# Monitoring of deep lymphocyte phenotypes in the blood and bronchoalveolar lavage fluid of patients with severe malaria-associated acute respiratory distress syndrome

## TL;DR

This study tracks immune cell changes in blood and lung fluid of a severe malaria patient with respiratory failure, showing how immune profiles differ and evolve.

## Contribution

The study demonstrates the feasibility of multi-compartment immune monitoring in severe malaria-associated respiratory distress.

## Key findings

- Dynamic shifts in T cells and innate lymphoid cells were observed despite persistent lymphopenia.
- A type 2 immune profile dominated during the acute phase, with reduced exhausted T cells indicating recovery.
- Blood and bronchoalveolar lavage fluid showed significantly different immune profiles.

## Abstract

Restoring immune homeostasis after an acute insult is essential for achieving a full recovery from an acute respiratory distress syndrome episode. Immune monitoring tools that are not exclusive to the blood compartment are in great demand to help guide treatment decisions. In this longitudinal study, we report a case of severe malaria-associated acute respiratory distress syndrome supported by venovenous extracorporeal membrane oxygenation. Although there was persistent lymphopenia, we observed dynamic shifts in T cells and rare innate lymphoid cell populations. The type 2 immune profile was preponderant at the acute phase, and decreased exhausted T-cell populations indicated recovery. There were significantly different blood and bronchoalveolar lavage fluid profiles. Multiple-compartment immune monitoring is possible and valuable for precise immune modulation.