title: Lactate levels in severe malarial anaemia are associated with haemozoin-containing neutrophils and low levels of IL-12.
abstract: BACKGROUND
  Hyperlactataemia is often associated with a poor outcome in severe malaria in African children. To unravel the complex pathophysiology of this condition the relationship between plasma lactate levels, parasite density, pro- and anti-inflammatory cytokines, and haemozoin-containing leucocytes was studied in children with severe falciparum malarial anaemia.
  
  
  METHODS
  Twenty-six children with a primary diagnosis of severe malarial anaemia with any asexual Plasmodium falciparum parasite density and Hb < 5 g/dL were studied and the association of plasma lactate levels and haemozoin-containing leucocytes, parasite density, pro- and anti-inflammatory cytokines was measured. The same associations were measured in non-severe malaria controls (N = 60).
  
  
  RESULTS
  Parasite density was associated with lactate levels on admission (r = 0.56, P < 0.005). Moreover, haemozoin-containing neutrophils and IL-12 were strongly associated with plasma lactate levels, independently of parasite density (r = 0.60, P = 0.003 and r = -0.46, P = 0.02, respectively). These associations were not found in controls with uncomplicated malarial anaemia.
  
  
  CONCLUSIONS
  These data suggest that blood stage parasites, haemozoin and low levels of IL-12 may be associated with the development of hyperlactataemia in severe malarial anaemia.
authors.affiliation: Nuffield Department of Clinical Laboratory Sciences and National Blood Service Oxford Centre, Oxford, OX3 9DU, UK. ccasals@mrc.gm <ccasals@mrc.gm>
authors.forename: Climent
authors.initials: C
authors.lastname: Casals-Pascual
authors.forename: Oscar
authors.initials: O
authors.lastname: Kai
authors.forename: Brett
authors.initials: B
authors.lastname: Lowe
authors.forename: Mike
authors.initials: M
authors.lastname: English
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Williams
authors.forename: Kathryn
authors.initials: K
authors.lastname: Maitland
authors.forename: Charles R C J
authors.initials: CR
authors.lastname: Newton
authors.forename: Norbert
authors.initials: N
authors.lastname: Peshu
authors.forename: David J
authors.initials: DJ
authors.lastname: Roberts
mesh_terms: D000740:Anemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology*; D002675:Child, Preschool; D005260:Female; D006420:Hemeproteins / Q000378:metabolism*; D006801:Humans; D007223:Infant; D018664:Interleukin-12 / Q000378:metabolism*; D007630:Kenya / Q000453:epidemiology; D019344:Lactic Acid / Q000097:blood*; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D008297:Male; D009504:Neutrophils / Q000378:metabolism*
chemical_list: D006420:Hemeproteins; D018664:Interleukin-12; D019344:Lactic Acid; C020753:hemozoin