Biochemical And Ultrastructural Study

      526 Faculty of Tropical Medicine SKELETAL MUSCLE INVOLVEMENT IN FALCIPARUM MALARIA : BIOCHEMICAL AND ULTRASTRUCTURAL STUDY Timothy M.

E. Davis1, Emsri Pongponrat2, Wichai Supanaranond2, Sasithorn Pukrittayakamee2, Timothy Helliwell3, Paul Holloway4, and Nicholas J. White 1 1The Wellcome Unit and 2Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, 3 Nuffield Department of Clinical Medicine, and the Department of Biochemistry, John Radcliffe Hospital, Oxford and 4Department of Pathology, The University of Liverpool, Royal Liverpool Hospital, Liverpool, United Kingdom. Key words : falciparum malaria, skeletal muscle, biochemical, ultrastructural                    Biochemical evidence of skeletal muscle damage is common in malaria, but rhabdomyolysis appears to be rare.

To investigate the relationship between serum creatine kinase and myoglobin levels, muslce histology, and renal function in Plasmodium falciparum infections, we studied 13 patients with uncomplicated malaria, 13 with severe noncerebral malaria, and 10 with cerebral malaria. A muscle biopsy specimen was obtained from each patient for light microscopy and electron microscopy. Mean serum creatine kinase concentration + SD were raised but similar for the three groups (258 + 277, 149 + 158, and 203 + 197 U/L, respectively; P = .5).

The mean serum myoglobin level + SD was highest in cerebral and severe malaria, respectively; P r = .39 for 36 patients : P = .02). The number of intravascular parasites, proportion of mature forms, and glycogen depletion were highest in biopsy specimens from patients with cerebral malaria.

Myonecrosis was not observed. Muscle appears to be an important site for P. falciparum sequestration, which could contribute to metabolic and renal complications. (Published in Clinical Infectious Diseases 1999; 29:831-5.

This study was supported by the Wellcome-Mahidol -Oxford University Tropical Medicine Research Programme.)
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