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Plasma nitrogen oxides and blood lactate concentrations in Ghanaian children with malaria
T Agbenyega1, B Angus, G Bedu-Addo
1Department of Physiology, University of Science and Technology, School of Medical Sciences, Kumasi, Ghana.
Insights
In severe malaria, elevated plasma lactate indicates disease severity, while nitric oxide levels do not correlate with coma depth or fatal outcomes. Lactate, not nitric oxide, reflects malaria
Area of Science:
- Biochemistry
- Immunology
- Infectious Diseases
Background:
- Nitric oxide (NO) is a crucial molecule in host defense and pathophysiological processes.
- Severe malaria presents complex pathophysiological challenges.
- Understanding biomarkers for malaria severity is critical for patient management.
Purpose of the Study:
- To investigate the role of nitric oxide (NO) in severe malaria.
- To correlate plasma and cerebrospinal fluid (CSF) nitric oxide metabolites (nitrite and nitrate) with disease severity markers.
- To compare NO levels with plasma lactate concentrations in malaria patients.
Main Methods:
- Plasma nitrate and nitrite concentrations were measured in children with malaria and control subjects.
- Plasma and CSF lactate levels were assessed.
- Measurements were correlated with clinical outcomes, including coma depth and mortality.
- Statistical analyses included t-tests and correlation coefficients.
Main Results:
- Plasma lactate levels were significantly elevated in patients with deep coma and fatal outcomes.
- Mean plasma nitric oxide concentrations did not differ significantly between outcome groups and were not related to coma depth.
- CSF lactate was higher in fatal cases compared to survivors.
- Plasma nitric oxide concentrations showed a negative correlation with admission parasitemia (r = -0.41, P < 0.0001).
Conclusions:
- Elevated plasma lactate, but not plasma nitrite or nitrate, reflects disease severity in malaria.
- Nitric oxide levels do not appear to be a reliable indicator of disease severity or outcome in this pediatric malaria cohort.
- Further research may explore the complex role of NO in malaria pathogenesis.
Abstract:
Nitric oxide is an important host defence molecule as well as being a mediator in many pathophysiological processes. To investigate its role in severe malaria, we measured plasma nitrate and nitrite concentrations in 70 children with malaria (54 with severe malaria) and 48 control subjects (33 with medical conditions and 15 surgical patients). We related these measurements to plasma lactate concentrations, an established marker of disease severity in malaria. Plasma lactate levels were significantly elevated in patients with deep coma (P = 0.0007) and those with a fatal outcome, but mean nitrogen oxide concentrations were not significantly different in the 2 outcome categories and were not related 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 microM in fatal cases compared with 12.5 microM 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, elevations of plasma lactate, but not nitrite or nitrate, reflected disease severity in malaria.