Abstract
BackgroundPlasmodium falciparum malaria remains one of the world’s major infectious diseases that cause most morbidity and mortality, particularly in children. In Ghana, most children below the ages of 5 years depending on the severity of the infection often lose their lives. However, it is still debatable why infection with falciparum malaria contributes to thrombocytopenia.MethodsThis study sought to investigate the expression of the various platelet indices and activation markers in children with falciparum malaria. Platelet indices (Platelet count [PLT], Plateletcrite [PCT], Mean Platelet Volume [MPV], Platelet Distribution Width [PDW] and Platelet-Large Cell Ratio [P-LCR]) and platelet surface membrane glycoproteins (GPIIb/IIIa [PAC-1], P-selectin [CD62p] and GPIV [CD36]) expressions were determined in children with falciparum malaria (cases) and healthy children (controls) using automated blood cell analysis and flow cytometry techniques, respectively.ResultsExcept for P-LCR, all the other platelet indices (PLT, MPV, PDW, and PCT) were significantly lower in the cases than the controls (P < 0.05). Also, it was observed that the level of expression of the activation markers; PAC 1 and CD62p showed a significant (P < 0.05) decreased before and after activation in falciparum malaria cases than in the controls. On the contrary, CD36 expression in the controls did not differ significantly (p > 0.05) from the malaria cases. Platelet activation markers were known to be associated with increased risk of falciparum malaria with the mean fluorescence intensity of PAC1 (Odds Ratio [OR] 34.0, Relative Risk [RR] 4.47, 95% Confidence Interval [CI] 4.904–235.7; p < 0.0001) and CD36 (OR 4.2, RR 1.82, 95% CI 0.9824–17.96; p = 0.04). Moreover, the percentage expression of CD62p (OR 4.0, RR 1.80, 95% CI 0.59–27.24; p = 0.19) was also observed to be probably associated with increased risk of falciparum malaria although not statistically significant (p > 0.05).ConclusionPlasmodium falciparum malaria has been known to be associated with platelet activation markers, which probably contributes to thrombocytopenia.
Highlights
Plasmodium falciparum malaria remains one of the world’s major infectious diseases that cause most morbidity and mortality, in children
This might probably be due to elevated level of specific immunoglobulin G (IgG) in the circulatory system which binds to the platelet-bound malaria antigens [8]
Bleeding score assessment Three children infected with P. falciparum malaria had bleeding history which was graded as minor type
Summary
Plasmodium falciparum malaria remains one of the world’s major infectious diseases that cause most morbidity and mortality, in children. Plasmodium falciparum is the most prevalent malaria parasites on the African continent, responsible for most malaria deaths globally. It contributes to most childhood parasitic infection and presents with signs and symptoms such as recurrent fever, fatigue, and body joint pains. Thrombocytopenia is a common haematological findings in children with malaria [2, 3] and the severity reflects increased parasite density It might occur through peripheral destruction [4], excessive removal of platelets by splenic pooling [5, 6] as well as platelet consumption by the process of disseminated intravascular coagulopathy [DIC] [7]. Platelet activation molecules (GPIV, P-selectin and GPIIb/IIIa) have been reported to mediate clumping of parasitized red blood cells (PRBC) which contributes to increase sequestration and disease severity [8]
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