title: [Malaria tropica with activation of blood coagulation and detection of tumor necrosis factor (NF-alpha) in serum].
abstract: 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.
authors.affiliation: Bernhard-Nocht-Institut für Tropenmedizin, Klinische Abteilung, Hamburg.
authors.forename: C J
authors.initials: CJ
authors.lastname: Hemmer
authors.forename: P
authors.initials: P
authors.lastname: Kern
authors.forename: K P
authors.initials: KP
authors.lastname: Radtke
authors.forename: R E
authors.initials: RE
authors.lastname: Egbring
authors.forename: P P
authors.initials: PP
authors.lastname: Nawroth
authors.forename: M
authors.initials: M
authors.lastname: Dietrich
mesh_terms: 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*
chemical_list: D001779:Blood Coagulation Factors; D001798:Blood Proteins; D011486:Protein C; D018046:Protein C Inhibitor; D014409:Tumor Necrosis Factor-alpha; D001708:Biopterins; D019798:Neopterin
vernacular_title: Malaria tropica mit Gerinnungsaktivierung und Nachweis von Tumornekrosefaktor (TNF-alpha) im serum.