ASSOCIATION BETWEEN SERUM LEVELS OF REACTIVE NITROGEN INTERMEDIATES AND COMA IN CHILDREN WITH CEREBRAL MALARIA IN PAPUA-NEW-GUINEA

Serum levels of reactive nitrogen intermediates (RNI; nitrate plus nit rite) were measured in 92 patients with cerebral malaria in the Madang Province of Papua New Guinea. RNI levels were compared to disease sev erity and clinical outcome, and correlated with both the depth of coma on admission and its duration. Median levels were higher among childr en with deeper coma than among those with lighter coma (35.6 mu M vs. 16.7 mu M; P=0.008) and also among children with longer duration of co ma (72 h; 59.3 mu M vs. 19.3 mu M; P=0.004). RNI levels also correlate d with clinical outcome, fatal cases having significantly higher RNI l evels than survivors (41.2 mu M vs. 18.5 mu M; P=0.014). Thus, high RN I levels are associated with indices of disease severity and may predi ct outcome in children with cerebral malaria. These data are consisten t with the hypothesis that nitric oxide is involved in the pathogenesi s of coma in human cerebral malaria.