
 subjects and sampling - the study was carried out in porto velho , ro , 
 an unstable malaria - endemic area , where p. vivax accounts for more than 75% of all 
 malaria cases ( oliveira - ferreira et al .
symptomatic patients diagnosed with malaria infection by a thick blood smear in an 
 outpatient clinic in porto velho were asked to participate in the study .
a total of 71 
 patients were enrolled for the study , 47 and 24 of whom were infected with p. vivax and 
 p. falciparum , respectively .
blood samples were collected by venipuncture from each 
 patient at the day of diagnosis ( d0 - in the acute phase ) and , after collection , all 
 patients were treated with the regimen recommended by the brazilian ministry of health 
 ( ms 2010 ) .
patients returned 15 days later ( d15 - in the convalescent stage ) for 
 follow - up examinations and paired blood samples were collected from 40 p. vivax and 15 
 p. falciparum infected patients .
all patients were symptomatic and had clinical symptoms 
 ranging from very mild illness to full - blown paroxysms , but there were no severe or 
 complicated malaria cases .
the patients were positive for either p. falciparum or p. 
 vivax parasites as determined by microscopy using thick and thin blood smears at d0 . 

asexual blood forms of p. falciparum or p. vivax were cleared from the peripheral blood 
 of all patients included in the study following therapy and no parasite reappearance was 
 observed during follow - up .
the control group ( n = 12 ) was composed of apparently healthy 
 individuals who lived in the same area , but were negative for malaria parasites as 
 determined thick blood smear and had not reported any malaria episodes for at least one 
 year .
ethical approval for the study was granted by the oswaldo cruz foundation ethical 
 committee and by the national ethical committee of brazil and informed consent was given 
 by the patients . 

laboratory tests - thick and thin blood films were stained with giemsa 
 and the plasmodium species were identified and parasitaemia was determined by 
 microscopic examination at d0 and d15 .
parasitaemia levels were estimated by counting 
 the number of parasites ( all species and stages ) per 200 white blood cells ( wbc ) on 
 blood films .
if fewer than nine parasites were detected , 300 additional leucocytes were 
 counted to obtain more precise results .
complete blood cell counts , including 
 haematologic indices , were performed at d0 and d15 using an automatic haematology 
 analyser ( pentra abx ) and peripheral blood smears were performed for routine 
 differential blood cellular quantification .
the cell counters provided data on wbc 
 counts and red blood cell ( rbc ) counts , haemoglobin ( hb ) levels , haematocrit and 
 reticulocyte , platelet , lymphocyte , eosinophil , segmented neutrophil , band cell , 
 monocyte and basophil counts .
the 
 patients were considered anaemic when their hb levels were  13 g / dl blood in males and 
  12 g / dl of blood in females .
multiplex microsphere cytokine immunoassay - the levels of 16 cytokines 
 and chemokines were detected in plasma samples using luminex technology ( luminex 
 corporation , austin , tx , usa ) .
thirteen cytokines [ il-1 , il-2 , il-4 , il-5 , il-6 , il7 , 
 il-10 , il-12 p70 , il-17 , ifn- , tnf- , g - csf , granulocyte - macrophage colony - stimulating 
 factor ( gm - csf ) ] and three chemokines ( il-8 , mcp-1 and mip-1 ) were analysed using a 
 bioplex - kit assay ( bio - rad laboratories , hercules , ca , usa ) .
the assay was performed 
 according to the manufacturer s instructions using a bioplex - kit in combination with the 
 luminex system .
briefly , 50 l of standard or test sample along with 50 l of mixed 
 beads were added into the wells of a pre - wetted 96-well microtitre plate .
after 1  h of 
 incubation and washing , 25 l of detection antibody mixture was added and the samples 
 were incubated for 30c min and then washed .
finally , 50 l of streptavidin - pe was added 
 and after 10c min of incubation and washing , the beads were resuspended in 125 l assay 
 buffer and analysed using a bioplex suspension array system ( bio - rad laboratories ) and 
 the bio - plex manager software ( v.3.0 ) .
a curve fit was applied to each standard curve according to the manufacturer s manual 
 and sample concentrations were interpolated from the standard curves .
the limit of 
 cytokine detection using this method was 2 pg / ml for all cytokines and chemokines .
the 
 median cytokine and chemokine levels in 12 healthy controls were 2 pg / ml for il-1 , 
 il-2 , il-4 , il-5 , il-6 , il-7 , il-10 , il-12 p70 , il-10 and gm - csf , 15.53 pg / ml for ifn- , 
 12.58 ml for tnf- , 4.3 pg / ml for gcs - f , 495 pg / ml for mcp-1 and 594.5 pg / ml for 
 mip-1. 
 statistical analysis - survey data were recorded and entered into a 
 database created with epi info 2007 ( centers for disease control and prevention , 
 atlanta , ga , usa ) .
analyses were performed using predictive analytics software v.17.0 
 ( spss inc , chicago , il , usa ) and prism v.5 ( graphpad software inc , san diego , ca , usa ) . 

differences in median haematological parameters and cytokine levels were expressed as 
 medians and interquartile ranges ( ir ) and compared using bonferroni s multiple 
 comparison test .
when this test indicated a significant difference ( p < 0.05 ) among 
 pairwise groups , a mann - whitney u test was used . to evaluate the significant differences 
 in haematological and cytokine parameters between the acute and convalescent phases from 
 the same patient ,
finally , the correlations between 
 parasitaemia , blood cells and cytokine levels were calculated using spearman s rank 
 correlation coefficient and p < 0.05 were considered statistically significant .

 study subjects - seventy - one patients infected with malaria were 
 enrolled in the study .
there were no differences 
 in mean age , time of residence in the endemic area and number of past malaria episodes 
 between p. vivax ( n = 47 ) and p. falciparum ( n = 24 ) infected patients . all patients 
 presented general clinical symptoms such as history of fever and headache at the time of 
 enrolment independent of plasmodium species .
the time elapsed between the appearance of 
 the first symptoms and malaria diagnosis was similar between patients with p. vivax ( 3 
 days ) and p. falciparum ( 3.5 days ) . although the mean parasitaemia was higher in p. 
 falciparum - infected individuals than p. vivax - infected individuals , this difference was 
 not statistically significant .
all patients were parasitaemia - negative by day 15 of 
 follow up after receiving effective drug treatment .
the characteristics of the 
 participants are presented in table i. 
 table iepidemiological and parasitological data of plasmodium vivax and plasmodium 
 falciparum infected - patients 
 p. vivax p. falciparum 
  ( n = 47 ) ( n = 24)male [ n ( % ) ] 35 ( 74.5)19 ( 79.2)age [ n ( % ) ] 28 ( 22 - 38)28.5 ( 23 - 41)years of residence in malaria endemic area [ n 
 ( % ) ] 24 ( 21 - 36)27 ( 19 - 38)years of residence in the state of rondnia [ n 
 ( % ) ] 23 ( 16 - 28)23 ( 16 - 28)total number of past malaria episodes [ n 
 ( % ) ] 3 ( 1 - 8)3.5 ( 1 - 10)months since last malaria episodes [ n ( % ) ] 10 ( 2.2 - 24)12.5 ( 2 - 102)parasitaemia ( number of parasites/l)2,293 ( 874 - 17,933)1,328 ( 793 - 12,623)days since the symptoms began [ n ( % ) ] 3 ( 1 - 8)3.5 ( 1.5 - 10)symptoms
[ n ( % ) ] fever39/8322/92chills32/6820/83headache39/8321/87vomiting23/4920/83myalgia31/6621/87the values on table indicate median ( interquartile range ) .
frequency of 
 symptoms and gender were compared between p. vivax and p. falciparum 
 infected - patients by chi - squared test .
mann - whitney u test were used to 
 compare parasitaemia , days since the symptoms began , time since the last 
 malaria infection , number of previously malaria episodes and time in malaria 
 endemic area .
there were not statistical differences on epidemiological , 
 clinical and parasitological data between patients infected by p. falciparum 
 and p. vivax . 
 
frequency of 
 symptoms and gender were compared between p. vivax and p. falciparum 
 infected - patients by chi - squared test .
mann - whitney u test were used to 
 compare parasitaemia , days since the symptoms began , time since the last 
 malaria infection , number of previously malaria episodes and time in malaria 
 endemic area .
there were not statistical differences on epidemiological , 
 clinical and parasitological data between patients infected by p. falciparum 
 and p. vivax . 

haematological results - to investigate haematological changes during 
 malaria infection , differential haematological parameters during the acute and 
 convalescent phases , expressed as the median ( ir ) , are shown in table ii .
the median lymphocyte and platelet counts in p. falciparum 
 and p. vivax patients during acute disease were lower than in the control subjects and 
 returned to control reference levels during the convalescent stage .
in contrast , the 
 median band cell counts were elevated in both p. vivax and p. falciparum - infected 
 patients during the acute phase ( p = 0.0041 and p = 0.0001 , respectively ) and returned 
 to normal levels during the convalescent stage .
we also found that patients with acute 
 p. vivax infection had low eosinophil counts ( p = 0.013 , control values 153/l ) that 
 increased during the convalescent stage .
all other haematological values were similar 
 among p. falciparum - infected , p. vivax - infected and control subjects .
although no 
 differences in hb levels were observed between p. vivax and p. falciparum patients 
 during the acute phase , anaemia was detected in 29.2% of p. falciparum and in 55.3% of 
 p. vivax patients . however , these frequencies were not significantly different from 
 those of control subjects , 38.9% and they remained similar during the convalescent 
 phase , during which 60% of patients previously infected by p. vivax and
table iicomparison of haematological profiles of control group and patients 
 infected by plasmodium vivax and plasmodium falciparum on acute and 
 convalescent phase of infection 
 p. vivaxp .
falciparum 

 acute phaseconvalescent phaseacute phaseconvalescent phasecontrol(n = 47)(n = 40)(n = 24)(n = 15)(n = 12)erythrogramrbc ( x106/l)4.6 ( 4.3 - 5.1)4.3 ( 4 - 4.7)4.9 ( 4.5 - 5.4)4.9 ( 4.7 - 5.3)4.6 ( 4.2 - 5)haematocrit ( % ) 41 ( 38 - 45)39 ( 35.5 - 42)44 ( 39 - 45)39 ( 38 - 43)39 ( 38 - 43)haemoglobin ( g / dl)14 ( 12.5 - 15.5)12.6 ( 11.7 - 13.9)14.5 ( 13.9 - 15.2)13.8 ( 11.9 - 14)13.8 ( 13 - 15)reticulocyte ( % ) 0.5 ( 0.3 - 0.8)0.3 ( 0.25 - 0.5)0.35 ( 0.27 - 0.45)0.4 ( 0.3 - 0.55)0.35 ( 0.25 - 0.50)platelet ( x103/l)156 ( 105 - 182)a , b277 ( 234.5 - 342.5)135 ( 96.25 - 135)a , b261 ( 195 - 365)275 ( 231 - 315)leucogram ( /l)wbc5,100 ( 4,000 - 6,600)5,550 ( 5,125 - 7,000)4,650 ( 3,825 - 6,375)5,900 ( 5,000 - 7,300)6,400
( 5,650 - 7,550)lymphocyte1,020 ( 780 - 1,406)a , b2,062 ( 1,625 - 2,389)1,038 ( 571.5 - 1,536)a , b2,000 ( 1,770 - 2,920)2,250 ( 1,872 - 2,570)basophil0 ( 0 - 0)0 ( 0 - 0)0 ( 0 - 0)0 ( 0 - 0)0 ( 0 - 0)eosinophil67 ( 33 - 168)b , c288.5 ( 162.8 - 418.5)82 ( 34 - 255)288
( 108 - 629)153 ( 82.5 - 265.5)band cell63 ( 0 - 282)d0 ( 0 - 0)118 ( 36 - 369.5)d0 ( 0 - 0)0 ( 0 - 0)neutrophil3,468 ( 2,240 - 4,480)3,048 ( 2,377 - 3,558)3,432
( 2,060 - 4,212)2,911 ( 2,031 - 3,650)3,830 ( 3,075 - 4,654)monocyte360 ( 214.5 - 470.5)360 ( 214.5 - 470.5)350.5 ( 215 - 527.3)292 ( 216 - 426)351.5 ( 250.5 - 547.5)a : p <
0.001 between indicated infected group and control ; b : p < 
 0.0001 between acute and convalescent phase of indicated group ; c : p < 
 0.05 between indicated infected group and control ; d : p < 0.01 between 
 indicated infected group and control .
comparison between control group and patients 
 infected by p. vivax and infected by p. falciparum were evaluated by 
 bonferroni s multiple comparison test .
when the test indicated a significant 
 difference ( p < 0.05 ) between groups pairwise , mann - whitney u test were 
 used . to assess the significant differences in haematological parameters 
 between acute and convalescent phase from the same patient ,
no statistical differences were observed between 
 p. vivax and p. falciparum - infected patients on acute or convalescent phase . 
 acute phase : day of diagnosis ; convalescent phase : 15 days after diagnosis ; 
 rbc : red blood cell ; wbc : white blood cell . 
 
a : p < 0.001 between indicated infected group and control ; b : p < 
 0.0001 between acute and convalescent phase of indicated group ; c : p < 
 0.05 between indicated infected group and control ; d : p < 0.01 between 
 indicated infected group and control .
comparison between control group and patients 
 infected by p. vivax and infected by p. falciparum were evaluated by 
 bonferroni s multiple comparison test .
when the test indicated a significant 
 difference ( p < 0.05 ) between groups pairwise , mann - whitney u test were 
 used . to assess the significant differences in haematological parameters 
 between acute and convalescent phase from the same patient , non parametric 
 paired t tests were used .
no statistical differences were observed between 
 p. vivax and p. falciparum - infected patients on acute or convalescent phase . 
 acute phase : day of diagnosis ; convalescent phase : 15 days after diagnosis ; 
 rbc : red blood cell ; wbc : white blood cell . 
 circulating cytokine and chemokine levels during the acute and convalescent 
 phases of a malaria episode - the data in fig .
1 compare circulating cytokine and chemokine levels in patients infected 
 with p. vivax and p. falciparum .
first , the cytokines il-5 , il-7 and gm - csf were not 
 detectable in most plasma samples and no differences were observed in mcp-1 levels 
 compared with controls . during the acute phase , p. vivax and p. falciparum patients had 
 significantly higher il-6 , il-8 , il-17 , ifn- , tnf- , mip-1 and g - csf plasma 
 concentrations than controls . to investigate changes in cytokine levels during 
 infection , we compared cytokine levels in the sera from the same patient during the 
 acute and convalescent phases and plasma levels of il-6 , il-8 , il-17 , ifn- , tnf- 
 mip-1 and g - csf were higher during the convalescent phase .
although p. falciparum and 
 p. vivax malaria patients have similar cytokine profiles during infection , p. falciparum 
 patients presented higher levels of il-6 , il-8 , il-17 , ifn- , mip-1 and g - csf than p. 
 vivax patients during the convalescent phase .
in contrast , only p. vivax patients 
 presented higher levels of tnf- during the convalescent phase than during the acute 
 phase of infection .
il-10 levels were detected at high concentrations in the majority of 
 p. falciparum and p. vivax patients during the acute phase and returned to completely 
 normal levels during the convalescent phase .
the median il-10 concentration during the 
 acute phase was 1,175 pg / ml ( ir = 155 - 3,135 ) at d0 and 2 pg / ml ( ir = 2 - 2 ) at d15 and 
 1,187 pg / ml ( ir = 502.5 - 3049 ) at d0 and 2 pg / ml ( ir = 2 - 149.8 ) at d15 in p. vivax and p. 
 falciparum - infected patients , respectively . 

1 : comparison of serum cytokines and chemokines levels between control , 
 plasmodium vivax and plasmodium falciparum patients in acute and convalescent 
 phase of infection .
the control group was indicated by white bars , while acute 
 and convalescent phase of infection were indicated by light and dark gray bars , 
 respectively .
the boxes represent the values between 25 - 75% quartile and the 
 line indicates the median .
comparison between control group and patients infected by p. vivax and infected 
 by p. falciparum were evaluated by compared by bonferroni s multiple comparison 
 test .
when the test indicated a significant difference ( p < 0.05 ) between 
 groups pairwise , mann - whitney u test were used . to assess
the significant 
 differences between acute and convalescent phase in p. vivax and p. falciparum 
 infected - patients non parametric paired t tests were used .
g - csf : 
 granulocyte - colony stimulating factor ; ifn : interferon ; il : interleukin ; mip : 
 macrophage inflammatory protein ; tnf : tumour necrosis factor . 
  the levels of il-1 , il-4 and il-12 were similar to those of the controls during the 
 acute phase for both p. falciparum and p. vivax patients and were higher during the 
 convalescent phase , with the exception of il-12 , which was higher only in the p. 
 falciparum group .
the plasma il-2 concentration was determined only during the acute 
 phase in p. falciparum patients . although the median il-2 levels were higher during the 
 convalescent phase , these differences were not statistically significant . 
 relationship between parasitaemia and other variables - spearman s 
 correlation coefficient values and p values are shown in fig .
vivax patients , we found a statistically significant 
 negative correlation between platelet count and parasitaemia during the acute phase 
 ( fig .
the acute phase plasma il-10 
 concentration was positively correlated with parasitaemia in p. vivax ( fig .
the same was true for the tnf- 
 concentration in p. falciparum - infected patients ( fig . 

no relationship was found between parasitaemia and the other blood cell 
 counts or the concentration of others cytokines assayed ( data not shown ) . 

associations 
 between parasitaemia , blood cells and cytokines level were investigated by 
 spearman s rank correlation coefficient and p values < 0.05 were considered 
 statistically significant .
haematological changes , such as alterations in total and differential wbc counts , are 
 widely used to differentiate between several types of infections and to monitor the 
 course of diseases ( ventura et al .
malaria - induced changes in the differential 
 white cell counts are very diverse and contradictory and include leucopoenia , 
 lymphopaenia , lymphocytosis , the presence of atypical lymphocytes , monocytosis , 
 neutropaenia , neutrophilia , immature neutrophils ( band cells ) , eosinopaenia , 
 eosinophilia and leukemoid reactions ( wickramasinghe 
 & abdalla 2000 , price et al .
the findings of our study show that increased 
 band cells and low lymphocyte and eosinophil counts are common during acute p. 
 falciparum and p. vivax malaria .
the decreased lymphocyte levels during malaria 
 infection have been attributed to the reallocation of cells to deep lymphoid organs or 
 by parasite induced apoptosis of human mononuclear cells ( hviid et al .
fifteen days following treatment , when no parasites were detected in either p. 
 falciparum and p. vivax patients , the lymphocyte counts were similar to those in the 
 control subjects , indicating that this period of time was sufficient for the patients to 
 achieve lymphocyte homeostasis .
with respect to eosinopaenia during the acute phase , it 
 has been suggested that malaria either suppresses eosinophil production and release from 
 the bone marrow or enhances the peripheral removal of these cells ( davis et al .
the 
 increased eosinophil counts we observed post - treatment have been observed in previous 
 studies ( kurtzhals et al .
the 
 induction of eosinophils was attributed to various factors such as higher release of 
 eosinophils after temporary bone marrow suppression caused by plasmodium , a direct 
 response to the parasite or a response to antimalarial drugs .
the transitory increase in band cells that was observed in both infections indicates a 
 stronger stimulus for neutrophil production during the acute phase . in this case ,
early 
 or premature release of neutrophils from the bone marrow occurs , resulting in an 
 increased proportion of younger , less well - differentiated neutrophils into the 
 circulation .
though this alteration is common knowledge in other acute diseases , very 
 few studies evaluating these disturbances have been conducted for this cell type in 
 malaria patients ( hanscheid et al .
erythrogram abnormalities are also very common in malaria patients and the most 
 prominent alterations are anaemia and thrombocytopaenia ( collins et al .
, the absence of marked anaemia in malaria patients may be due to the early 
 diagnosis and prompt treatment , free of charge , provided by the malaria control program 
 in brazil .
although 
 some authors have described more intense thrombocytopaenia during acute falciparum 
 malaria compared to vivax malaria whereas others have described the opposite , no 
 difference in thrombocytopaenia was observed between these types of malaria in our study 
 ( ghosh 2007 , taylor et al .
however , we did observe a negative correlation between 
 platelet counts and parasitaemia during acute p. vivax infection only .
these 
 inconsistent relationships may reflect differences in epidemiology , the immune status of 
 malaria patients and many others factors ( casals - pascual 
 et al .
. 
 disseminated intravascular coagulation , immune mechanisms , dysmyelopoiesis and 
 hypersplenism are some examples of mechanisms that could be related to platelet 
 reduction in malaria patients ( patel et al .
2011 ) . the role of cytokine signalling during malaria episodes is still far from being 
 understood .
the most famous inflammatory marker of severe malaria is tnf- , which is 
 closely associated with fever , paroxysms , anaemia , ce- rebral malaria and many other 
 systemic infection symptoms ( karunaweera et al . 

2005 ) . in our study , 
 the cytokine and chemokine profiles in acute p. vivax and p.
the acute phase was characterised by the presence of pro - inflammatory cytokines 
 ( il-1 , il-2 , il-6 , il-17 , ifn- , tnf- ) , anti - inflammatory cytokines ( il-4 and il-10 ) , 
 chemokines ( il-8 , mip-1 ) and g - csf in most malaria patients . during the convalescent 
 phase ( d15 ) ,
the levels of all these cytokines increased compared with d0 , except for 
 il-10 levels , which were elevated only during the acute phase and were associated with 
 parasite density .
we and others have shown a marked il-10 response during symptomatic 
 uncomplicated p. vivax malaria infection and a significant positive correlation between 
 plasma il-10 levels and parasite density during p. vivax and p. falciparum infection . 

the discordant results regarding cytokine production during the convalescent phase in 
 our study suggests different regulatory mechanisms for early parasite clearance . whether 
 the differences in serum cytokine levels noted in our study are biologically significant 
 is also unclear .
it is tempting to speculate that the phagocytic cells are committed to 
 a more th1-biased phenotype during drug - induced clearance of parasitaemia and release of 
 parasite metabolites , such as haemozoin , which is a known inducer of pro - inflammatory 
 responses via signalling through toll - like receptors 9 ( coban et al . 2005 ) .
nonetheless , before the initiation of antimalarial 
 treatment , a notably high il-10 concentration that markedly decreased with the 
 resolution of parasitaemia was observed and this down regulation of the th2 response 
 discriminated the successfully treated malaria patients .
il-10 has a number of effects 
 and il-10 inhibited il-6 , ifn- and tnf- secretion and function in an in vitro malaria 
 model when anti - il-10 antibody was produced .
another plausible cause for the increase in 
 several cytokine levels between the acute and convalescent phases could be the 
 diminished suppressive effect by il-10 on other cytokines such as pro - inflammatory 
 cytokines , as well as a reduced systemic inflammatory response due to all haematological 
 alterations returning to references values . il-10 perturbations appear to have the most 
 significant inhibitory effect on other cytokine concentrations . in this endemic area ,
we 
 were unable to rule out concomitant intestinal parasite infections with organisms such 
 as helminths , which potentially influenced the results ( hartgers & yazdanbakhsh 2006 ) .
an association of il-10 levels with 
 parasitaemia has also been reported in plasmodium knowlesi and p. vivax infections . 

moreover , il-10 levels in both p. vivax and p. knowlesi patients were elevated , but were 
 not associated with markers of disease severity ( cox - singh et al .
in contrast , the ifn/il-10 ratio has been 
 successfully used as a marker for pathological inflammatory activity in p. vivax 
 patients with varying disease severity ( andrade et al . 

several studies report that il-10 has been implicated in malaria 
 pathophysiology ( dodoo et al .
, il-10 predominated in the 
 early anti - inflammatory response in p. falciparum and p. vivax - infected patients and 
 dropped drastically during the convalescent phase when malaria had been cured in all 
 patients . in conclusion ,
a complex array of cytokines is released in adult patients with 
 uncomplicated malaria infection with apparent feedback inhibition and cross - regulatory 
 functions .
il-10 appears to be involved during the acute phase of the disease and its 
 decrease correlates with recovery as biological and clinical malaria features disappear . 

further studies are required to determine whether these elevated il-10 levels play a 
 beneficial role by reducing the parasite - induced inflammatory response
. additionally , there are no reports of cytokine concentrations in humans 15 days after 
 the beginning of treatment ; therefore , the data presented here could for the first time 
 indicate a shift from a th1/th2 balanced response to a more pronounced th1-regulated 
 immune response during the first 15 days of uncomplicated malaria treatment in brazilian 
 endemic areas .
differences in epidemiology , nutritional status , demographic factors and 
 the presence of co - infections are factors that could be related to the ambiguous 
 findings of previous studies .
 haematological and cytokine alterations in malaria are a broad and controversial 
 subject in the literature . 
 however , few studies have simultaneously evaluated various 
 cytokines in a single patient group during the acute and convalescent phases of 
 infection . 
 the aim of this study was to sequentially characterise alterations in 
 haematological patters and circulating plasma cytokine and chemokine levels in 
 patients infected with plasmodium vivax or plasmodium falciparum from a brazilian 
 endemic area during the acute and convalescent phases of infection . during the acute 
 phase , thrombocytopaenia , eosinopaenia , lymphopaenia and an increased number of band 
 cells 
 were observed in the majority of the patients . during the convalescent phase 
 , 
 the haematologic parameters returned to normal . during the acute phase , 
 p. vivax and 
 p. falciparum patients had significantly higher interleukin ( il)-6 , il-8 , il-17 , 
 interferon- , tumour necrosis factor ( tnf)- , macrophage inflammatory protein-1 and 
 granulocyte - colony stimulating factor levels than controls and maintained high levels 
 during the convalescent phase . 
 il-10 was detected at high concentrations during the 
 acute phase , but returned to normal levels during the convalescent phase . 
 plasma 
 il-10 concentration was positively correlated with parasitaemia in p. vivax and p. 
 falciparum - infected patients . 
 the same was true for the tnf- concentration in p. 
 falciparum - infected patients . 
 finally , the haematological and cytokine profiles were 
 similar between uncomplicated p. falciparum and p. vivax infections . 