Annals of Tropical Medicine & Parasitology
ISSN: 0003-4983 (Print) 1364-8594 (Online) Journal homepage: http://www.tandfonline.com/loi/ypgh19
Altered plasma lipid pattern in falciparum malaria S. Mohanty, S. K. Mishra, B. S. Das, S. K. Satpathy, D. Mohanty, J. K. Patnaik & T. K. Bose To cite this article: S. Mohanty, S. K. Mishra, B. S. Das, S. K. Satpathy, D. Mohanty, J. K. Patnaik & T. K. Bose (1992) Altered plasma lipid pattern in falciparum malaria, Annals of Tropical Medicine & Parasitology, 86:6, 601-606, DOI: 10.1080/00034983.1992.11812715 To link to this article: http://dx.doi.org/10.1080/00034983.1992.11812715
Published online: 15 Nov 2016.
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Citing articles: 22 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ypgh19 Download by: [Australian Catholic University]
Date: 25 August 2017, At: 18:21
Annals of Tropical Medicine and Parasitology, Vol. 86, No.6, 601-601i (1992)
Altered plasma lipid pattern in falciparum malaria BY S. MOHANTY, S. K. MISHRA, B.S. DAS, S. K. SATPATHY, D. MOHANTY, J. K. PATNAIK AND T. K. BOSE
Downloaded by [Australian Catholic University] at 18:21 25 August 2017
!spat General Hospital, Rourkela-769 005, Orissa, India Received 19 August 1992, Revised 23 September 1992, Accepted 2S September 1992
Plasma levels ofHDL, LDL, total cholesterol and triglycerides were measured in 60 patients with falciparum malaria (37 severe cases and 23 mild) and in 83 healthy individuals, to study malaria-induced changes in plasma lipids. Triglyceride levels were lower in the patients than in the controls but the difference was significant only for those with severe malaria (P < 0·001 ). In contrast, the levels of all the other plasma lipids were significantly higher (P < 0·001) in those with severe malaria than in those with mild malaria, and in the mild malaria cases compared with the controls. Initially LDL cholesterol was estimated by the Friedwald formula, but this gave negative values in a few cases of severe malaria. Plasma lipoproteins were therefore also measured by nephelometry; the estimated levels of S particles, corresponding to LDL, were then found to be lower in all malaria cases than in the controls (P < 0·001) but never negative. Interestingly, levels of L particles in the patients with severe malaria were significantly elevated compared with the other patients and controls (P < 0·001), indicating impaired metabolism of chylomicrons. Plasma albumin, considered a negative acute phase protein (i.e. its level decreases as a consequence of the acute phase response), was reduced significantly and was directly correlated to HDL cholesterol levels (r= 0·715 and r= 0·895, respectively) in both mild and severe malaria. Follow-up of 22 of the severe malaria cases three weeks after treatment indicated that, while triglycerides had returned to similar levels to those in the controls, total cholesterol levels were still elevated and could give misleading results iflipid profiles were used, immediately after malaria infection, to assess an individual's risk of developing atherosclerosis.
Plasma lipid and lipoprotein patterns change as (Lambrecht et al., 1978) whereas increases in a result of malaria infection. Serum levels of plasma levels of triglycerides, phospholipids lipids were found to be elevated in Plasmodium and cholesterol were seen in falciparum malaria knowlesi-infected monkeys, for example, mainly in Nigerians (Onongbu and Onyeneke, 1983). due to increases in triglycerides, phospholipids In another African study, low levels of HDL, and non-esterified fatty acids; a consistent LDL, total cholesterol and apolipoprotein A, increase in free cholesterol was at the cost of the and elevated apolipoprotein B were observed esterified component (Angus et al., 197la,b). in falciparum malaria (Djoumessi, 1989). A Similarly, rodent malaria parasitaemias cor- similar pattern of decreased plasma HDL and related well with levels of chylomicrons, VLDL LDL and moderately elevated triglycerides was and LDL (Maurois et a!., 1978). However, observed by Nilsson-Ehle and Nilson-Ehle changes in plasma lipid levels in humans (1990) in acute malaria. The present study of changes in plasma with malaria are inconsistent; for example, a-lipoproteins and VLDL disappeared, tran- lipids in malaria was undertaken because P. siently, m patients with v1vax malaria .falciparum is widely prevalent in India (WHO, 0003-4983/92/060601
+ 06 $08.00/0
© 1992 Liverpool School of Tropical Medicine
602
MOHANTY ET AL.
1986) and estimation of plasma lipids has become a common screening test for risk of developing atherosclerosis.
All the malaria patients were treated as soon as the first blood samples had been taken, the severe malaria cases with intravenous quinine and appropriate supportive care, the mild cases with chloroquine.
Downloaded by [Australian Catholic University] at 18:21 25 August 2017
SUBJECTS AND METHODS
Subjects Individuals attending the I spat General Hospital, Rourkela, India, were enrolled in the study; 165 were in-patients with severe falciparum malaria, 23 were out-patients with mild falciparum malaria, and 83 were healthy individuals attending for routine medical check-ups. Malaria diagnosis was according to standard criteria (WHO Malaria Action Programme, 1986).
Statistical Analyses Whenever there were more than two groups, one-way analysis of variance (ANOV A) was used to detect significant differences between the groups, and the Newman-Keul test was used to make the pairwise comparisons. The Student's t-test was used when there were only two groups, and regression analysis was performed to establish the level of any correlation.
RESULTS
Blood Analyses Venous blood samples were collected from all subjects, before treatment in the cases of the malaria patients, so that routine tests (parasite and differential and total leucocyte counts and haemoglobin levels) could be made. Part of each sample taken from each individual after they had fasted overnight ( 12 hours) was heparinized so that plasma lipids could be estimated and other biochemical tests, to assess renal, hepatic and glycaemic status, could be performed. Plasma cholesterol, triglyceride, total protein, albumin and other biochemical parameters were estimated on an Hitachi-70S autoanalyser using Boehringer Mannheim test kits. HDL cholesterol was estimated in the supernatant left after precipitation with phosphotungstate and magnesium chloride. The usefulness of Friedwald's formula (Friedwald et al., 1972), which was initially used to calculate LDL cholesterol levels, was put into doubt when it gave negative values for samples from five patients with severe malaria. Lipoproteins were therefore also measured by nephelometry (Stone and Thorp, 1966) using the Thorp micro-nephelometer mark-IV (Scientific Furnishing, U.K.). Plasma levels of total cholesterol, triglyceride and albumin were also measured 3, 7, 11, 15 and 21 days after diagnosis in the 22 severe malaria patients who consented.
Levels of total cholesterol were significantly higher, and those of triglycerides significantly lower, in each of the 165 patients with severe malaria than in the controls (P
ISSN: 0003-4983 (Print) 1364-8594 (Online) Journal homepage: http://www.tandfonline.com/loi/ypgh19
Altered plasma lipid pattern in falciparum malaria S. Mohanty, S. K. Mishra, B. S. Das, S. K. Satpathy, D. Mohanty, J. K. Patnaik & T. K. Bose To cite this article: S. Mohanty, S. K. Mishra, B. S. Das, S. K. Satpathy, D. Mohanty, J. K. Patnaik & T. K. Bose (1992) Altered plasma lipid pattern in falciparum malaria, Annals of Tropical Medicine & Parasitology, 86:6, 601-606, DOI: 10.1080/00034983.1992.11812715 To link to this article: http://dx.doi.org/10.1080/00034983.1992.11812715
Published online: 15 Nov 2016.
Submit your article to this journal
View related articles
Citing articles: 22 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ypgh19 Download by: [Australian Catholic University]
Date: 25 August 2017, At: 18:21
Annals of Tropical Medicine and Parasitology, Vol. 86, No.6, 601-601i (1992)
Altered plasma lipid pattern in falciparum malaria BY S. MOHANTY, S. K. MISHRA, B.S. DAS, S. K. SATPATHY, D. MOHANTY, J. K. PATNAIK AND T. K. BOSE
Downloaded by [Australian Catholic University] at 18:21 25 August 2017
!spat General Hospital, Rourkela-769 005, Orissa, India Received 19 August 1992, Revised 23 September 1992, Accepted 2S September 1992
Plasma levels ofHDL, LDL, total cholesterol and triglycerides were measured in 60 patients with falciparum malaria (37 severe cases and 23 mild) and in 83 healthy individuals, to study malaria-induced changes in plasma lipids. Triglyceride levels were lower in the patients than in the controls but the difference was significant only for those with severe malaria (P < 0·001 ). In contrast, the levels of all the other plasma lipids were significantly higher (P < 0·001) in those with severe malaria than in those with mild malaria, and in the mild malaria cases compared with the controls. Initially LDL cholesterol was estimated by the Friedwald formula, but this gave negative values in a few cases of severe malaria. Plasma lipoproteins were therefore also measured by nephelometry; the estimated levels of S particles, corresponding to LDL, were then found to be lower in all malaria cases than in the controls (P < 0·001) but never negative. Interestingly, levels of L particles in the patients with severe malaria were significantly elevated compared with the other patients and controls (P < 0·001), indicating impaired metabolism of chylomicrons. Plasma albumin, considered a negative acute phase protein (i.e. its level decreases as a consequence of the acute phase response), was reduced significantly and was directly correlated to HDL cholesterol levels (r= 0·715 and r= 0·895, respectively) in both mild and severe malaria. Follow-up of 22 of the severe malaria cases three weeks after treatment indicated that, while triglycerides had returned to similar levels to those in the controls, total cholesterol levels were still elevated and could give misleading results iflipid profiles were used, immediately after malaria infection, to assess an individual's risk of developing atherosclerosis.
Plasma lipid and lipoprotein patterns change as (Lambrecht et al., 1978) whereas increases in a result of malaria infection. Serum levels of plasma levels of triglycerides, phospholipids lipids were found to be elevated in Plasmodium and cholesterol were seen in falciparum malaria knowlesi-infected monkeys, for example, mainly in Nigerians (Onongbu and Onyeneke, 1983). due to increases in triglycerides, phospholipids In another African study, low levels of HDL, and non-esterified fatty acids; a consistent LDL, total cholesterol and apolipoprotein A, increase in free cholesterol was at the cost of the and elevated apolipoprotein B were observed esterified component (Angus et al., 197la,b). in falciparum malaria (Djoumessi, 1989). A Similarly, rodent malaria parasitaemias cor- similar pattern of decreased plasma HDL and related well with levels of chylomicrons, VLDL LDL and moderately elevated triglycerides was and LDL (Maurois et a!., 1978). However, observed by Nilsson-Ehle and Nilson-Ehle changes in plasma lipid levels in humans (1990) in acute malaria. The present study of changes in plasma with malaria are inconsistent; for example, a-lipoproteins and VLDL disappeared, tran- lipids in malaria was undertaken because P. siently, m patients with v1vax malaria .falciparum is widely prevalent in India (WHO, 0003-4983/92/060601
+ 06 $08.00/0
© 1992 Liverpool School of Tropical Medicine
602
MOHANTY ET AL.
1986) and estimation of plasma lipids has become a common screening test for risk of developing atherosclerosis.
All the malaria patients were treated as soon as the first blood samples had been taken, the severe malaria cases with intravenous quinine and appropriate supportive care, the mild cases with chloroquine.
Downloaded by [Australian Catholic University] at 18:21 25 August 2017
SUBJECTS AND METHODS
Subjects Individuals attending the I spat General Hospital, Rourkela, India, were enrolled in the study; 165 were in-patients with severe falciparum malaria, 23 were out-patients with mild falciparum malaria, and 83 were healthy individuals attending for routine medical check-ups. Malaria diagnosis was according to standard criteria (WHO Malaria Action Programme, 1986).
Statistical Analyses Whenever there were more than two groups, one-way analysis of variance (ANOV A) was used to detect significant differences between the groups, and the Newman-Keul test was used to make the pairwise comparisons. The Student's t-test was used when there were only two groups, and regression analysis was performed to establish the level of any correlation.
RESULTS
Blood Analyses Venous blood samples were collected from all subjects, before treatment in the cases of the malaria patients, so that routine tests (parasite and differential and total leucocyte counts and haemoglobin levels) could be made. Part of each sample taken from each individual after they had fasted overnight ( 12 hours) was heparinized so that plasma lipids could be estimated and other biochemical tests, to assess renal, hepatic and glycaemic status, could be performed. Plasma cholesterol, triglyceride, total protein, albumin and other biochemical parameters were estimated on an Hitachi-70S autoanalyser using Boehringer Mannheim test kits. HDL cholesterol was estimated in the supernatant left after precipitation with phosphotungstate and magnesium chloride. The usefulness of Friedwald's formula (Friedwald et al., 1972), which was initially used to calculate LDL cholesterol levels, was put into doubt when it gave negative values for samples from five patients with severe malaria. Lipoproteins were therefore also measured by nephelometry (Stone and Thorp, 1966) using the Thorp micro-nephelometer mark-IV (Scientific Furnishing, U.K.). Plasma levels of total cholesterol, triglyceride and albumin were also measured 3, 7, 11, 15 and 21 days after diagnosis in the 22 severe malaria patients who consented.
Levels of total cholesterol were significantly higher, and those of triglycerides significantly lower, in each of the 165 patients with severe malaria than in the controls (P
