Multiplicity of infection and genetic diversity of Plasmodium falciparum isolates from patients with uncomplicated and severe malaria in Gezira State, Sudan.

Muzamil Mahdi Abdel Hamid,Nouh S Mahgoub,Arwa F Elamin,Mohamed Siddigeltayeb Muneer,Shaza O Mustafa,Abdelmohaymin A A Abdalla,Mutaz Amin,Musab M Ali Albsheer

doi:10.1186/s13071-016-1641-z

Muzamil Mahdi Abdel Hamid, Nouh S Mahgoub + Show 6 more

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https://doi.org/10.1186/s13071-016-1641-z

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Journal: Parasites & Vectors	Publication Date: Jun 27, 2016
Citations: 60	License type: cc-by

Affiliation: University of Khartoum

Abstract

BackgroundMultiplicity and genetic diversity of Plasmodium falciparum infection might play a role in determining the clinical outcome of malaria infection and could be a fair reflection of the disease transmission rate. This study investigated the genetic diversity of P. falciparum and multiplicity of infection in relation to the severity of malaria and age of patients in Gezira State, Sudan.MethodsA cross-sectional health facilities-based survey was conducted in Gezira State, Sudan in January 2012. A total of 140 P. falciparum malaria patients diagnosed with microscopy and confirmed using nested PCR were recruited and classified into uncomplicated malaria and severe malaria states according to the standard WHO criteria. DNA was extracted and MSP1 and MSP2 allelic families were determined using nested PCR.ResultsThe overall multiplicity of infection (MOI) was 2.25 and 2.30 and 2.15 for uncomplicated and severe malaria respectively. There were no statistically significant differences between uncomplicated and severe malaria (SM) patient groups in MOI with regard to MSP1, MSP2 and overall MOI (Mann-Whitney U-test; all P < 0.05). The predominant MSP1 allelic families were MAD20 for uncomplicated malaria and RO33 for severe malaria. The distribution of both FC27 and IC1/3D7 MSP2 allelic families were approximately the same across disease severity. One hundred and eleven P. falciparum isolates (81 %) consisted of multiple genotypes; 71/90 (78.9 %) in uncomplicated malaria and 40/50 (85.1 %) in severe malaria patient groups. Neither MSP1 nor MSP2 allelic families showed association with malaria severity. No statistically significant differences in multiplicity of infection were observed between different age groups.ConclusionIn this study the majority of P. falciparum isolates from uncomplicated and severe malaria patients consisted of multiple genotypes. Further molecular epidemiological studies delineate the link between P. falciparum genotype with the malaria phenotype in different regions are encouraged.

Highlights

Multiplicity and genetic diversity of Plasmodium falciparum infection might play a role in determining the clinical outcome of malaria infection and could be a fair reflection of the disease transmission rate
Regular molecular epidemiological surveys that monitor the genetic diversity of P. falciparum populations in different regions of the country as well as worldwide and linking parasite genotypes to the disease phenotypes are crucially important. In this health care service-based study we aimed to investigate the genetic diversity of P. falciparum and multiplicity of infection and their relationship to the disease severity and patient age
Patients and malaria definition A total of 140 patients from those screened for malaria during a cross-sectional study conducted in January 2012 were confirmed positive for P. falciparum malaria by microscopy and nested polymerase chain reaction (PCR)

Summary

Introduction

Multiplicity and genetic diversity of Plasmodium falciparum infection might play a role in determining the clinical outcome of malaria infection and could be a fair reflection of the disease transmission rate. This study investigated the genetic diversity of P. falciparum and multiplicity of infection in relation to the severity of malaria and age of patients in Gezira State, Sudan. Malaria caused by Plasmoduim falciparum is a major public health problem in sub-Saharan countries. In 2015 theglobal burden of the disease reached 214 million cases with 97 countries and 3.2 billion people at risk [1]. In Sudan, malaria is a leading cause of morbidity and mortality. High malaria transmission occurs in 87 % of the population [2]. The peak months of malaria transmission are from September to November. In GeziraState there is an additional peak by the end of February, which corresponds to the end of the irrigation season when small pools of water form along the drying canals with subsequent increase in mosquito density [3]

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