PREDICTION OF ACCELERATED CURE IN PLASMODIUM-FALCIPARUM MALARIA BY THE ELEVATED CAPACITY OF TUMOR-NECROSIS-FACTOR PRODUCTION

Cytokine regulation was compared in three groups of Gabonese patients with Plasmodium falciparum malaria before and after therapy: adults wi th uncomplicated malaria, children with uncomplicated malaria, and chi ldren with severe malaria. Plasma levels of tumor necrosis factor (TNF ), interleukin-6 (IL-6), IL-8, TNF receptors (TNF R), and the TNF/TNF R ratios were significantly higher in severe malaria compared with unc omplicated malaria. High plasma levels of all immunoregulatory molecul es were associated with slow cure after therapy. In all patients, phyt ohemagglutinin-induced cytokine production was depressed on admission compared with convalescence. A significant difference was the higher T NF production capacity in patients with severe malaria on day 2 and da y 5 compared with that in patients with uncomplicated malaria. In cont rast to IL-6 and IL-8, a high TNF production capacity during the acute phase of malaria predicted a rapid clinical and parasitologic cure in the patients. These findings illustrate the dual role of TNF in the p rotection and pathology of malaria.