ARE ANTICARDIOLIPIN ANTIBODIES RESPONSIBLE FOR SOME OF THE COMPLICATIONS OF SEVERE ACUTE PLASMODIUM-FALCIPARUM MALARIA

What were first called simply false-positive Wassermann reactions and then lupus anticoagulant are now known as antiphospholipid or anticard iolipin antibodies (ACA). These are known to cause a tendency to throm bosis and are frequently present in many neurological conditions and i nfections. The pathological significance of these antibodies in acute infections, if any, is unknown. We investigated the presence of these antibodies in Plasmodium falciparum malaria in an endemic area in Nata l/KwaZulu, and attempted to correlate the presence of this antibody wi th cerebral manifestations. Immunoglobulin G-anticardiolipin antibodie s measured by enzyme-linked immunosorbent assay occurred significantly more frequently in 62 patients with acute Plasmodium falciparum malar ia (33,9%) than in 37 control subjects (2,7%) (P < 0,0001). There was no significant difference in the mean parasite loads in those patients who were positive for ACA (1,75%) and those who were negative (1,59%) (P = 0,83). No correlation was found between parasite load and ACA le vels in the patient group, or between the number of cerebral manifesta tions in patients with and without the antibody. The frequency of sple nomegaly was not significantly different in patients with and without ACA (P = 0,06). We conclude that there is a high prevalence of ACA in acute falciparum malaria. The pathological significance of this antibo dy and its relationship to complications, especially cerebral ones, wa rrant greater attention and may improve the understanding of cerebral malaria and its management.