Impairment of Plasmodium falciparum-specific antibody response in severe malaria

Serum antibody response to plasmodial antigens was investigated in 97 Thai patients with Plasmodium falciparum malaria. No difference in immunoglobulin G (IgG) antibody levels was detected between groups without or with cerebral manifestations of malaria (n = 40). In patients with the most severe form of the disease, i.e., those who died despite adequate therapy (n = 12), antibody detected in the immunofluorescent-antibody test was found at lower levels than in those who recovered (geometric means: IgG = 1/420 versus 1/3,800; IgM = 1/15 versus 1/70); similarly, precipitating malarial antibodies were present in only 1 of these 12 patients, while they were detectable in 65 of the remaining 85 patients (76.5%). In contrast, anticytomegalovirus antibody levels were similar in the different groups of patients. Results show that depression of antibody response may extend to antiplasmodial responses during severe malaria. The link between fatality and a low level of antibody production suggests that an appropriate immune response to malarial antigens may be required to achieve recovery with drug treatment and provides a new direction for malaria therapy research.