• Isabelle M Medana, Ralf-Björn Lindert, Ulrich Wurster, Tran Tinh Hien, Nicholas P J Day, Nguyen Hoan Phu, Mai Nguyen Thi Hoang NT, Ly Van Chuong, Tran Thi Hong Chau, Gareth D H Turner, Jeremy J Farrar, and Nicholas J White.
• Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Academic block, Level 4, John Radcliffe Hospital Headington, Oxford OX3 9DU, UK. isabelle.medana@ndcls.ox.ac.uk
• Trans. R. Soc. Trop. Med. Hyg. 2005 Aug 1; 99 (8): 610-7.

AbstractA retrospective study of cerebrospinal fluid (CSF) markers of brain parenchymal damage was conducted in Vietnamese adults with severe malaria. Three markers were analysed by immunoassays: the microtubule-associated protein tau, for degenerated axons; neuron-specific enolase (NSE), for neurons; and S100B for astrocytes. The mean concentration of tau proteins in the CSF was significantly raised in patients with severe malaria compared with controls (P=0.0003) as reported for other central nervous system diseases. By contrast, the mean concentration of NSE and S100B remained within the normal range. Tau levels were associated with duration of coma (P=0.004) and S100B was associated with convulsions (P=0.006). Concentrations of axonal and astrocyte degeneration markers also were associated with vital organ dysfunction. No association was found between the level of markers of brain parenchymal damage on admission and a fatal outcome. On admission to hospital, patients with severe malaria had biochemical evidence of brain parenchymal damage predominantly affecting axons.

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