DINAMIKA RESPON SITOKIN PRO-INFLAMASI DAN SITOKIN ANTI-INFLAMASI PADA MALARIA BERAT : HUBUNGANNYA DENGAN MANIFESTASI KLINIS

Malaria still remains a major health problem in tropical and sub-tropical areas in the world, including Indonesia (particularly in the Eastern Region, including East Kalimantan). Severe (complicated) malaria is found in 2 � 10 % of individual infected with Plasmodium falciparum with high mortality rate of 10 � 50 %. Erythrocyte invasion by Plasmodium is the the cental and beginning of malaria pathogenesis, which is followed by parasite sequestration in microvascular of vital organs (cytoadherence and rosetting) resulting in tissue hypoxia, and immune responses involving various effector cells and pro-inflammatory cytokines and anti-inflammatory cytokines presented as local and systemic inflammation that can cause multiple organ impairments and death. The aims of this study were to evaluate immune responses which included the dynamics of pro-inflammatory cytokines (TNF-�, IFN-�) and anti-inflammatory cytokine (IL-10) responses and their correlations with clinical manifestations in severe malaria patients in East Kalimantan. It was conducted an analytic prospective study in 23 severe falciparum malaria and 26 uncomplicated falciparum malaria patients at A. Wahab Sjahranie General Hospital Samarinda from August 2011 to March 2014. In this study data evaluated included origin place of patients, place of stay/ work, previous malaria infection, serial levels of TNF-�, IFN-�, IL-10, parasite counts, GCS, total bilirubin, creatinine since the first day of admission until the fifth day. This study showed that in severe malaria patients it was found significant increases of TNF-�, IFN-�, IL-10 levels, namely 2 � 16-folds (average 5-folds), 2 � 35-folds (average 9-folds), 2 � 87-folds (average 58-folds) above baseline respectively, which decreased rapidly after anti-malarial treatment.TNF-�, IFN-�� IL-10 levels in severe malaria group were significantly higher than those of uncomplicated malaria group (p < 0.05). TNF-�, IFN-� levels and IFN-�/IL-10 ratio were negatively-correlated with GCS, positively-correlated with total bilirubin level and serum creatinine level. IL-10 level was positively-correlated with total bilirubin level. The strongest correlation was seen between IFN-� level and total bilirubin level (r = 0.7