Abstract
PurposeWhen considering malaria disease severity, estimation of parasitemia in erythrocytes is important, but sometimes misleading, since the infected erythrocytes may be sequestered in peripheral capillaries. In African children and Asian adults with falciparum malaria, parasitemia as assessed by quantitative PCR (qPCR) in plasma seems to be a valuable indicator of disease severity, but data on African adults as well as the impact of co-infection with HIV is lacking.MethodsIn 131 patients with falciparum malaria in a public tertiary teaching hospital in Mozambique, plasma malaria parasitemia as assessed by qPCR, compared to qualitative malaria PCR in blood cell fraction, was related to malaria disease severity and HIV co-infection.ResultsOf the 131 patients with falciparum malaria, based on positive qualitative PCR in the blood cell fraction, 93 patients (72%) had positive malaria qPCR in plasma. Patients with severe malaria as defined by the WHO criteria had higher malaria quantitative plasma parasitemia (median 143 genomes/µL) compared to those with uncomplicated malaria (median 55 genomes/µL, p = 0.037) in univariate analysis, but this difference was attenuated after adjusting for age, sex and HIV co-infection (p = 0.055). A quarter of the patients with severe malaria had negative qPCR in plasma.ConclusionsThis study of adult African in-patients with falciparum malaria with and without HIV co-infection, neither confirms nor rejects previous studies of malaria qPCR in plasma as an indicator of disease severity in patients with falciparum malaria. There is a need for further and larger studies to clarify if parasitemia as assessed malaria qPCR in plasma could be a surrogate marker of disease severity in falciparum malaria.
Highlights
In spite of decreasing incidence, falciparum malaria still causes about half a million fatalities every year, whereof 93% occur in sub-Saharan Africa and about two thirds are children below 5 years of age [1]
26% (22/85) of the patients with severe malaria had negative quantitative plasma PCR, and those patients had significant more frequent severe anaemia compared to the ones with positive quantitative PCR (qPCR) (p < 0.001)
The present study is, the first report on qPCR assessment in patients with falciparum malaria in African adults, and importantly, the present study included patients co-infected with HIV
Summary
In spite of decreasing incidence, falciparum malaria still causes about half a million fatalities every year, whereof 93% occur in sub-Saharan Africa and about two thirds are children below 5 years of age [1]. There are several published DNA (deoxyribonucleic acid) based qPCR methods for quantitation of P. falciparum [6] Most of these methods are highly sensitive for detection of malaria and can detect the parasite even at very low levels (i.e., 0.03 parasites/μL present in blood) [6, 7], reflecting that most of the methods target a multi-copy gene e.g. mitochondria 20–160 copies per genome [8], TARE-2 250–280 copies per genome [9]. This gene target exists in five to eight copies per genome [6] They examined African children and Asian adults and they did not consider HIV co-infection, which is an important factor in relation to disease severity in falciparum malaria [11,12,13].
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