Plasma Plasmodium falciparum Histidine-rich Protein 2 Concentrations in Children With Malaria Infections of Differing Severity in Kilifi, Kenya.
PfHRP2
Plasmodium falciparum histidine-rich protein-2
malaria
parasite biomass
sequestration
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
05 10 2021
05 10 2021
Historique:
received:
10
06
2020
pubmed:
11
8
2020
medline:
21
10
2021
entrez:
11
8
2020
Statut:
ppublish
Résumé
Most previous studies support a direct link between total parasite load and the clinical severity of Plasmodium falciparum malaria infections. We estimated P. falciparum parasite loads in 3 groups of children with malaria infections of differing severity: (1) children with World Health Organization-defined severe malaria (n = 1544), (2) children admitted with malaria but without features of severity (n = 200), and (3) children in the community with asymptomatic parasitemia (n = 33). Peripheral parasitemias were highest in those with uncomplicated malaria (geometric mean [GM] parasite count, 111 064/μL; 95% confidence interval, CI, 86 798-141 819/μL), almost 3 times higher than in those with severe malaria (39 588/μL; 34 990-44 791/μL) and >100 times higher than in those with asymptomatic malaria (1092/μL; 523-2280/μL). However, the GM P. falciparum histidine-rich protein 2 (PfHRP2) values (95% CI) increased with severity, being 7 (4-12) ng/mL in asymptomatic malaria, 843 (655-1084) ng/mL in uncomplicated malaria, and 1369 (1244-1506) ng/mL in severe malaria. PfHRP2 concentrations were markedly lower in the subgroup of patients with severe malaria and concomitant invasive bacterial infections of blood or cerebrospinal fluid (GM concentration, 312 ng/mL; 95% CI, 175-557 ng/mL; P < .001) than in those without such infections (1439 ng/mL; 1307-1584; P < .001). The clinical severity of malaria infections related strongly to the total burden of P. falciparum parasites. A quantitative test for plasma concentrations of PfHRP2 could be useful in identifying children at the greatest clinical risk and identifying critically ill children in whom malaria is not the primary cause.
Sections du résumé
BACKGROUND
Most previous studies support a direct link between total parasite load and the clinical severity of Plasmodium falciparum malaria infections.
METHODS
We estimated P. falciparum parasite loads in 3 groups of children with malaria infections of differing severity: (1) children with World Health Organization-defined severe malaria (n = 1544), (2) children admitted with malaria but without features of severity (n = 200), and (3) children in the community with asymptomatic parasitemia (n = 33).
RESULTS
Peripheral parasitemias were highest in those with uncomplicated malaria (geometric mean [GM] parasite count, 111 064/μL; 95% confidence interval, CI, 86 798-141 819/μL), almost 3 times higher than in those with severe malaria (39 588/μL; 34 990-44 791/μL) and >100 times higher than in those with asymptomatic malaria (1092/μL; 523-2280/μL). However, the GM P. falciparum histidine-rich protein 2 (PfHRP2) values (95% CI) increased with severity, being 7 (4-12) ng/mL in asymptomatic malaria, 843 (655-1084) ng/mL in uncomplicated malaria, and 1369 (1244-1506) ng/mL in severe malaria. PfHRP2 concentrations were markedly lower in the subgroup of patients with severe malaria and concomitant invasive bacterial infections of blood or cerebrospinal fluid (GM concentration, 312 ng/mL; 95% CI, 175-557 ng/mL; P < .001) than in those without such infections (1439 ng/mL; 1307-1584; P < .001).
CONCLUSIONS
The clinical severity of malaria infections related strongly to the total burden of P. falciparum parasites. A quantitative test for plasma concentrations of PfHRP2 could be useful in identifying children at the greatest clinical risk and identifying critically ill children in whom malaria is not the primary cause.
Identifiants
pubmed: 32772115
pii: 5890098
doi: 10.1093/cid/ciaa1141
pmc: PMC8492128
mid: EMS124244
doi:
Substances chimiques
Antigens, Protozoan
0
HRP-2 antigen, Plasmodium falciparum
0
Protozoan Proteins
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e2415-e2423Subventions
Organisme : Wellcome Trust
ID : 202800/Z/16/Z
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 202800
Pays : United Kingdom
Organisme : DELTAS Africa Initiative
Organisme : Wellcome Trust
ID : 089275
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 209265
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 203077/Z/16/Z
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 203077
Pays : United Kingdom
Organisme : New Partnership for Africa's Development Planning and Coordinating Agency
Organisme : African Academy of Sciences's Alliance for Accelerating Excellence in Science in Africa
Organisme : Wellcome Trust
ID : 091758
Pays : United Kingdom
Organisme : DEL-15-003
Organisme : EPA
ID : EP-C-15-003
Pays : United States
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : KEMRI-Wellcome Trust Research Programme
ID : 209265/Z/17/Z
Organisme : UK government
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.
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