Impact of epstein-barr virus reactivation on cytokine levels in pregnant women with malaria in the west region of cameroon

Abstract

We have previously reported that pregnant women with EBV reactivation are more prone to severe malaria than those with latent EBV. This suggests that lytic reactivation of EBV is strongly associated with malaria severity and could be investigated as a risk factor for severe malaria during pregnancy. To understand the association between EBV reactivation and malaria severity, we investigated the levels of IL-6, IFN-γ, TNF-α, IL-10, and TGF-β in pregnant women with malaria and reactivated EBV vs. latent EBV. A total of 220 pregnant women were recruited from three hospitals in the West region of Cameroon. Malaria was diagnosed by microscopy and Nested PCR, while EBV reactivation was assessed by detecting EBV nuclear antigen IgG, viral capsid antigen IgM, and early antigen IgG using ELISA. Cytokine levels were measured by ELISA, and data were analyzed using GraphPad Prism version 9.0. Women with reactivated EBV and severe malaria showed significantly lower IL-6 levels compared to those with latent EBV and severe malaria (29.86 pg/ml vs. 55.83 pg/ml, p = 0.02). Interestingly, TGF-β levels were significantly elevated in women with reactivated EBV and severe malaria than those with latent EBV and severe malaria (17.6 pg/ml vs. 6.1 pg/ml, p = 0.01). A strong negative correlation was observed between IL-10 levels and parasitemia in women with reactivated EBV and severe malaria (r=-0.9762, p = 0.0004). Our data revealed that lytic EBV reactivation may impair the inflammatory response by down-regulating the IL-6 level and elevating the TGF-β level, contributing to a loss of control of the parasitemia and potentially exacerbating malaria. This study provides further insight into the immunological interaction between EBV and P. falciparum and could contribute to improving malaria therapies in EBV-infected malaria patients.