TNFα*2 marks high risk of severe disease duringPlasmodium falciparummalaria and other infections in Sri Lankans

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Abstract
We have investigated the association between alleles of the genes for tumour necrosis factor‐alpha (TNF‐α) and TNF‐β and severity of disease during malarial (Plasmodium falciparum) and other infections in the Sri Lankan population. Patients were categorized as having either (i) uncomplicated malaria, (ii) severe and complicated malaria, or (iii) severe and complicated infection in which a diagnosis of malaria had been excluded. For all the patients, as well as for a group of matched healthy controls, TNF‐α and TNF‐β allelic types were identified using the polymerase chain reaction (PCR) and allele‐specific oligonucleotide probes and restriction enzyme digestion. The odds in favour of carrying the TNFα*2 allele, mainly of the heterozygous genotype (TNFα*1,*2), were two to three times greater among individuals with severe disease, of either malarial or other infectious origin, relative to healthy controls or to those with uncomplicated malarial infections. No significant risk was associated with either of the alleles of TNF‐β.