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It has long been believed that paroxysms of malaria fever are due to a toxin released by rupturing schizonts. The nature of this toxin is beginning to be understood. A critical mediator of malaria fever is tumour necrosis factor (TNF), which is released by monocytes/macrophages and is a potent pyrogen. Rupturing schizonts release a toxin (or toxins) that stimulate macrophages to release TNF. The precise structure of the toxin is unknown but it appears to involve a phosphatidylinositol-like moiety. In addition to causing fever, TNF-inducing toxins are believed to be involved in the pathogenesis of cerebral malaria. However, cerebral malaria occurs in only a small proportion of infected individuals; for the population as a whole, the benefits of the TNF response to the malaria toxin probably outweigh its disadvantages.

Original publication




Journal article


Annals of tropical medicine and parasitology

Publication Date





613 - 616


Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, U.K.


Humans, Malaria, Cerebral, Malaria, Fever, Pyrogens, Tumor Necrosis Factor-alpha, Toxins, Biological