Interferon-γ and Interleukin-10 Profiles Correlate with Disease Severity in Sudanese Children with Plasmodium falciparum Malaria.

Background/Objectives: Severe Plasmodium falciparum malaria remains a leading cause of childhood morbidity and mortality in sub-Saharan Africa. The clinical outcome is largely driven by the balance between pro-inflammatory and anti-inflammatory cytokines. However, immunological data from Sudanese children remain limited and the diagnostic utility of cytokine biomarkers has not been formally evaluated in this population. Therefore, this study aims to compare plasma levels of IFN-γ and IL-10 among Sudanese children with severe malaria (SM), uncomplicated malaria (UM) and healthy controls (HC) and to evaluate their diagnostic accuracy using in differentiating SM from UM cases. Methods: A hospital-based case-control study was conducted at Mohamed Elamin Hamid Pediatric Hospital, Omdurman, Sudan. The study enrolled 105 children (aged 3 months to 16 years) divided into three age- and sex-matched groups (n = 35 per group): SM, UM and HC. Plasma cytokines IFN-γ and IL-10 were measured by ELISA. Results: The anthropometric measurements did not differ significantly across the groups. SM was significantly associated with lower hemoglobin and markedly reduced platelet counts. Both IFN-γ and IL-10 were significantly elevated in SM versus UM and HC (p < 0.001). A strong positive correlation was observed between IFN-γ and IL-10 (rho = 0.688, p < 0.001) in malaria patients. Additionally, a significant correlation was observed between IL-10 and platelet count (rho = -0.338, p = 0.009). Both IL-10 (AUC = 0.0.720) and IFN-γ (AUC = 0.687) demonstrated moderate diagnostic performance in discriminating between SM vs. UM. Conclusions: Elevated levels of IFN-γ and IL-10 strongly associated with severe P. falciparum malaria in Sudanese children. Measuring IL-10 and IFN-γ at the time of presentation may differentiate between SM and UM cases. Further studies are needed.