title: Polymorphonuclear leucocyte elastase in Plasmodium falciparum malaria.
abstract: Sixty-one patients with falciparum malaria were studied prospectively to determine the plasma concentrations of the lysosomal proteinase, polymorphonuclear leucocyte elastase (PMN-elastase) and their relationship to disease severity. The patients were divided into 3 groups; severe (parasitaemia > 5%) or vital organ dysfunction (n = 23), moderate (parasitaemia 1%-5% without complications) (n = 15), and mild (parasitaemia < 1%) (n = 23). The mean plasma PMN-elastase level in 10 healthy Thai volunteers was 49.5 (SD = 21.6) ng/ml (range 33-65 ng/ml). Plasma PMN-elastase concentrations on admission were elevated (> 2 x SD above normal) in all patients with severe malaria and were above 100 ng/ml in 86.6% and 65% of the moderately severe and mild patients respectively. PMN-elastase levels during the first 3 hospital days were significantly higher in severe malaria compared with the other 2 groups (P = < 0.001-0.013). The levels decreased as the patients became afebrile and aparasitaemic. Admission plasma concentrations of PMN-elastase correlated directly with bilirubin (rs = 0.50, P < 0.001), serum glutamic oxalacetic transaminase (rs = 0.54, P0.001), parasite count (rs = 0.62, P < 0.001), blood urea nitrogen (rs = 0.54, P < 0.001) and inversely with antithrombin III activity (rs = 0.54, P < 0.001) and the platelet count (rs = 0.58, P < 0.001). Polymorphonuclear leucocyte activation may contribute to the pathogenesis of severe malaria.
authors.affiliation: Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand.
authors.forename: S
authors.initials: S
authors.lastname: Pukrittayakamee
authors.forename: R
authors.initials: R
authors.lastname: Clemens
authors.forename: C
authors.initials: C
authors.lastname: Pramoolsinsap
authors.forename: H E
authors.initials: HE
authors.lastname: Karges
authors.forename: S
authors.initials: S
authors.lastname: Vanijanonta
authors.forename: D
authors.initials: D
authors.lastname: Bunnag
authors.forename: N J
authors.initials: NJ
authors.lastname: White
mesh_terms: D058186:Acute Kidney Injury / Q000201:enzymology; D000293:Adolescent; D000328:Adult; D000368:Aged; D004211:Disseminated Intravascular Coagulation / Q000201:enzymology; D005260:Female; D006801:Humans; D007565:Jaundice / Q000201:enzymology; D019272:Leukocyte Elastase; D016779:Malaria, Cerebral / Q000201:enzymology; D016778:Malaria, Falciparum / Q000150:complications / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000201:enzymology*; D010196:Pancreatic Elastase / Q000097:blood*; D011446:Prospective Studies
chemical_list: D010196:Pancreatic Elastase; D019272:Leukocyte Elastase