INTRALEUKOCYTIC MALARIA PIGMENT AND CLINICAL SEVERITY OF MALARIA IN CHILDREN

Intraleucocytic malaria pigment has been suggested as a measure of dis ease severity in malaria. We have tested this hypothesis by studying 1 46 children aged 6 months to 14 years in 4 categories-cerebral malaria , mild malaria, asymptomatic malaria and 'no malaria'-in Ibadan, Niger ia, an area of intense malaria transmission in Africa. Children with c erebral malaria were studied at the university hospital, those with mi ld malaria at 2 primary health centres and the other 2 groups were stu died in a primary school. The proportion of pigment-containing neutrop hils showed a clear rise across the spectrum no malaria-asymptomatic m alaria-mild malaria-cerebral malaria (median values 2.0%, 6.5%, 9.0% a nd 27.0%, respectively; P<0.0001). The proportion of pigment-containin g monocytes did not differ significantly between the mild malaria, asy mptomatic malaria and no malaria groups but the cerebral malaria group had a higher median value than the other 3 groups. The ratio of pigme nt-containing neutrophils to pigment-containing monocytes showed the s ame trend across the groups of subjects as was observed with the numbe r of pigment-containing neutrophils. It is concluded that the pigment- containing neutrophil count is a simple marker of disease severity in childhood malaria in addition to the parasite count.