Abstract
BackgroundThere are limited data on the evolution of the leukocyte and platelet counts in malaria patients.MethodsIn a clinical trial of chloroquine vs. chloroquine plus doxycycline vs. doxycycline alone against Plasmodium vivax (n = 64) or Plasmodium falciparum (n = 98) malaria, the total white cell (WCC) and platelet (PLT) counts were measured on Days 0, 3, 7 and 28 in 57 indigenous Papuans with life long malaria exposure and 105 non Papuan immigrants from other parts of Indonesia with limited malaria exposure.ResultsThe mean Day 0 WCC (n = 152) was 6.492 (range 2.1–13.4) × 109/L and was significantly lower in the Papuans compared to the non Papuans: 5.77 × 109/L vs. 6.86 × 109/L, difference = -1.09 [(95% CI -0.42 to -1.79 × 109/L), P = 0.0018]. 14 (9.2%) and 9 (5.9%) patients had leukopaenia (<4.0 × 109/L) and leukocytosis (>10.0 × 109/L), respectively. By Day 28, the mean WCC increased significantly (P = 0.0003) from 6.37 to 7.47 × 109/L (73 paired values) and was similar between the two groups. Ethnicity was the only WCC explanatory factor and only on Day 0.The mean Day 0 platelet count (n = 151) was 113.0 (range 8.0–313.0) × 109/L and rose significantly to 186.308 × 109/L by Day 28 (P < 0.0001). There was a corresponding fall in patient proportions with thrombocytopaenia (<150 × 109/L): 119/151 (78.81%) vs. 16/73 (21.92%, P < 0.00001). Papuan and non Papuan mean platelet counts were similar at all time points. Only malaria species on Day 0 was a significant platelet count explanatory factor. The mean D0 platelet counts were significantly lower (P = 0.025) in vivax (102.022 × 109/L) vs. falciparum (122.125 × 109/L) patients.ConclusionChanges in leukocytes and platelets were consistent with other malaria studies. The Papuan non Papuan difference in the mean Day 0 WCC was small but might be related to the difference in malaria exposure.
Highlights
There are limited data on the evolution of the leukocyte and platelet counts in malaria patients
In experimentally induced falciparum malaria, Aotus monkeys had an increase in the absolute neutrophil counts seven days post infection that was followed by neutropaenia by Day 14; the reverse was found for the lymphocyte counts [24]
Studies in temperate climates have found that individuals of African origin tend to have lower total leukocyte, neutrophil and platelet counts compared to Caucasians and women have higher leukocyte and neutrophil counts than men [25,26]
Summary
There are limited data on the evolution of the leukocyte and platelet counts in malaria patients. The malaria induced changes in the total white cell (WC) and platelet (PLT) counts have been documented in several clinical series of vivax and falciparum malaria in malaria immune and naïve patients of all ages [1,2,3,4,5,6,7,8,9], describing mostly the WC and PLT counts at presentation. Leukocytosis was more common in Plasmodium vivax infected African American soldiers (27%) compared to Caucasian soldiers (9%) but the latter had higher rates (47 vs 26%) of relative lymphocytosis (lymphocyte count > 35%) [14]. TNFα levels were greater in non immune Sri Lankans with P. vivax [28]
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