SERUM VITAMIN-A AND VITAMIN-E CONCENTRATIONS IN ACUTE FALCIPARUM-MALARIA - MODULATORS OR MARKERS OF SEVERITY

1. To assess the association between vitamin A, vitamin E and the clin ical course of severe malaria, serial morning blood samples were taken from 24 Vietnamese patients, aged 18-62 years, receiving intensive tr eatment for complicated Plasmodium falciparum infections. A single fas ting blood sample was also taken from 10 control subjects aged 22-45 y ears. Serum retinol, carotene and vitamin E concentrations were measur ed by h.p.I.c. 2. Admission serum retinol concentration was depressed relative to that of the control subjects (0.69 +/- 0.35 versus 1.86 +/ - 0.41 mu mol/l mean+/-SD, P < 0.001) and correlated inversely with in dices of hepatic function, but positively with the simultaneous serum creatinine concentration (P < 0.05). During the first week of treatmen t, serum retinol concentration increased in parallel with improving li ver function, whereas serum creatinine concentration remained elevated in the majority of patients. Serum alpha- and beta-carotene concentra tions remained depressed throughout. 3. Serum vitamin E concentration, corrected for total serum cholesterol concentration in the form of a ratio, was also depressed at presentation (3.1 +/- 1.8 x 10(3) versus 4.2 +/- 0.8 x 10(3) in control subjects; P < 0.05), but tended to be h igher than the control value at the time of discharge (0.1 > P > 0.05) ; there was a significant correlation between admission ratio and para site clearance time (P = 0.04). 4. On the basis of this and previous s tudies, vitamin A replacement could be considered in selected severely ill patients without renal impairment. As found previously in animal models, depressed vitamin E levels may have a beneficial effect on the course of malarial infection.