Tumor necrosis factor and severe malaria

To investigate the relation of tumor necrosis factor-a (TNFa) to Plasmodiumfalciparum infec-tion, plasma TNFa concentrations were measured in Zairian children with severe malaria, mild malaria, or other illnesses. The initial geometric mean plasma concentration of TNFa among 61 children with P. falciparum infection, (71 pg/ml) was higher than the level in 26 severely ill, aparasitemic children (10 pg/ml; P <.(01). Among 29 parasitemic children, initial geometric mean TNFa levels decreased from 77 to 5 pg/ml (P <.001)at day 7. TNFa levels increased with parasite density and were associated with hyperparasitemia, severe anemia, hypoglycemia, and young age but not with cerebral malaria or fatal outcome. However, TNFa levels were elevated equally in children with cerebral malaria and with other signs of severe malaria. With multiple linear regression, TNFa levels were elevated independently in children with hyperparasitemia (P =.(01) and severe anemia (P =.04). In this study, high TNFa levels were associated with several manifestations of severe malaria and were not specific to cerebral malaria. Thmor necrosis factor-a (TNFa), a cytokine produced by monocytes/macrophages and T lymphocytes, is thought to play an important role in the host response to inflammation an