Serum tumour necrosis factor in children suffering from plasmodium falciparum infection

Abstract

The involvement of tumour necrOSlS factor (TNF) In human malaria was investigated in children infected with P.lasmodium falciparum in Kilifi and in uninfected children in the same community. For these investigations, a total of 71 children aged between 4 months and 6.8 years with an average age of 2.9 years were enrolled. Fourteen of these children were uninfected, twenty three had non-severe malaria and thirty four had severe malaria. TNF levels were determined using both a cytotoxicity assay and an immunoassay (ELISA). Glucose levels were determined by Glucose oxidase method. Parasitaemia was determined from thin blood films stained by Giemsa stain. Formol-ether concentration method for stool was used for the examination of helminth ova and protozoan cysts. High TNF levels were.seen more frequently in severe malaria patients than in either non severe malaria or uninfected children (p<O.OOl and p<O.OOOOl ,. respectively). TNF levels increased directly with increasing Plasmodium falciparum parasite densities (r=O.54, p=O.002). However TNF levels were equally elevated in children with cerebral malaria and those with other signs of severe malaria. Children with hyperparasitaemia, anaemia and age <3 years had elevated TNF levels on univariate analysis. There was no correlation between the TNF levels and blood glucose of the 34 children suffering from severe Plasmodium falciparum infection. In 3 patients suffering from cerebral malaria TNF levels were reduced to normal after 3 days of treatment. In this study high TNF levels were associated with several manifestations of severe malaria, and the data also indicated that moderate TNF response to Plasmodium falciparum infection is not necessarily deleterious to the host.