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Heme oxygenase (HO) is thought to be induced in severe malaria, but the pathophysiologic consequences have not been examined. It is induced by hemolysis, oxidative stress, and inflammation. It degrades heme, producing carbon monoxide (CO), which causes elevated levels of carboxyhemoglobin (COHb). In a prospective study of 1,520 children admitted to a Kenyan district hospital, COHb levels were no higher in children with malaria than with other infections. The COHb levels in children with severe malarial anemia were higher than in other children with malaria, but significantly lower than in children with other causes of severe anemia such as sickle cell disease. Levels of COHb were not significantly higher in children with cerebral malaria or in those dying of malaria. These results do not support a systemic increase in HO activity in malaria compared with other infectious diseases, but the roles of HO and CO in malaria require further study.
Received February 16, 2004. Accepted for publication March 3, 2004.
Acknowledgments: We thank the Medical Officer of Health, the Medical Superintendent, the staff of Kilifi District Hospital, and N. Peshu (Director of the centre) for their support. This paper is published with the permission of the director of the Kenya Medical Research Institute.
Financial support: This study was supported by the Kenya Medical Research Institute and the Wellcome Trust. C. R. J. C. Newton is a Wellcome Trust Senior clinical fellow (050533).
Authors addresses: Aubrey J. Cunnington, Department of Paediatrics, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, United Kingdom, E-mail: acunning{at}doctors.org.uk. Stuart F.W. Kendrick, Department of Medicine, University Hospital of North Durham, North Road, Durham, DH1 5TW, United Kingdom, E-mail: stuart.kendrick{at}doctors.org.uk. Betty Wamola, Department of Paediatrics, Whittington Hospital, Highgate Hill, London, N19 5NF, United Kingdom and Kenya Medical Research Institute, Centre for Geographic Medicine Research (Coast)/Wellcome Trust Research Unit, PO Box 230, Kilifi, Kenya, E-mail: bwamola{at}kilifi.mimcom.net. Brett Lowe, Kenya Medical Research Institute, Centre for Geographic Medicine Research (Coast)/Wellcome Trust Research Unit, PO Box 230, Kilifi, Kenya, E-mail: blowe{at}kilifi.mimcom.net. Charles R. J. C. Newton, Kenya Medical Research Institute, Centre for Geographic Medicine Research (Coast)/Wellcome Trust Research Unit, PO Box 230, Kilifi, Kenya and Neurosciences Unit, The Wolfson Centre, Mecklenburgh Square, London,WC1N 2AP, United Kingdom, E-mail: cnewton{at}kilifi.mimcom.net.
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