IMMUNOLOGICAL AND BIOCHEMICAL-ALTERATIONS IN SEVERE FALCIPARUM-MALARIA - RELATION TO NEUROLOGICAL SYMPTOMS AND OUTCOME

The relation between the immune response and the clinical features of severe falciparum malaria was studied in Burundian adults with (n = 31 ) and without (n = 17) cerebral involvement. At the time of admission, mean values for age, temperature, and blood levels of hemoglobin, cre atinine, bilirubin, and glucose were similar in the two groups. Plasma levels of tumor necrosis factor alpha, interferon gamma, interleukin 10 (IL-10), and soluble intercellular adhesion molecule 1 were similar ly elevated in the two groups. Mean parasite counts and mean plasma le vels of soluble E-selectin were higher in severe noncerebral malaria t han in cerebral malaria and were correlated with each other. After adj ustment for parasitemia, levels of soluble E-selectin remained higher in noncerebral malaria. All seven patients who died had cerebral disea se. These patients had higher levers of creatinine, bilirubin, IL-10, and soluble E-selectin than did patients with nonfatal cerebral malari a. After adjustment for creatinine and bilirubin levels, IL-10 and sol uble E-selectin concentrations were similar in fatal and nonfatal case s of cerebral infection. In these African adults, none of the immunolo gic variables investigated was specific to cerebral malaria or to a fa tal outcome.