PLASMA NITROGEN-OXIDES AND BLOOD LACTATE CONCENTRATIONS IN GHANAIAN CHILDREN WITH MALARIA

Nitric oxide is an important host defence molecule as well as being a mediator in many: pathophysiological processes, To investigate its rol e in severe malaria, we measured plasma nitrate and nitrite concentrat ions in 70 children with malaria (54 with severe malaria) and 48 contr ol subjects (33 with medical conditions and 15 surgical patients). We related these measurements to plasma lactate concentrations, an establ ished marker of disease severity in malaria. Plasma lactate levels wer e significantly elevated in patients with deep coma (P=0.0007) and tho se with a fatal outcome,but mean nitrogen oxide concentrations were no t significantly different in the 2 outcome categories and were not rel ated to depth of coma (P>0.5). In patients whose cerebrospinal fluid ( CSF) was examined, lactate concentrations were elevated in fatal cases (geometric mean 8.2 mmol/L, n=5) compared with survivors (3.4 mmol/L, n=13; P=0.032); corresponding CSF nitrogen oxide concentrations were 10.7 mu M in fatal cases compared with 12.5 mu M in survivors (P=0.5). Plasma nitrogen oxide concentrations were negatively correlated with admission parasitaemia (r=-0.41, n=70; P<0.0001). In our population, e levations of plasma lactate, but not nitrite or nitrate, reflected dis ease severity in malaria.