Malaria, immunity and mental disorders: A plausible relationship?

EBioMedicine; 40 (), 2019
Ano de publicação: 2019

Malaria is the most common and dangerous parasitic disease, being responsible every year for nearly half a million deaths, and an estimated 219 million clinical cases, globally [1]. The devastating short-term effects that an acute malarial infection can have on any given individual have been historically well characterized, and there are also abundant data on the subacute and chronic sequelae derived from severe malarial episodes, which are understandable in the context of the sudden and profound insult that such an aggressive infection may have in the central nervous system and other key organs [2]. However, much scarcer information exists regarding other more subtle or prolonged deleterious effects of malarial infection and disease on well-being, beyond its acute phase, particularly in regard to common mental disorders (CMD) and neuro-psychiatric health. In this recent article of EBioMedicine [3] Rachel Jenkins and colleagues explore the three-way relationship between malaria, mental disorders and immunity in a representative sample of adults randomly selected from the Kombewa Health and Demographic Surveillance system running in Kisumu, a highly malaria-endemic county located in Western Kenya [4]. To do so, authors applied a myriad of validated structured questionnaires designed to assess mental health and collected blood samples of the studied individuals to confirm malaria parasitaemia and test for common markers of immune function (CD4/ CD3 ratio, CD4 counts, IL-1β, IL-6, IL-8, and IL-10, TNF-β, TNF-α). Although no associations were found between malaria and psychotic symptoms, their results confirm a statistically significant association between malaria and CMD (OR 1.7, p = 0.014), a heterogeneous group of distress states which typically manifest with anxiety, depressive and unexplained somatic symptoms. Their results also hint at the potential mediating role that the cytokine TNF-α may play in this association. The association between mental health and non-communicable diseases has been widely studied [5], with evidence of inflammation significantly contributing to the pathogenesis of major psychiatric disorders (including depression [6] or schizophrenia [7], among others), and the inflammasome -a multiprotein oligomer responsible for the activation of inflammatory responses- proposed as a central mediator [8]. Conversely, the association between mental health and communicable

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