A Low interleukin-10 Tumor Necrosis Factor-Alpha Ratio Is Associated With Malaria Anemia in Children Residing in a Holoendemic Malaria Region in Western Kenya

J Infect Dis. 1999 Jan;179(1):279-82. doi: 10.1086/314548.


The balance between Th1 cytokines (tumor necrosis factor [TNF]-alpha, interferon [IFN]-gamma) and Th2 cytokines (interleukin [IL]-10, -4) may be critical in the development of severe falciparum malaria. Therefore, plasma concentrations of these cytokines were determined in children with various manifestations of malaria. Plasma levels of IFN-gamma and IL-4 were undetectable in most children. However, TNF-alpha and IL-10 were significantly elevated in children with high-density parasitemia and malaria anemia compared with children in control groups. In children with mild malaria, IL-10, but not TNF-alpha, was significantly elevated. While the highest concentrations of TNF-alpha were found in children with malaria anemia, IL-10 levels were highest in children with high-density uncomplicated malaria. The mean ratio of IL-10 to TNF-alpha was significantly higher in children with mild and high-density parasitemia (4.64, P<.005) than in children with malaria anemia (1.77). Thus, higher levels of IL-10 over TNF-alpha may prevent development of malaria anemia by controlling the excessive inflammatory activities of TNF-alpha.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anemia / blood*
  • Anemia / etiology
  • Anemia / immunology*
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Down-Regulation
  • Humans
  • Interleukin-10 / blood*
  • Kenya
  • Malaria, Falciparum / blood*
  • Malaria, Falciparum / complications
  • Malaria, Falciparum / immunology*
  • Models, Biological
  • Tumor Necrosis Factor-alpha / metabolism*


  • Tumor Necrosis Factor-alpha
  • Interleukin-10