Increased gastrointestinal permeability in patients with Plasmodium falciparum malaria

Sequential gastrointestinal permeability in patients with Plasmodium falciparum malaria was determined by measuring the permeation of sucrose, lactulose, and mannitol to assess both gastric and small intestine permeability. Sucrose absorption (gastroduodenal permeability) was increased in patients with severe malaria (defined as either >5% parasitemia or a serum bilirubin level of >50 micromol/L) and became normal by day 2 following treatment. A similar proportion of patients with uncomplicated malaria had increased gastroduodenal permeability initially, which resolved by day 7 of treatment. During acute malarial illness, the lactulose: mannitol (L:M) ratio in urine was increased and was found to be higher in patients with severe malaria than in those with uncomplicated malaria and in controls, but this ratio reverted to normal during convalescence. At the time of admission, the L:M ratios in patients 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 uncomplicated malaria and in controls. We conclude that gastrointestinal permeability is increased during severe and uncomplicated falciparum malaria but reverts to normal during convalescence.