Clusters of Cytokines Determine Malaria Severity in Plasmodium falciparum–Infected Patients

necrosis factor (TNF)-a, and transforming growth factor (TGF)–b in clinically well-defined groups of Plas-modium falciparum–infected patients manifesting mild malaria (MM), severe noncerebral malaria (SM), or cerebral malaria (CM) and in control subjects from Gondia, a malaria-endemic site in India, as well as in healthy subjects from non–malaria-endemic areas. Two-way coupled cluster analysis revealed 2 clusters of cytokines relevant to clinical subgroups of disease. The first cluster was composed of IFN-g, IL-2, IL-5, IL-6, and IL-12, the levels of which were significantly increased during infection but were predominant in patients with MM and allowed us to distinguish them from patients with SM or CM. The second cluster was composed of TGF-b, TNF-a, IL-10, and IL-1b, the levels of which were highly correlated with each other in the different clinical groups of patients and significantly increased with disease severity, particularly in CM. Discriminant analyses allowed us to propose a minimal model. Levels of cytokines such as IL-5, IL-1b, IL-10, and IL-2 increase with infection. Levels of IL-12, IL-5, and IL-6 discriminate severe forms of malaria from MM. Finally, levels of IL-1b, IL-12, and IFN-g are relevant for the discrimination of CM from SM: high IL-1b levels are associated with CM, and high IL-12 and IFN-g levels are associated with SM. Plasmodium falciparum malaria is a major public-health problem in sub-Saharan Africa and southern Asia, wit