Serum tumour necrosis factor in children suffering from Plasmodium falciparum infection in Kilifi District, Kenya.

Tumour necrosis factor-alpha (TNF alpha) levels were measured by bioassay and immunoassay in sera of children infected with Plasmodium falciparum and uninfected children in the same community in Kilifi District, Kenya. Seventy-one children, mean age 2.9 years (range 4 months-6.8 years), were enrolled; 34 children had severe malaria, 23 had mild (non-severe) malaria and 14 had no malaria. TNF alpha levels were significantly elevated in children with severe malaria compared with those with non-severe malaria and the uninfected group (P <0.001 and P <0.00001, respectively). The levels correlated directly with parasite densities (r = 0.54, P <0.002). Among the children with severe malaria, TNF alpha levels correlated directly with the degree of anaemia but inversely with age. High tumour necrosis factor levels were associated with manifestations of severe malaria infection but declined to normal levels after effective antimalarial treatment.