THE RATIO OF REACTIVE NITROGEN INTERMEDIATES TO TUMOR-NECROSIS-FACTORAND CLINICAL OUTCOME OF FALCIPARUM-MALARIA DISEASE

Serum levels of reactive nitrogen intermediates (RNI; nitrate+nitrite) , interferon gamma (IFN gamma) and tumour necrosis factor (TNF) were m easured in 177 Papua New Guinean children with different clinical mani festations of malaria. The groups investigated were asymptomatic paras itaemic, mild malaria, cerebral malaria survivors and cerebral malaria non-survivors. The levels of TNF were highest among the cases of cere bral malaria who died and lowest among the asymptomatic parasitaemic c hildren (mean log TNF levels 2 .83 pg/mL vs. 1.455 pg/mL; P=0.001). Si milarly, the levels of IFN gamma were highest among the cerebral and l owest among the asymptomatic patients (mean log TNF levels 0338 pg/mL vs 0.054 pg/mL; P <0.0001). RNI levels were high among both the asympt omatic parasitaemic group and those who died due to cerebral malaria ( mean log RNI levels 1.56 mu M vs. 1.412 mu M; P=0.18). The ratio of RN I to TNF, however, was significantly higher among the asymptomatic par asitaemic children and lowest among those who died due to cerebral mal aria (mean log (RNI:TNF) ratio 0.118 vs.-0.789; P<0.001). We concluded that the ratio of serum RNI to serum TNF is a more useful indicator o f outcome of falciparum malaria in this population than the absolute l evels of either alone.