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BACKGROUND Few data exist concerning pathogenesis of severe malaria in areas of unstable malaria transmission. OBJECTIVES The study was conducted in Senga hospital, central Sudan, which is characterized by unstable malaria transmission to investigate the cytokine profiles in children with severe Plasmodium falciparum malaria. METHODS Enzyme-linked immunosorbent assay was used to measure the concentrations of three cytokines, interferon gamma (IFN-γ), interleukin-4 (IL-4) and IL-10, in sera of three groups of children (31 in each arm): those with one or more manifestations of severe malaria, those children with uncomplicated P. falciparum malaria and healthy controls. RESULTS The levels of both IFN-γ and IL-10 were significantly higher in patients with severe P. falciparum malaria. Medium positive correlations were observed between IFN-γ and IL-10. CONCLUSION Thus, the high levels of both IFN-γ and IL-10 indicated their role in the pathogenesis of severe P. falciparum malaria.

Summary Background: Understanding the cytokine interactions that underlie both control and disease should be helpful when investigating the pathogenesis of malaria during pregnancy. Few data exists concerning pathogenesis of malaria during pregnancy in areas of unstable malaria transmission. Objectives: The study was conducted in New Halfa hospital, eastern Sudan, which is characterized by unstable malaria transmission to investigate the cytokine profiles in peripheral, placental and cord blood in parturient women. Methods: Enzyme-linked immunosorbent assay was used to measure the concentrations of three cytokines, interferon-c (IFN-c), interleukin-4 (IL-4) and IL-10, in sera from peripheral, placental and cord blood of 87 Sudanese women. Results: The concentrations of these cytokines were significantly higher in peripheral, placental sera from uninfected women than in sera from infected women. IFN-c concentrations were significantly lower in the cord sera from uninfected women in comparison to the infected ones. The levels of these cytokines were not significantly different between the primiparae and multipare. Cord sera in all groups showed lower levels of these cytokines. Strong positive correlations were observed between peripheral and placental cytokines. Conclusion: The immune responses that occur in placental, peripheral and cord blood were influenced by the malaria infections, irrespective of the parity. The immune response during Plasmodium falciparum infection is not different in the peripheral and placental compartments, further studies are required.

The prevalence and possible risk factors for anaemia were investigated in 744 pregnant Sudanese women attending the antenatal clinic of New Halfa teaching hospital, eastern Sudan between October 2003 and April 2004. Of those, 466 (62.6%) had anaemia (haemoglobin [Hb]

This study was carried in New Halfa Hospital, eastern Sudan from October 1997 to February 2001. Twenty-eight pregnant Sudanese women infected with Plasmodium falciparum were treated with intramuscular artemether (six injections, 480 mg) after failure of chloroquine and quinine therapy. The patients were followed-up until delivery; the babies were followed-up until the age of 1 year. Artemether was given to one patient in the tenth week of gestation, to 12 during the second trimester, and to 15 during the third trimester. It was well tolerated, the parasitaemia was cleared and the patients were symptom-free within three days. One patient (3.5%) delivered at 32 weeks and the baby died six hours after delivery. The other 27 (96.5%) delivered full-term live babies. None of the pregnant women died and there was no abortion, stillbirth or congenital abnormalities in the newborn babies.

A case–control study was carried out in Kassala and Medani Maternity Hospitals in Sudan to investigate acute-phase proteins [haptoglobin, C-reactive protein (CRP), ferritin and albumin] in three groups of pregnant women (32 in each arm) comprising those with severe Plasmodium falciparum malaria or uncomplicated P. falciparum malaria and healthy controls. Whilst there was no significant difference in the levels of albumin and haptoglobin, ferritin and CRP levels were significantly higher in pregnant women with severe P. falciparum malaria. There were significant positive correlations between parasite count and haptoglobin, and medium positive correlations between parasite count and CRP.

The haptoglobin phenotypes of Sudanese patients with complicated and uncomplicated falciparum malaria, and those of uninfected randomly selected individuals, were determined by electrophoresis of sera on polyacrylamide gels followed by benzidine staining of the gels. Among 273 malaria patients, the proportions with haptoglobin phenotypes (1-1), (2-1) and (2-2) were 60.8%, 29.7% and 9.5%, respectively, and in 72 cerebral malaria patients the proportions were 63.9%, 29.2%, and 6.9%. The distribution among 208 control individuals was 26.0%, 55.8% and 18.3%, respectively. The difference between patients and controls was highly significant (P < 0.001). The distribution of the different haptoglobin phenotypes among the randomly selected group of 208 Sudanese individuals was comparable to that in many other populations. The results suggests that the haptoglobin phenotype (1-1) is associated with susceptibility to falciparum malaria and the development of severe complications; alternatively, the other phenotypes may confer resistance.