Endotoxaemia in complicated falciparum malaria

In a prospective hospital-based study, endotoxin was detected by amoebocyte limulus lysate test in the blood of 18 of 20 patients with complicated Plasmodium falciparum (16 with cerebral malaria, 2 with blackwater fever, one with acute malarial hepatitis and one with hepatorenal failure) and in all 5 patients with uncomplicated malaria tested, but in none of 5 healthy volunteers. There were 4 deaths among the 18 patients with complicated malaria and endotoxaemia. No correlation between endotoxaemia and presence of complications, clinical severity, or degree of parasitaemia was found. A concomitant bacterial infection could account for endotoxaemia in 11 of the 16 patients with cerebral malaria and endotoxaemia; in the other 5 patients with cerebral malaria, 4 with other complications, and 5 with uncomplicated malaria, endotoxin was detected in the blood without any evidence of bacterial infection.