Abstract
BackgroundErythrocyte-associated antigenic polymorphisms or their absence have perhaps evolved in the human population to protect against malarial infection. Studies in various populations consistently demonstrate that blood group 'O' confers resistance against severe falciparum infection. In India, Odisha state has one of the highest incidences of Plasmodium falciparum infection and contributes to the highest number of deaths by falciparum malaria. This study aims to evaluate the relationship between ABO blood group and severe malaria in an adult population at the tertiary care centre in Odisha.MethodsA total of 353 P. falciparum infected subjects and 174 healthy controls were screened for ABO blood group. Falciparum-infected individuals were categorized as severe malaria and uncomplicated malaria. Severe malaria was further clinically phenotyped into cerebral malaria, non-cerebral severe malaria and multi-organ dysfunction. A meta-analysis was performed to assess the role of ABO blood group in severe malaria.ResultsFrequency of blood group 'B' was significantly higher in patients with severe malaria compared to the uncomplicated cases (P < 0.0001; OR = 4.09) and healthy controls (P < 0.0001; OR = 2.79). Irrespective of the level of clinical severity, blood group 'B' was significantly associated with cerebral malaria (P < 0.0001; OR = 5.95), multi-organ dysfunction (P < 0.0001; OR = 4.81) and non-cerebral severe malaria patients (P = 0.001; OR = 3.02) compared to the uncomplicated category. Prevalence of 'O' group in uncomplicated malaria (P < 0.0001; OR = 2.81) and healthy controls (P = 0.0003; OR = 2.16) was significantly high compared to severe malaria. Meta-analysis of previous studies, including the current one, highlighted the protective nature of blood group 'O' to severe malaria (P = 0.01). On the other hand, carriers of blood group 'A' (P = 0.04) and 'AB' (P = 0.04) were susceptible to malaria severity.ConclusionsResults of the current study indicate that blood group 'O' is associated with reduced and 'B' blood group with increased risk of development of severe malaria in Odisha, India. Meta-analysis also supports the protective nature of blood group 'O' from severe falciparum infection.
Highlights
Erythrocyte-associated antigenic polymorphisms or their absence have perhaps evolved in the human population to protect against malarial infection
Variations in gene encoding functional glucotransferase have been associated with protections from severe P. falciparum malaria [9] and this observation has been further strengthened by a recent genome wide association study [10]
Severe malaria(SM) was categorized into three groups based on distinct clinical features: 1) Cerebral malaria (CM), 2) Non cerebral severe malaria (NCSM) and 3) Multi-organ-dysfuction (MOD)
Summary
Erythrocyte-associated antigenic polymorphisms or their absence have perhaps evolved in the human population to protect against malarial infection. Studies in various populations consistently demonstrate that blood group ‘O’ confers resistance against severe falciparum infection. This study aims to evaluate the relationship between ABO blood group and severe malaria in an adult population at the tertiary care centre in Odisha. Blood group ‘O’ carries a disaccharide H antigen (Fuca1-2Galb1) due to the absence of the enzyme glucotransferase [8]. Variations in gene encoding functional glucotransferase have been associated with protections from severe P. falciparum malaria [9] and this observation has been further strengthened by a recent genome wide association study [10]. RBCs of blood group ‘O’ do not express tri-saccharide, and rosettes formed by infected ‘O’ blood group RBCs are smaller and disrupted compared to blood groups A, B or AB [4,7,11]
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