TNF and malaria: Higher maximum CRP was associated with an increased risk of a peak ALT of ≥ 2.5 × ULN, suggesting that systemic inflammation likely contributes to the development of post-treatment LFT abnormalities in VISs, as previously postulated.39 Rodent malaria studies have suggested that TNF-α generated during malaria infection and free heme, produced following rapid hemolysis, act together to induce hepatocyte apoptosis and transaminase leakage.58–61 Testing for additional markers of hemolysis, free heme, and TNFα would also be worth undertaking in future studies.