Thiamine deficiency and malaria in adults from southeast Asia.
BACKGROUND
Thiamine deficiency (beriberi) is common in some parts of southeast Asia. Acute thiamine deficiency can mimic many complications of malaria, such as encephalopathy and lactic acidosis. We examined the incidence of thiamine deficiency in adults admitted to hospital with malaria in Thailand.


METHODS
For this prospective study, we recruited consecutive patients with malaria or other febrile illness who presented to Paholpolpayuhasena Hospital, Kanchanaburi, Thailand, between May and July, 1992. We used the activation coefficient (alpha) for transketolase activity in erythrocytes to measure thiamine deficiency (defined as alpha>1.31) in patients with severe and uncomplicated malaria and in controls (patients' relatives and healthy volunteers). To exclude the possibility of interference in the assays, transketolase activity was also measured in erythrocytes used to culture parasites.


RESULTS
12 (52%) of 23 patients with severe malaria and ten (19%) of 54 patients with uncomplicated malaria had alpha values above the normal range (p<0.0001 and p=0.0014, respectively, compared with controls), which indicated severe thiamine deficiency. Thiamine deficiency was more severe in patients with cerebral malaria than in those with uncomplicated malaria and the controls (p=0.008).


CONCLUSIONS
In adults admitted to hospital in Thailand, thiamine deficiency commonly complicates acute falciparum malaria, particularly in severe infections, and could contribute to dysfunction of the central nervous system.
Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
S
S
Krishna
A M
AM
Taylor
W
W
Supanaranond
S
S
Pukrittayakamee
F
F
ter Kuile
K M
KM
Tawfiq
P A
PA
Holloway
N J
NJ
White
D000140:Acidosis, Lactic / Q000209:etiology; D000328:Adult; D016022:Case-Control Studies; D004912:Erythrocytes / Q000201:enzymology / Q000469:parasitology; D005260:Female; D006801:Humans; D015994:Incidence; D016779:Malaria, Cerebral / Q000150:complications / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology*; D008297:Male; D011446:Prospective Studies; D013785:Thailand / Q000453:epidemiology; D013832:Thiamine Deficiency / Q000150:complications / Q000453:epidemiology*; D014174:Transketolase / Q000097:blood
D014174:Transketolase