Endotoxin levels were measured in the blood and cerebrospinal fluid (CSF) of control individuals and 2 groups of patients with African sleeping sickness. Endotoxin levels were markedly elevated in the blood (infected groups mean endotoxin values 40·2 pg/ml and 53·8 pg/ml, compared to control 11·6 pg/ml, P < 0·0001 for both increases) and CSF (infected groups mean endotoxin values 45·8 pg/ml and 50·1 pg/ml compared to control 6·3 pg/ml, P < 0·0001 for both increases) of the patients. The levels were reduced 6 weeks following different drug treatments in the 2 groups (blood levels to mean 33·8·pg/ml and 28·5 pg/ml; CSF levels to 37·4 pg/ml and 27·0 pg/ml). The blood endotoxin values correlated with the CSF values before treatment (r = 0·74 and 0·57 for the 2 groups; P < 0·0001 for both) and after treatment (r = 0·57 and 0·56 for the 2 groups; P < 0·0001 for both). It is concluded that raised endotoxin equilibrates in the blood and CSF compartments, and may contribute significantly to the pathology of sleeping sickness.
