Tatjana
Dopsaj, Violeta
Metapodaci
Prikaz svih podataka o disertacijiSažetak
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 kri...terijumima 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.