Send to

Choose Destination
Lancet. 1999 Feb 13;353(9152):546-9.

Thiamine deficiency and malaria in adults from southeast Asia.

Author information

Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.



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.


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.


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).


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.


Beriberi or thiamine deficiency is common in countries where malaria is endemic. The hypotheses that subclinical thiamine deficiency complicates malaria and may be associated with lactic acidosis and coma were investigated in a prospective study conducted in Kanchanaburi, Thailand. 77 consecutive patients who presented to Paholpolpayuhasena Hospital between May and July 1992 with malaria or other febrile illnesses and 50 healthy relatives and volunteers were enrolled. The activation coefficient for transketolase activity in erythrocytes was used to measure thiamine deficiency. The mean Box-Cox transformed coefficients were 0.166 among cases with severe malaria (n = 23), 0.145 in cases with uncomplicated malaria (n = 54), 0.138 in healthy volunteers (n = 27), 0.137 in febrile controls (n = 10), and 0.122 in healthy relatives of patients (n = 13). 12 patients (52%) with severe malaria and 10 (19%) of those with uncomplicated malaria had coefficients above the normal range. Thiamine deficiency occurred in significantly more patients with cerebral malaria than in those with uncomplicated malaria (odds ratio, 4.8; 95% confidence interval, 1.68-13.8). The 12 patients who died from severe malaria had higher coefficient values than the 115 patients and controls who survived. Finally, the 15 patients with lactic acidosis had significantly higher coefficient values than those without this complication. A study of thiamine administration to patients with cerebral malaria is recommended to allow distinctions between the findings recorded in this study and the possibility of a causal link.

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center