NITRIC OXIDES IN PLASMA, URINE, AND CEREBROSPINAL-FLUID IN PATIENTS WITH SEVERE FALCIPARUM-MALARIA

It has been suggested that nitric oxide (NO) plays an important role i n the pathogenesis of severe falciparum malaria. Since NO has a very s hea half-life, nitrate and nitrite (NOx) levels, stable metabolites of NO, are used as measures of NO production. We measured plasma NOx lev els in 24 adults with severe falciparum malaria on the Thai-Burmese bo rder. After correction for renal function, there was no correlation be tween plasma NOx levels, or the total amount of NOx excreted in the ur ine, and disease severity. Plasma NOx levels decreased after the first 48 hr in all patients (P = 0.007), suggesting decreased NO production . The NOx levels in cerebrospinal fluid (CSF) correlated well with pla sma NOx levels, but these did not show a correlation with coma depth, and were not significantly different from those in a healthy control g roup. These findings do not support the hypothesis that excessive NO p roduction contributes to the pathogenesis of severe falciparum malaria . However, local changes in NO production, e.g., in the central nervou s system, might not be reflected in the total NOx production or NOx le vels in the CSF.