[Malaria tropica with activation of blood coagulation and detection of tumor necrosis factor (NF-alpha) in serum].
A 38-year-old patient with cerebral P. falciparum malaria was admitted 12 days after a short trip to Kenya. The serum level of tumor necrosis factor (TNF-alpha) was elevated (251 pg/ml). In contrast, Protein C (plasma activity 36.1%; antigen concentration 31.7%) and protein C inhibitor 1 (activity 0.55 U/ml) levels were decreased. This suggested a state of functional activation of the clotting system which was confirmed by elevated levels (4.8 ng/ml) of circulating thrombin-antithrombin-III-complexes (TAT). Protein S (total and free) and coagulation factor IX levels were within normal range. Under successful antiparasitic therapy, TNF-alpha as well as protein C and protein C inhibitor 1 levels returned to baseline within one week. In the context of other studies that demonstrate procoagulant effects of TNF-alpha, it is remarkable that in the case of complicated P. falciparum malaria, an elevated concentration of TNF-alpha can be paralleled by a decreased plasma level of protein C and an increase in TAT suggesting a procoagulant state.
Hemmer
C J
CJ
Bernhard-Nocht-Institut für Tropenmedizin, Klinische Abteilung, Hamburg.
Kern
P
P
Radtke
K P
KP
Egbring
R E
RE
Nawroth
P P
PP
Dietrich
M
M
D000328:Adult; D000818:Animals; D001708:Biopterins / Q000031:analogs & derivatives* / Q000097:blood; D001779:Blood Coagulation Factors / Q000378:metabolism; D001780:Blood Coagulation Tests; D001798:Blood Proteins / Q000378:metabolism*; D004660:Encephalitis / Q000276:immunology*; D006801:Humans; D008288:Malaria / Q000276:immunology*; D008297:Male; D019798:Neopterin; D010963:Plasmodium falciparum; D011486:Protein C / Q000378:metabolism*; D018046:Protein C Inhibitor; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D001779:Blood Coagulation Factors; D001798:Blood Proteins; D011486:Protein C; D018046:Protein C Inhibitor; D014409:Tumor Necrosis Factor-alpha; D001708:Biopterins; D019798:Neopterin
Malaria tropica mit Gerinnungsaktivierung und Nachweis von Tumornekrosefaktor (TNF-alpha) im serum.