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Background  Hyperlactataemia is often associated with a poor outcome in severe malaria in African children. To unravel the complex pathophysiology of this condition the relationship between plasma lactate levels, parasite density, pro- and anti-inflammatory cytokines, and haemozoin-containing leucocytes was studied in children with severe falciparum malarial anaemia.    Methods  Twenty-six children with a primary diagnosis of severe malarial anaemia with any asexual  Plasmodium falciparum  parasite density and Hb < 5 g/dL were studied and the association of plasma lactate levels and haemozoin-containing leucocytes, parasite density, pro- and anti-inflammatory cytokines was measured. The same associations were measured in non-severe malaria controls (N = 60).    Results  Parasite density was associated with lactate levels on admission ( r  = 0.56,  P  < 0.005). Moreover, haemozoin-containing neutrophils and IL-12 were strongly associated with plasma lactate levels, independently of parasite density ( r  = 0.60,  P  = 0.003 and  r  = -0.46,  P  = 0.02, respectively). These associations were not found in controls with uncomplicated malarial anaemia.    Conclusion  These data suggest that blood stage parasites, haemozoin and low levels of IL-12 may be associated with the development of hyperlactataemia in severe malarial anaemia.

Lactate levels in severe malarial anaemia are associated with haemozoin-containing neutrophils and low levels of IL-12