[Pathophysiology of malaria. The current issue].

Patho-physiology of malaria is often presented with very old, rudimentary and not scientifically proved explanations. In fact, the mechanisms involved in malaria and mainly in cerebral malaria are very complex and, until now, partly unknown. Four hypotheses (sludging, modifications or blood-brain barrier permeability, mechanical or immunological phenomena) have to be considered. Several cytokines and mainly TNF seem to play the major role but other parameters are also essential in relation with Plasmodium (strain characteristics) or with the patient (HLA groups, immunological response). All technologies (immunology, iso-enzymology, molecular biology) bring new and important informations but, at the same time, make the issue ever more complex. Nevertheless, patho-physiology remains one of the most interesting aspects of malaria, both from a fundamental and a practical point of view, as fighting against this disease will probably become easier when we understand its mechanisms better.