Differences in haematological parameters and haemoglobin phenotypes in symptomatic and asymptomatic subjects with Plasmodium falciparum infection in parts of Kaduna metropolis, Nigeria

Background: Plasmodium falciparum is the leading cause of malaria morbidity and mortality in Nigeria with varied symptoms and haematological consequences. The objective of this study is to assess the differences in haematological parameters and haemoglobin phenotypes in symptomatic P. falciparum infected and apparently healthy asymptomatic individuals in parts of Kaduna metropolis.Methodology: A total of 1000 subjects; 500 symptomatic and 500 apparently healthy subjects asymptomatic for malaria, were recruited from selected hospitals and National Blood Bank in Kaduna metropolis. Blood samples were collected for thick and thin film microscopy to determine malaria parasitaemia and parasite species identification respectively. Haematological parameters were determined using automated blood analyser (KX-21N, Sysmex, Japan) and haemoglobin phenotypes by alkaline cellulose acetate electrophoresis.Results: Of the 1000 subjects recruited, 347 (34.7%) were positive for P. falciparum on blood film, which included 226 (45.2%) of 500 symptomatic and 121 (24.2%) of 500 asymptomatic subjects (p<0.00001). Of the 347 P. falciparum infected subjects, 275 (79.3%) had HbAA, 61 (17.6%) had HbAS, 1 (0.3%) had HbAC, 8 (2.3%) had HbSS, and 2 (0.6%) had HbSSf phenotypes. One hundred and sixty-three (72.1%) of the 226 symptomatic subjects had HbAA while 112 (92.6%) of the 121 asymptomatic subjects had HbAA, which indicated a significantly higher frequency of asymptomatic malaria in subjects with HbAA (p<0.00001). Conversely, 53 (23.5%) of the 226 symptomatic subjects had HbAS while 8 (6.6%) of 121 asymptomatic subjects had HbAS, indicating a significantly higher frequency of symptomatic malaria in subjects with HbAS (p=0.000086). The frequency of parasitaemia > 3,000 parasites/μL of blood was 100% for HbSSf, 25% for HbSS, 8.2% for HbAS and 2.2% for HbAA, which showed significantly higher frequency in subjects with HbSS (X2=7.5989, p=0.0054) and HbAS (X2=3.9627, p=0.046519) compared to HbAA. In symptomatic subjects, only MCHC value was significantly higher in subjects with HbAS (33.21±2.430) compared to those with HbAA (32.09 ±2.315) (p=0.003), while all other haematological parameters were not significantly different (p>0.05). In asymptomatic subjects, none of the haematological parameters was significantly different between subjects with HbAS and HbAA (p>0.05).Conclusion: Although the frequency of P. falciparum infection in this study is generally higher in subjects with HbAA, symptomatic infection and higher parasite density are associated with HbAS, HbSS and HbSSf. Effective utilisation of personal preventive measures by inhabitants, in addition to current malaria control and intervention strategies should be adequately implemented in Kaduna metropolis. Keywords: Haematological parameters, haemoglobin, electrophoresis, Plasmodium falciparum, malaria Différences dans les paramètres hématologiques et les phénotypes d'hémoglobine chez les sujets symptomatiques et asymptomatiques atteints d'une infection à Plasmodium falciparum dans certaines parties de la métropole de Kaduna, Nigéria Contexte: Plasmodium falciparum est la principale cause de morbidité et de mortalité liées au paludisme au Nigéria avec des symptômes et des conséquences hématologiques variés. L'objectif de cette étude est d'évaluer les différences de paramètres hématologiques et de phénotypes d'hémoglobine chez des individus symptomatiques infectés par P. falciparum et asymptomatiques apparemment en bonne santé dans certaines parties de la métropole de Kaduna. Méthodologie: Un total de 1000 sujets; 500 sujets symptomatiques et 500 sujets apparemment sains asymptomatiques pour le paludisme ont été recrutés dans certains hôpitaux et dans la Banque nationale du sang de la métropole de Kaduna. Des échantillons de sang ont été prélevés pour la microscopie à couche épaisse et mince afin de déterminer respectivement la parasitémie du paludisme et l'identification des espèces de parasites. Les paramètres hématologiques ont été déterminés à l'aide d'un analyseur sanguin automatisé (KX-21N, Sysmex, Japon) et des phénotypes d'hémoglobine par électrophorèse sur acétate de cellulose alcaline. Résultats: Sur les 1000 sujets recrutés, 347 (34,7%) étaient positifs pour P. falciparum sur frottis sanguin, qui comprenait 226 (45,2%) de 500 sujets symptomatiques et 121 (24,2%) de 500 sujets asymptomatiques (p<0,00001). Sur les 347 sujets infectés par P. falciparum, 275 (79,3%) avaient HbAA, 61 (17,6%) avaient HbAS, 1 (0,3%) avaient HbAC, 8 (2,3%) avaient HbSS et 2 (0,6%) avaient des phénotypes HbSSf. Cent soixante-trois (72,1%) des 226 sujets symptomatiques avaient une HbAA tandis que 112 (92,6%) des 121 sujets asymptomatiques avaient une HbAA, ce qui indiquait une fréquence significativement plus élevée de paludisme asymptomatique chez les sujets avec HbAA (p<0,00001). À l'inverse, 53 (23,5%) des 226 sujets symptomatiques avaient une HbAS tandis que 8 (6,6%) des 121 sujets asymptomatiques avaient une HbAS, indiquant une fréquence significativement plus élevée de paludisme symptomatique chez les sujets avec HbAS (p=0,000086). La fréquence de parasitémie> 3000 parasites / μL de sang était de 100% pour l'HbSSf, 25% pour l'HbSS, 8,2% pour l'HbAS et 2,2% pour l'HbAA, ce qui a montré une fréquence significativement plus élevée chez les sujets atteints d'HbSS (X2=7,5989, p=0,0054) et HbAS (X2=3,9627, p=0,046519) par rapport à l'HbAA. Chez les sujets symptomatiques, seule la valeur MCHC était significativement plus élevée chez les sujets avec HbAS (33,21±2,430) par rapport à ceux avec HbAA (32,09±2,315) (p=0,003), tandis que tous les autres paramètres hématologiques n'étaient pas significativement différents (p>0,05). Chez les sujets asymptomatiques, aucun des paramètres hématologiques n'était significativement différent entre les sujets avec HbAS et HbAA (p>0,05). Conclusion: Bien que la fréquence des infections à P. falciparum dans cette étude soit généralement plus élevée chez les sujets atteints d'HbAA, une infection symptomatique et une densité parasitaire plus élevée sont associées à l'HbAS, l'HbSS et l'HbSSf. Une utilisation efficace des mesures de prévention personnelle par les habitants, en plus des stratégies actuelles de lutte antipaludique et d'intervention, devrait être mise en oeuvre de manière adéquate dans la métropole de Kaduna. Mots clés: Paramètres hématologiques, hémoglobine, électrophorèse, Plasmodium falciparum, paludisme

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THROMBOCYTOPENIA

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.01.1862 ◽

2011 ◽

Vol 18 (01) ◽

pp. 75-79

Author(s):

ATIF SITWAT HAYAT ◽

MOHAMMAD SAEED SIDDIQUI ◽

NAILA SHAIKH ◽

Muqeet Ullah

Keyword(s):

Plasmodium Falciparum ◽

Falciparum Malaria ◽

Tertiary Care ◽

Febrile Illness ◽

Blood Film ◽

Falciparum Infection ◽

Common Symptom ◽

Severe Thrombocytopenia ◽

Care Hospital ◽

Cell Counts

Background: Malaria is usually associated with reduction in blood cell counts and mild to moderate thrombocytopenia is a common feature of falciparum infection. This study has been conducted to find out frequency and degree of thrombocytopenia in patients suffering from falciparum malaria at a tertiary care hospital of Abbottabad. Methods: It was a descriptive case-control study being carried out at Ayub teaching hospital and Northern institute of Medical Sciences (NIMS) Abbottabad over a period of ten months. All patients with acute febrile illness without localizing signs were considered for study. A total 250 patients having falciparum malaria diagnosed by peripheral blood film examination have been studied. Complete blood counts were performed by Automated Beckman Coulter Analyzer. Blood films were examined by clinical pathologist for plasmodium falciparum via light microscopy using oil-immersion lens. Results: Out of 250 patients, 155(62%) were females and 95(38%) males with M:F ratio of 1:1.5. Mean age was 36±1.2 years (range 17-58 years). Out of 250, 175(70%) had thrombocytopenia (p<0.05) while 75(30%) had normal platelet counts. Thus mild, moderate and severe thrombocytopenia had been observed in 121(48.4%), 41(16.4%) and 13(5.2%) respectively (p<0.05). Fever appeared to be most common symptom observed in all patients (100%) followed by vomiting and nausea (88%). Anemia was the commonest sign present (80%) during our study. Conclusions: We discovered high frequency of mild thrombocytopenia in falciparum malaria. Therefore, thrombocytopenia can be supportive in diagnosis of plasmodium falciparum infection.

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The ABO blood group system and Plasmodium falciparum malaria

Blood ◽

10.1182/blood-2007-03-077602 ◽

2007 ◽

Vol 110 (7) ◽

pp. 2250-2258 ◽

Cited By ~ 141

Author(s):

Christine M. Cserti ◽

Walter H. Dzik

Keyword(s):

Plasmodium Falciparum ◽

Relative Proportion ◽

Plasmodium Falciparum Malaria ◽

Blood Groups ◽

Falciparum Infection ◽

Human Migration ◽

Published Data ◽

Sequence Information ◽

Blood Group System ◽

Abo Blood Groups

In the century since the discovery of the ABO blood groups, numerous associations between ABO groups and disease have been noted. However, the selection pressures defining the ABO distributions remain uncertain. We review published information on Plasmodium falciparum infection and ABO blood groups. DNA sequence information dates the emergence and development of the group O allele to a period of evolution before human migration out of Africa, concomitant with P falciparum's activity. The current geographic distribution of group O is also consistent with a selection pressure by P falciparum in favor of group O individuals in malaria-endemic regions. We critically review clinical reports of ABO and P falciparum infection, documenting a correlation between disease severity and ABO group. Finally, we review published data on the pathogenesis of P falciparum infection, and propose a biologic model to summarize the role of ABO blood groups in cytoadherence biology. Such ABO-related mechanisms also point to a new hypothesis to account for selection of the Le(a−b−) phenotype. Taken together, a broad range of available evidence suggests that the origin, distribution, and relative proportion of ABO blood groups in humans may have been directly influenced by selective genetic pressure from P falciparum infection.

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Low prevalence of Plasmodium falciparum infection among asymptomatic individuals in a highland area of Kenya

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/j.trstmh.2005.04.012 ◽

2005 ◽

Vol 99 (10) ◽

pp. 780-786 ◽

Cited By ~ 25

Author(s):

Chandy C. John ◽

Marilyn M. McHugh ◽

Ann M. Moormann ◽

Peter O. Sumba ◽

Ayub V. Ofulla

Keyword(s):

Plasmodium Falciparum ◽

Falciparum Infection ◽

Highland Area ◽

Plasmodium Falciparum Infection ◽

Asymptomatic Individuals ◽

Low Prevalence

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Performance of a High-Sensitivity Rapid Diagnostic Test for Plasmodium falciparum Malaria in Asymptomatic Individuals from Uganda and Myanmar and Naive Human Challenge Infections

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.17-0245 ◽

2017 ◽

Vol 97 (5) ◽

pp. 1540-1550 ◽

Cited By ~ 66

Author(s):

Smita Das ◽

Ihn Kyung Jang ◽

Becky Barney ◽

Roger Peck ◽

John C. Rek ◽

...

Keyword(s):

Plasmodium Falciparum ◽

Falciparum Malaria ◽

Diagnostic Test ◽

Rapid Diagnostic Test ◽

High Sensitivity ◽

Plasmodium Falciparum Malaria ◽

Asymptomatic Individuals

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Cytokine Profile Distinguishes Children With Plasmodium falciparum Malaria From Those With Bacterial Blood Stream Infections

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz587 ◽

2019 ◽

Vol 221 (7) ◽

pp. 1098-1106

Author(s):

Nicole S Struck ◽

Marlow Zimmermann ◽

Ralf Krumkamp ◽

Eva Lorenz ◽

Thomas Jacobs ◽

...

Keyword(s):

Plasmodium Falciparum ◽

Bloodstream Infection ◽

Falciparum Malaria ◽

Prediction Accuracy ◽

Acute Infection ◽

Plasmodium Falciparum Malaria ◽

Classification Model ◽

Disease Prediction ◽

Asymptomatic Malaria ◽

Cytokine Profiles

Abstract Background Malaria presents with unspecific clinical symptoms that frequently overlap with other infectious diseases and is also a risk factor for coinfections, such as non-Typhi Salmonella. Malaria rapid diagnostic tests are sensitive but unable to distinguish between an acute infection requiring treatment and asymptomatic malaria with a concomitant infection. We set out to test whether cytokine profiles could predict disease status and allow the differentiation between malaria and a bacterial bloodstream infection. Methods We created a classification model based on cytokine concentration levels of pediatric inpatients with either Plasmodium falciparum malaria or a bacterial bloodstream infection using the Luminex platform. Candidate markers were preselected using classification and regression trees, and the predictive strength was calculated through random forest modeling. Results Analyses revealed that a combination of 7–15 cytokines exhibited a median disease prediction accuracy of 88% (95th percentile interval, 73%–100%). Haptoglobin, soluble Fas-Ligand, and complement component C2 were the strongest single markers with median prediction accuracies of 82% (with 95th percentile intervals of 71%–94%, 62%–94%, and 62%–94%, respectively). Conclusions Cytokine profiles possess good median disease prediction accuracy and offer new possibilities for the development of innovative point-of-care tests to guide treatment decisions in malaria-endemic regions.

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Impact of Plasmodium falciparum infection on haematological parameters in children living in Western Kenya

Malaria Journal ◽

10.1186/1475-2875-9-s3-s4 ◽

2010 ◽

Vol 9 (Suppl 3) ◽

pp. S4 ◽

Cited By ~ 76

Author(s):

Robert N Maina ◽

Douglas Walsh ◽

Charla Gaddy ◽

Gordon Hongo ◽

John Waitumbi ◽

...

Keyword(s):

Plasmodium Falciparum ◽

Falciparum Infection ◽

Haematological Parameters ◽

Western Kenya ◽

Plasmodium Falciparum Infection

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The pathogenesis of Plasmodium falciparum malaria in humans: insights from splenic physiology

Blood ◽

10.1182/blood-2010-04-202911 ◽

2011 ◽

Vol 117 (2) ◽

pp. 381-392 ◽

Cited By ~ 192

Author(s):

Pierre A. Buffet ◽

Innocent Safeukui ◽

Guillaume Deplaine ◽

Valentine Brousse ◽

Virginie Prendki ◽

...

Keyword(s):

Plasmodium Falciparum ◽

Falciparum Malaria ◽

Large Fraction ◽

Clinical Manifestations ◽

Plasmodium Falciparum Malaria ◽

Parasite Clearance ◽

Falciparum Infection ◽

Dynamic Interactions ◽

Infected Rbcs ◽

High Parasite

AbstractClinical manifestations of Plasmodium falciparum infection are induced by the asexual stages of the parasite that develop inside red blood cells (RBCs). Because splenic microcirculatory beds filter out altered RBCs, the spleen can innately clear subpopulations of infected or uninfected RBC modified during falciparum malaria. The spleen appears more protective against severe manifestations of malaria in naïve than in immune subjects. The spleen-specific pitting function accounts for a large fraction of parasite clearance in artemisinin-treated patients. RBC loss contributes to malarial anemia, a clinical form associated with subacute progression, frequent splenomegaly, and relatively low parasitemia. Stringent splenic clearance of ring-infected RBCs and uninfected, but parasite-altered, RBCs, may altogether exacerbate anemia and reduce the risks of severe complications associated with high parasite loads, such as cerebral malaria. The age of the patient directly influences the risk of severe manifestations. We hypothesize that coevolution resulting in increased splenic clearance of P. falciparum–altered RBCs in children favors the survival of the host and, ultimately, sustained parasite transmission. This analysis of the RBC–spleen dynamic interactions during P falciparum infection reflects both data and hypotheses, and provides a framework on which a more complete immunologic understanding of malaria pathogenesis may be elaborated.

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