Tumor necrosis factor in falciparum malaria.

To investigate the relationship of TNFalpha levels to Plasmodium falciparum (PF) infection, plasma TFNalpha concentrations were measured in Pakistani adults and children with mind, severe, cerebral and chronic falciparum malaria and healthy (control) subjects. The initial geometric mean plasma concentrations of TFNalpha in adult patients with severe malaria (187.6 pg/mL) were significantly higher than mild malaria patients (87.1 pg/mL, P < 0.001). TNFalpha levels were not correlated to parasite density, cerebral malaria, young age, hypoglycemia or fatal outcome; however, they were associated with severe anemia, and hepatic and kidney dysfunction. TNFalpha levels were not significantly increased in 16 patients with hyperparasitemia and were significantly elevated (P < 0.02) in chronic malaria patients as compared to control subjects. TNFalpha levels were elevated independently in patients with anemia, hypoglycemia (P < 0.001, P < 0.05), and hepatic and kidney (P < 0.001 each) dysfuntion. In this study, high TNFalpha levels were associated with several manifestations of severe malaria and were not specific to cerebral malaria and hyperparasitemia.