Nitric oxide (NO) has been nicknamed "murderer" and "mediator" because it has toxic and signaling properties. We review these two aspects of NO synthesis from the perspective of the clinical infectious disease specialist by considering the potential of NO as an endothelium-derived relaxing factor (EDRF) in inflammation and sepsis and its potential as an antimicrobial system. We deviate from observations in recent authoritative reviews and point to important speciesdifferences that make it unlikely that NO serves as an EDRF mediating inflammatory vasodilatation in humans or that NO synthesized by human phagocytes has an antimicrobial function. We propose that in humans, NO synthesis is more confined and compartmentalized than in certain other animal species, and therefore, unwelcome toxicity, vasodilatation, or disturbance of paracrine signaling mechanisms (i.e., modulation of phagocytic cell functions) are avoided during inflammation.Nitric oxide (NO) has received much attention over the last few years and was named molecule of the year in 1992 [1]. The recent scientific literature is replete with articles on the many aspects of biological and pathological processes involving NO (reviewed in [2][3][4]), suggesting at times that NO might be a jack-of-all-trades. Two aspects of the generation of NO are of particular interest to infectious disease specialists: (I) the potential role of NO as a cytotoxic molecule contributing to the antimicrobial armature of phagocytes and (2) the role of NO as a vasodilator of inflammation and mediator of septic shock. We outline our view on the role of NO in infectious processes in the human system. Our view deviates in some aspects from recent authoritative analyses [2-4] and takes into account evolutionary adaptations favorable to a utilization of this highly reactive and toxic molecule, nicknamed "murderer" [3], as a mediator.NO is produced in human and laboratory animals by NO synthases (NOS). NOS isoenzymes [5] have been categorized into inducible and constitutive isoforms (table I). However, it is apparent that activity of inducible NOS (iNOS) is also constitutively present in many tissues, and that a constitutively present activity of iNOS is further upregulated by enzymeinducing signals in these cell types [6][7][8]. It has also become clear that the expression and activity of the constitutive NOS (eNOS) are modulated as well [9].NO as Antimicrobial Product of Mononuclear Phagocytes NO derived in mononuclear phagocytes by a high-output iNOS from L-arginine has been proposed to have antibacterial,