Serum Vitamin A and E Concentrations in Acute Falciparum Malaria: Modulators or Markers of Severity?

Abstract

1. To assess the association between vitamin A, vitamin E and the clinical course of severe malaria, serial morning blood samples were taken from 24 Vietnamese patients, aged 18-62 years, receiving intensive treatment for complicated Plasmodium falciparum infections. A single fasting blood sample was also taken from 10 control subjects aged 22-45 years. Serum retinol, carotene and vitamin E concentrations were measured by h.p.l.c. 2. Admission serum retinol concentration was depressed relative to that of the control subjects (0.69 +/- 0.35 versus 1.86 +/- 0.41 mumol/l mean +/- SD, P < 0.001) and correlated inversely with indices of hepatic function, but positively with the simultaneous serum creatinine concentration (P < 0.05). During the first week of treatment, serum retinol concentration increased in parallel with improving liver function, whereas serum creatinine concentration remained elevated in the majority of patients. Serum alpha- and beta-carotene concentrations remained depressed throughout. 3. Serum vitamin E concentration, corrected for total serum cholesterol concentration in the form of a ratio, was also depressed at presentation (3.1 +/- 1.8 x 10(3) versus 4.2 +/- 0.8 x 10(3) in control subjects; P < 0.05), but tended to be higher than the control value at the time of discharge (0.1 > P > 0.05); there was a significant correlation between admission ratio and parasite clearance time (P = 0.04). 4. On the basis of this and previous studies, vitamin A replacement could be considered in selected severely ill patients without renal impairment. As found previously in animal models, depressed vitamin E levels may have a beneficial effect on the course of malarial infection.

Studies on biochemical changes with special reference to oxidant and antioxidants in malaria patients

“…The dwindle observed in vitamin E might be due to; i) its transfer to red blood cell membrane to counteract the increased oxidative stress during acute phase of disease by inhibiting membrane lipid peroxidation, ii) its increased utilization as plasma antioxidant and iii) the impaired release of vitamin E may occur during acute phase of disease (23). The fall in vitamin E level failed to control platelet aggregation, as vitamin E is known to restrain platelet aggregation (24).…”

Comparative study on lipid peroxidation and antioxidant vitamins E and C inFalciparum andVivax malaria

“…The impaired release of antioxidant Vitamin E may also occur during acute phase of disease (23). Vitamin E accounts for most of the chain breaking antioxidant activity in the erythrocyte membrane.…”

Prise en charge du paludisme pédiatrique: rôle des interventions nutritionnelles

“…Certaines études ont suivi le taux plasmatique de vitamine E chez des patients atteints de paludisme se présentant à un hôpital. Ces études ont montré que les patients qui présentaient une concentration sérique faible de vitamine E récupéraient plus rapidement des accès palustres que leurs témoins respectifs [148,149] .…”

“…Davis et coll. [148] ont observé une corrélation négative entre l' ␣ -tocophérol plasmatique et des indices biochimiques de la fonction hépatique chez des patients atteints de paludisme sévère, suggérant une libé-ration alterée de la vitamine E par le foie au cours d'un accès palustre.…”