Bone marrow suppression and severe anaemia associated with persistent Plasmodium falciparum infection in African children with microscopically undetectable parasitaemia

TY - JOUR

T1 - Bone marrow suppression and severe anaemia associated with persistent Plasmodium falciparum infection in African children with microscopically undetectable parasitaemia

AU - Helleberg, Marie

AU - Goka, Bamenla Q

AU - Akanmori, Bartholomew D

AU - Obeng-Adjei, George

AU - Rodriques, Onike

AU - Kurtzhals, Jørgen

N1 - Keywords: Anemia; Animals; Bone Marrow Diseases; Child; Child, Preschool; Erythropoiesis; Erythropoietin; Female; Hemoglobins; Humans; Infant; Interleukin-10; L-Lactate Dehydrogenase; Malaria, Falciparum; Male; Parasitemia; Proteins; Receptors, Transferrin; Tumor Necrosis Factor-alpha

PY - 2005

Y1 - 2005

N2 - BACKGROUND: Severe anaemia can develop in the aftermath of Plasmodium falciparum malaria because of protracted bone marrow suppression, possibly due to residual subpatent parasites. MATERIALS AND METHODS: Blood was collected from patients with recent malaria and negative malaria microscopy. Detection of the Plasmodium antigens, lactate dehydrogenase (Optimal), aldolase and histidine rich protein 2 (Now malaria) were used to differentiate between patients with (1) no malaria, (2) recent cleared malaria, (3) persistent P. falciparum infection. Red cell distribution width (RDW), plasma levels of soluble transferrin receptor (sTfR) and erythropoietin (EPO) were measured as markers of erythropoiesis. Interleukin (IL) 10 and tumour necrosis factor (TNF)alpha were used as inflammation markers. RESULTS: EPO was correlated with haemoglobin, irrespective of malaria (R = -0.36, P < 0.001). Persistent P. falciparum infection, but not recent malaria without residual parasites, was associated with bone marrow suppression i.e., low RDW (P < 0.001 vs. P = 0.56) and sTfR (P = 0.02 vs. P = 0.36). TNF-alpha and IL-10 levels were not associated with bone marrow suppression. CONCLUSION: In the treatment of malaria, complete eradication of parasites may prevent subsequent development of anaemia. Severely anaemic children may benefit from antimalarial treatment if antigen tests are positive, even when no parasites can be demonstrated by microscopy.

AB - BACKGROUND: Severe anaemia can develop in the aftermath of Plasmodium falciparum malaria because of protracted bone marrow suppression, possibly due to residual subpatent parasites. MATERIALS AND METHODS: Blood was collected from patients with recent malaria and negative malaria microscopy. Detection of the Plasmodium antigens, lactate dehydrogenase (Optimal), aldolase and histidine rich protein 2 (Now malaria) were used to differentiate between patients with (1) no malaria, (2) recent cleared malaria, (3) persistent P. falciparum infection. Red cell distribution width (RDW), plasma levels of soluble transferrin receptor (sTfR) and erythropoietin (EPO) were measured as markers of erythropoiesis. Interleukin (IL) 10 and tumour necrosis factor (TNF)alpha were used as inflammation markers. RESULTS: EPO was correlated with haemoglobin, irrespective of malaria (R = -0.36, P < 0.001). Persistent P. falciparum infection, but not recent malaria without residual parasites, was associated with bone marrow suppression i.e., low RDW (P < 0.001 vs. P = 0.56) and sTfR (P = 0.02 vs. P = 0.36). TNF-alpha and IL-10 levels were not associated with bone marrow suppression. CONCLUSION: In the treatment of malaria, complete eradication of parasites may prevent subsequent development of anaemia. Severely anaemic children may benefit from antimalarial treatment if antigen tests are positive, even when no parasites can be demonstrated by microscopy.

U2 - 10.1186/1475-2875-4-56

DO - 10.1186/1475-2875-4-56

M3 - Journal article

C2 - 16321150

SN - 1475-2875

VL - 4

SP - 56

JO - Malaria Journal

JF - Malaria Journal

IS - 1

ER -