Malaria tropica mit Gerinnungsaktivierung und Nachweis von Tumornekrosefaktor (TNF-α) im Serum

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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-α) 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 thrombinantithrombin-III-complexes (TAT). Protein S (total and free) and coagulation factor IX levels were within normal range. Under successful antiparasitic therapy, TNF-α 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-α, it is remarkable that in the case of complicated P. falciparum malaria, an elevated concentration of TNF-α can be paralleled by a decreased plasma level of protein C and an increase in TAT suggesting a procoagulant state.