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Background  In Pakistan,  Plasmodium vivax  is endemic causing approximately 70% of the malaria cases. A number of haematological changes, especially thrombocytopaenia have been reported for  P. vivax . Several host factors including cell-mediated immune cells, such as IL-1, IL-6 and IL-10 have been documented for  P. vivax -induced thrombocytopaenia. However, study on correlation of cytokines and thrombocytopaenia in  P. vivax , particularly in patients with severe signs and symptoms has not been reported from Pakistan.    Methods  A case control study to correlate TNF, IL-6 and IL-10 in healthy controls and thrombocytopaenic  P. vivax -infected patients (both uncomplicated and complicated cases) from southern Pakistan was carried out during January 2009 to December 2011. One Hundred and eighty two patients presenting with microscopy-confirmed asexual  P. vivax  mono-infection and 100 healthy controls were enrolled in the study at Aga Khan University Hospital, Karachi. Enzyme-linked immunosorbent assay (ELISA) was performed for determination of TNF, IL-6 and IL-10 levels.    Results  Out of 182 cases, mild thrombocytopaenia (platelet count 100,000-150,000 mm 3 ) was observed in ten (5.5%), moderate (50,000-100,000 mm 3 ) in 93 (51.1%), and profound thrombocytopaenia (<50,000 mm 3 ) was detected in 79 (43.4%) patients. IL-6 and IL-10 levels were found approximately three-fold higher in the mild cases compared to healthy controls. Two-fold increase in TNF and IL-10 (p < 0.0001) was observed in profound thrombocytopaenic when compared with moderate cases, while IL-6 was not found to be significantly elevated.    Conclusion  Cytokines may have a possible role in  P. vivax -induced thrombocytopaenia in Pakistani population. Findings from this study give first insight from Pakistan on the role of cytokines in  P.vivax -associated thrombocytopaenia. However, further studies are required to understand the relevance of cytokines in manifestations of thrombocytopaenia in  P. vivax  malaria.

malaria journal

Tumour necrosis factor, interleukin-6 and interleukin-10 are possibly involved in Plasmodium vivax-associated thrombocytopaenia in southern Pakistani population