INCREASED GASTROINTESTINAL PERMEABILITY IN PATIENTS WITH PLASMODIUM-FALCIPARUM MALARIA

Sequential gastrointestinal permeability in patients with Plasmodium f alciparum malaria was determined by measuring the permeation of sucros e, lactulose, and mannitol to assess both gastric and small intestine permeability. Sucrose absorption (gastroduadenal permeability) was inc reased in patients with severe malaria (defined as either >5% parasite mia or a serum bilirubin level of >50 mu mol/L) and became normal by d ay 2 following treatment. A similar proportion of patients with uncomp licated malaria had increased gastroduadenal permeability initially, w hich resolved by day 7 of treatment. During acute malarial illness, th e lactulose: mannitol (L:M) ratio in urine was increased and was found to be higher in patients with severe malaria than in those with uncom plicated malaria and in controls, but this ratio reverted to normal du ring convalescence. At the time of admission, the L:M ratios in patien ts with uncomplicated malaria were increased but became normal by day 2 after treatment. Conversely, the duration of increased L:M ratios in patients with severe malaria was longer. By day 7, the L:M ratios in patients with severe malaria were higher than those in patients with u ncomplicated malaria and in controls. We conclude that gastrointestina l permeability is increased during severe and uncomplicated falciparum malaria but reverts to normal during convalescence.