Health & Medicine

Will the bad get any worse? A Discovery of “the Alarm” of Severe Malaria

Walailak University researchers vouched for a prognostic biomarker of severe malaria through a systematic review and meta-analysis and shed light on the potential severity of malaria. The data will make sure that each malaria patient receives the medical attention he needs. 

Wouldn’t it be amazing if you could just fix things in time and set them right, especially life-threatening illnesses? 

     That might be the case now after Assoc. Prof. Dr. Manas Kotepui, Lecturer of School of Allied Health Science, Walailak University, and expert in tropical disease, together with the research team identify association between the protein Tumor Necrosis Factor-α or TNF-α “severe malaria alarm” with severe conditions of malaria.

     World Health Organization (WHO) has estimated 241 million cases of malaria globally, causing over 627,000 deaths. In Thailand, more than 7,000 cases were reported between 2020 to 2021 according to Thailand Malaria Elimination Program by Thailand’s Ministry of Public Health. However, it seems that protein in our body that can be used as a potential prognostic biomarker or the alarm of severe malaria.

     Malaria, a life-threatening infectious disease, is caused by a transmission of parasites from the bite of female Anopheles mosquitoes to our body. Parasites, namely Plasmodium falciparum or P. falciparum, P. vivax, P. malariae, P. ovale curtisi, P. ovale wallikeri, and P. knowlesi, will have their life cycle in human body, and the blood stage parasites later will cause clinical symptoms of malaria. Using the WHO’s Malaria Guidelines, symptoms of malaria can be classified into categories. 

    Severe malaria can be pointed out by the presence of one or more of the following symptoms: impaired consciousness, prostration, convulsions, severe malarial anemia, acidosis, hypoglycemia, pulmonary edema, renal impairment, jaundice, significant bleeding, and hyper parasitemia. For uncomplicated malaria, patients present the symptoms with a positive parasitological test, but no sign of severe malaria, while asymptomatic malaria patients have the parasites in their blood stream but no symptom being exhibited.

     To investigate whether there are any markers in our body that can be used to prognosticate on the severity of the disease, Assoc. Prof. Dr. Manas and his team conducted the research “Tumour Necrosis Factor-α as a Prognostic Biomarker of Severe Malaria: A Systematic Review and Meta-Analysis”. The research collect data from 1,694 studies published between 1989 to 2019, 588 in PubMed, 464 in Web of Science, and 642 in Scopus. At the end, 31 studies met eligibility criteria and were included for meta-analysis. 

     Results suggest that during the parasite-caused infection of cells, the secretion of Tumour Necrosis Factor-α or TNF-α in human body increases and so the TNF-α is an important signaling protein in our immune systems produced during the acute inflammation. It is responsible for a variety of signaling events in cells, leading to cell necrosis or apoptosis (cell death). It also promotes the recruitment of immune cells to areas of inflammation, and initiates immune reaction fighting back the invasion of the parasites. 

     This research by Assoc. Prof. Dr. Manas Kotepui and his team was conducted with 3 main objectives. The first objective is to compare TNF-α levels in patients with severe and uncomplicated malaria. The second objective is to compare TNF-α levels between patients with fatal and non-fatal severe malaria. And the third is to compare TNF-α levels between patients with uncomplicated and asymptomatic malaria. Gathering and statistically analyzing data from the aforementioned databases, the team had come to the conclusion that patients with severe malaria showed higher TNF-α levels in the serum than those with uncomplicated malaria. In addition, patients with uncomplicated malaria showed higher TNF-α levels than those with asymptomatic malaria. And there is no difference in TNF-α levels of fatal severe malaria comparing to those with non-fatal severe malaria.

      “This conclusion confirms and is consistent with results from previous studies that the increase of TNF- α levels in human serum is associated with severity of the disease. So, TNF-α may be used as a prognostic biomarker of severe malaria” said Assoc. Prof. Dr. Manas Kotepui.

     The research finding has led to a new question of how further studies can be done, in order to figure out a way to implement this biomarker, to help in the reduction of severe malaria and the provision of specific medical treatment in time. Even though malaria is a life-threatening disease, it is preventable and curable. The best practice to still to prevent the malaria infection is, of course, to prevent the mosquito bites. 

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Written by Settaboot Onphakdee
Edited by Nootchanat Sukkaew