Thiamine deficiency and malaria in adults from southeast Asia

Background Thiamine deficiency (beriberi) is common in some parts of southe ast 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 Hospit al, Kanchanaburi, Thailand, between May and July, 1.992. We used the activa tion coefficient (a) for transketolase activity in erythrocytes to measure thiamine deficiency (defined as alpha>1.31) in patients with severe and unc omplicated malaria and in controls (patients' relatives and healthy volunte ers). To exclude the possibility of interference in the assays, transketola se activity was also measured in erythrocytes used to culture parasites. Findings 12 (52%) of 23 patients with severe malaria and ten (19%) of 54 pa tients with uncomplicated malaria had ct 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 con trols (p=0.008). Interpretation In adults admitted to hospital in Thailand, thiamine deficie ncy commonly complicates acute falciparum malaria, particularly in severe i nfections, and could contribute to dysfunction of the central nervous syste m.