The Relationship of Hemoglobin, Interleukin-10 and Tumor Necrosis Factor Alpha Levels In Asymptomatic Malaria Patients in Trenggalek, Jawa Timur, Indonesia

Arif Rahman Nurdianto, Heny Arwati, Yoes Prijatna Dachlan, Dyah Ayu Febiyanti


Background: Malaria is still a universal health problem, especially in tropical countries because of high morbidity and mortality rates. Infection by Plasmodium falciparum and Plasmodium vivax could result in asymptomatic disease of malaria and be found in Trenggalek, Jawa Timur. Differences in pathogenesis among affected individuals are affected by many factors, and the immune system is one of them. Among substances involved in the malarial immunity is Tumor Necrosis Factor (TNF)-α and Interleukin (IL)-10, produced by the body's defense system as the reaction to the parasite. Therefore a study was designed to detect the level of TNF-α and IL-10 in asymptomatic malaria patients.

Materials and Methods: A cross-sectional study was conducted. Thirty male asymptomatic malaria subjects, age 21 to 60 years were selected. Blood from each subject was collected and the levels of TNF-α and IL-10 were analyzed using enzyme-linked immunosorbent assay (ELISA) method. Significant values considered at p<0.05.

Results: There was an increased level of TNF-α with the average of 218.760 pg/µL, and an increased level of IL-10 with an average of 257.574 pg/µL in asymptomatic malaria subjects. In normal person IL-10 level is 12.6 (8.5-16.7) pg/mL and the levels of TNF-α in normal person is 0-1.5 pg/mL because they are not produce. There was a positive correlation of TNF-α with IL-10 (r=0.332; p>0.05), and positive correlation between TNF-α and the rate of hemoglobin (r=0.002; p>0.05). IL-10 was correlated negatively with the rate of hemoglobin (r=-0.363; p<0.05).

Conclusion: The results from this study conclude that TNF-α and IL-10 levels increase in asymptomatic malaria subjects.

Keywords: asymptomatic malaria, TNF-α, IL-10, parasite, hemoglobin

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Pemerintah Provinsi Jawa Timur [Internet]. Malaria case in Province of East Java [cited 2014 Nov 14]. Available from:

CChaisavaneeyakorn S, Othoro C, Shi YP, Otieno J, Chaiyaroj SC, Lal AA, et al. Relationship between plasma interleukin-12 (IL-12) and IL-18 levels and severe malarial anemia in an area of holoendemicity in Western Kenya. Clin Diagn Lab Immunol. 2003; 10: 362-6, CrossRef.

Fernandes AAM, Carvalho LJM, Zanini GM, Ventura AMRS, Souza JM, Cotias PM, et al. Similar cytokine response and degrees of anemia in patients with Plasmodium falciparum and Plasmodium vivax infections in Brazilian Amazon Region. Clin Vaccine Immunol. 2008; 15: 650-8, CrossRef.

Arwati H, Kusmartisnawati, Poppy, Dachlan YP. Asymptomatic malaria in Trenggalek District, East Java Province as revealed by microscopic examination and single step PCR. Folia Medica Indonesiana. 2013; 49: 150-4.

Bousema JT, Gougana LC, Drakeley CJ, Meutstege AM, Okech PA, Akim IMJ, et al. Plasmodium falciparum gametocyte carriage in symptomatic children in western Kenya. Malar J. 2014; 3: 18, CrossRef.

Wilson NO, Bythwood T, Solomon W, Jolly P, Yatich N, Jiang Y, et al. Elevated levels of IL-10 and G-CSF associated with asymptomatic malaria in pregnant women. Infect Dis Obstet Gynecol. 2010; 2010: 317430, CrossRef.

Nugroho A. Harijanto PN, Datau E.A. Imunologi pada malaria. In: Harijanto PN, ed. Malaria Epidemiologi, Patogenesis, Manifestasi Klinik, & Penanganan. Jakarta: EGC; 2000. p.128-47.

Da Silva. Alterations in cytokines and hematological parameters during the acute and convalescent phases of Plasmodium falciparum and Plasmodium vivax infections. Mem Inst Oswaldo Cruz. 2014; 109(2): 154-62, CrossRef.

Kleiner G, Marcuzzi A, Zanin V, Monasta L, Zauli G. Cytokine levels in The serum of healthy subjects. Mediators Inflamm. 2013; 2013: 434010, CrossRef.

LutyAJ, Kun JF, Kremsner PG. Mannose-binding lectin plasma levels and gene polymorphism in Plasmodium falciparum malaria. J Infect Dis. 1998; 178: 1221-4, Link.

Nussenblatt V, Mukasa G, Metzger A, Ndeezi G, Garrett E, Richard D, et al. Anemia and interleukin-10, tumor necrosis factor alpha, erythropoietin levels among children with acute, uncomplicated Plasmodium falciparum malaria. Clin Diagn Lab Immunol. 2001; 8: 1164-70, CrossRef.

Day NP, Hien TT, Schollaardt T, Loc PP, Chuong LV, Chau TT, et al. The prognostic and pathophysiologic role of pro and anti-inflammatory cytokines in severe malaria. J Infect Dis. 1999; 180: 1288-97, CrossRef.

Malaguarnera L, Musumeci S. The immune response to plasmodium falciparum malaria. Lancet Infect Dis. 2002; 2: 472-8, CrossRef.

May H, Nicholas JW. Molecular mechanism of cytoadherence in malaria. Am J Physiol Cell. 1999; 276: C1231-42, CrossRef.

Kurtzhal JAL, Adabayeri V, Akanmori BD. Low plasma concentration interleukin 10 in severe malarial anemia compared with cerebral and uncomplicated Malaria. Lancet. 1998; 351: 1768-72, CrossRef.

Haldar K, Mohandas N. Malaria, erythrocytic infection, and anemia. Hematology Am Soc Hematol Educ Program. 2009; 2009: 87-93, CrossRef.

Phillips RE, Pasvol G. Anaemia of Plasmodium falciparum malaria. Baillieres Clin Haematol. 1992; 5: 315-30, CrossRef.


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