To assess the relationship between severity of
malaria and progression of skeletal muscle damage during initial treatment, we studied 28 Thai adults with slide-positive
falciparum malaria. Six had uncomplicated
malaria (Group 1), 12 had severe non-
cerebral malaria (Group 2) and ten had
cerebral malaria (Group 3). There were no significant differences between baseline serum
creatine kinase (CK) levels in the three groups (P=0.071). There was no change in serum CK during the first 48 h of treatment in Group 1 cases. In Group 2 patients, the median peak serum CK was nine times that at baseline while in Group 3, serum CK peaked at a median concentration 20 times that at presentation. In Groups 2 and 3, the peak serum CK occurred at least 24 h after presentation in more than half the patients, and was independent of
intramuscular injections and convulsions during initial
therapy. These longitudinal data suggest that: (i) severe
falciparum malaria is associated with skeletal muscle damage that increases during initial
therapy especially in patients with
coma; (ii) the effect of other major treatment or
infection-specific factors that are associated with muscle damage does not diminish this relationship; and (iii)
cerebral malaria in combination with a high baseline and rising serum CK should pre-empt monitoring and management strategies aimed at preserving renal function including
renal dialysis.