Plasmodium Falciparum Infection In Children Research Articles

Prevalence of Plasmodium falciparum infection in children under 15 years in two oil palm plantations in Aboisso, Côte d'Ivoire

Prevalence of Plasmodium falciparum infection in children under 15 years in two oil palm plantations in Aboisso, Côte d'Ivoire

Cytokine response in asymptomatic and symptomatic Plasmodium falciparum infections in children in a rural area of south-eastern Gabon.

Plasmodium falciparum is a parasite that causes asymptomatic or symptomatic malaria infections in humans depending on various factors. These infections are also a major cause of anemia in intertropical countries such as Gabon. Past studies have clearly demonstrated that inflammatory markers such as cytokines play a key role in the pathogenesis of malaria disease. However, the clinical manifestations of severe malaria vary according to the level of transmission and more information is needed to gain a better understanding of the factors involved. As such, the objective of this study was to investigate the circulating levels of nine cytokines in asymptomatic and symptomatic P. falciparum infections in Gabonese children and their roles in the pathogenesis of anemia. Blood samples were collected from 241 children aged 3 to 180 months in Lastourville, south-eastern Gabon. Diagnosis of P. falciparum infection was performed using Rapid Diagnosis Tests, microscopy and nested PCR. Levels in the plasma of the Th1 (IFN-γ, TNF-α, IL-6 and IL-12p70), Th17 (IL-17A and IL-22) and Th2 (IL-10, IL-4 and IL-13) cytokines were measured by ELISA. Data showed that IL-6, IFN-γ, IL-12p70, IL-10, and IL-13 levels were significantly higher in children with symptomatic P. falciparum infection compared to uninfected children. IL-10 levels were significantly higher in symptomatic children than in asymptomatic children, who had moderately increased levels compared to uninfected controls. Moreover, only IL-10 and IL-6 levels were significantly higher in children with severe malarial anemia compared to children with uncomplicated malaria who had significantly lower IL-10 levels than children with moderate malarial anemia. These data indicate that the progression of P. falciparum infection towards an advanced stage in children is accompanied by a significant increase in type Th1 and/or Th2 cytokines. These inflammatory mediators could serve as potential predictors of anemia for malaria patients.

Plasma biomarkers of hemoglobin loss in Plasmodium falciparum–infected children identified by quantitative proteomics

AbstractAnemia is common among young children infected with Plasmodium falciparum and severe malarial anemia (SMA) is a major cause of their mortality. Two major mechanisms cause malarial anemia: hemolysis of uninfected as well as infected erythrocytes and insufficient erythropoiesis. In a longitudinal birth cohort in Mali, we commonly observed marked hemoglobin reductions during P falciparum infections with a small proportion that progressed to SMA. We sought biomarkers of these processes using quantitative proteomic analysis on plasma samples from 9 P falciparum-infected children, comparing those with reduced hemoglobin (with or without SMA) vs those with stable hemoglobin. We identified higher plasma levels of circulating 20S proteasome and lower insulin-like growth factor-1 (IGF-1) levels in children with reduced hemoglobin. We confirmed these findings in independent enzyme-linked immunosorbent assay-based validation studies of subsets of children from the same cohort (20S proteasome, N = 71; IGF-1, N = 78). We speculate that circulating 20S proteasome plays a role in digesting erythrocyte membrane proteins modified by oxidative stress, resulting in hemolysis, whereas decreased IGF-1, a critical factor for erythroid maturation, might contribute to insufficient erythropoiesis. Quantitative plasma proteomics identified soluble mediators that may contribute to the major mechanisms underlying malarial anemia. This study was registered at www.clinicaltrials.gov as #NCT01168271.

Asymptomatic and sub-microscopic Plasmodium falciparum infection in children in the Mount Cameroon area: a cross-sectional study on altitudinal influence, haematological parameters and risk factors

BackgroundThe Mount Cameroon area has experienced a 57.2% decline in confirmed malaria cases between 2006 and 2013 with the implementation of different control measures but, the disease is still of public health concern. The objective of the study was to assess the burden of asymptomatic and sub-microscopic Plasmodium infection, altitudinal influence on it, their effect on haematological parameters as well as identify the risk factors of infection.MethodologyA cross-sectional community-based survey involving 1319 children of both sexes aged 6 months to 14 years was conducted between July 2017 and May 2018. Malaria parasitaemia was confirmed by Giemsa-stained microscopy, sub-microscopic Plasmodium infection by 18S mRNA using nested PCR and full blood count analysis was done using an auto haematology analyser.ResultsMalaria parasite, asymptomatic malaria parasitaemia and sub-microscopic Plasmodium infection and anaemia were prevalent in 36.4%, 34.0%, 43.8% and 62.3% of the children, respectively. The risk of having sub-microscopic Plasmodium infection was highest in children 5‒9 (OR = 3.13, P < 0.001) and 10‒14 years of age (OR = 8.18, P < 0.001), non-insecticide treated net users (OR = 1.69, P < 0.04) and those anaemic (OR = 9.01, P < 0.001). Children with sub-microscopic infection had a significantly lower mean haemoglobin (9.86 ± 1.7 g/dL, P < 0.001), red blood cell counts (4.48 ± 1.1 × 1012/L, P < 0.001), haematocrit (31.92%, P < 0.001), mean corpuscular haemoglobin concentration (313.25 ± 47.36, P = 0.035) and platelet counts (280.83 ± 112.62, P < 0.001) than their negative counterparts. Children < 5 years old (73.8%), having asymptomatic (69.8%) and sub-microscopic Plasmodium infection (78.3%) as well as resident in the middle belt (72.7%) had a higher prevalence of anaemia than their peers.ConclusionThe meaningful individual-level heterogeneity in the burden of asymptomatic and sub-microscopic Plasmodium infection in addition to its corollary on haematological variables among children in the different attitudinal sites of the Mount Cameroon Region accentuate the need for strategic context specific planning of malaria control and preventative measures.

Erythrocyte Lipid and Antioxidant Changes in Plasmodium falciparum-infected Children Attending Mother and Child Hospital in Akure, Nigeria.

Understanding the molecular and cellular pathways activated in response to Plasmodium falciparum infection is crucial for the development of pharmacological intervention to malaria. The present study was designed to evaluate the lipid components and the oxidative status of erythrocyte obtained from children under 5 years infected with Plasmodium falciparum. Parasitemia was assessed prior and after treatment with antimalarial, erythrocyte lipid profile, levels of lipid peroxidation and antioxidant status (reduced glutathione, GSH; superoxide dismutase, SOD; catalase and glutathione peroxidase, GPx) were measured. Results obtained showed that in Plasmodium infected erythrocyte, the total phospholipids, cholesterol and LDL-cholesterol concentrations were significantly elevated beyond the normal level. In addition, an upsurge in erythrocyte oxidant (lipid peroxide) status with a concomitant downregulation of the antioxidant status (GSH concentration and SOD, catalase and GPx activities) was observed in P. falciparum-infected children. However, following a three-day treatment with artemisinin combination drugs, there was a significant reduction in erythrocyte phospholipids, total cholesterol and LDL-cholesterol concentration as well as lipid peroxide levels. Significant augmentation in erythrocyte antioxidant status (GSH, SOD, catalase and GPx) were also observed after treatment with antimalarials. This study demonstrated that erythrocyte lipids and oxidative status are usually altered in Plasmodium falciparum-infected children. Thus, monitoring erythrocyte lipid profile and oxidative status could offer a viable diagnostic strategy in early detection of malaria in children.

Role of genetic factors and ethnicity on the multiplicity of Plasmodium falciparum infection in children with asymptomatic malaria in Yaoundé, Cameroon

In this cross-sectional study, we investigated host genetic factors and ethnic variation in circulating Plasmodium falciparum merozoite surface protein 2 (msp-2) clones among children with asymptomatic malaria.Isolates from seventy two asymptomatic malaria children were used for genotyping block 3 of msp-2 gene by nested polymerase chain reaction (PCR). Sickle cell trait and glucose-6-phosphate dehydrogenase (G6PD) deficiency were analysed by restriction fragment length polymorphism of DNA products from PCR targeting codons 6 and 68 of the beta-globin (HBB) and G6PD genes respectively. ABO blood group was typed by agglutination method.A total of forty two msp-2 genotypes (20 for 3D7 and 22 for FC27) were detected for an average (standard error of mean) multiplicity of infection (MOI) of 2.45 (0.16). The MOI was statistically the same among the five identified ethnic groups (P = 0.83). The overall prevalence of sickle cell trait and G6PD deficiency were 12.50 % and 22.22 % respectively. MOI was similar between children with Hb AA and Hb AS genotypes (P = 0.42). MOI was significantly high among children with a mutant G6PD genotype (P = 0.017). MOI was significantly higher in blood group O than group A (P = 0.03).Our findings show that although ethnicity and sickle cell trait have no association with MOI, the association was observed with G6PD genotype and ABO group. The results suggest the need for extension and expansion of the current study in order to investigate the mechanisms involved.

Assessment of co-segregated TLR4 genotypes among Nigerian children with asymptomatic and clinical malaria

ObjectiveTo assess the occurrence and pattern of Toll-like receptor 4 (TLR4) co-segregated genotypes among children with Plasmodium falciparum malaria in Nigeria. MethodsIn this case-control study, a total of 79 Plasmodium falciparum infected children aged 2–7 years and 105 age-matched uninfected controls of Yoruba descents in Lagos were studied. The extracted DNA samples were used for TLR4 genotyping at codons 299 (Asp > Gly) and 399 (Thr > Ile) by PCR-restriction fragment length polymorphism. Malaria infection was diagnosed by blood smear microscopy and infected children were stratified into asymptomatic, uncomplicated and severe malaria sub-groups. Malnutrition was determined by measuring the mid upper arm circumference and anemia was defined as hemoglobin < 11 g/dL. ResultsThe proportions of children with acute malnutrition and severe anemia were 12.0% and 3.2%, respectively. Parasitemia and malnutrition were not correlated and four distinct patterns of TLR4 genotypes were found in the study population: Asp299Asp/Thr399Thr (90.2%), Asp299Gly/Thr399Thr (4.3%), Gly299Gly/Thr399Thr (3.8%) and Asp299Gly/Thr399Ile (1.6%). These genotypes did not differ significantly (P > 0.05) in frequency between infected and non-infected children. However, low and high occurrences of the TLR4 Asp299Asp/Thr399Thr and Asp299Gly/Thr399Thr genotypes were observed in the severe malaria subgroup. ConclusionsThis study reveals a protective role for TLR4 Asp299Gly/Thr399Ile and Asp299Asp/Thr399Thr genotypes against severe malaria in Nigerian children.

Severe anaemia associated with Plasmodium falciparum infection in children: consequences for additional blood sampling for research.

BackgroundPlasmodium falciparum infection may cause severe anaemia, particularly in children. When planning a diagnostic study on children suspected of severe malaria in sub-Saharan Africa, it was questioned how much blood could be safely sampled; intended blood volumes (blood cultures and EDTA blood) were 6 mL (children aged <6 years) and 10 mL (6–12 years). A previous review [Bull World Health Organ. 89: 46–53. 2011] recommended not to exceed 3.8 % of total blood volume (TBV). In a simulation exercise using data of children previously enrolled in a study about severe malaria and bacteraemia in Burkina Faso, the impact of this 3.8 % safety guideline was evaluated.MethodsFor a total of 666 children aged >2 months to <12 years, data of age, weight and haemoglobin value (Hb) were available. For each child, the estimated TBV (TBVe) (mL) was calculated by multiplying the body weight (kg) by the factor 80 (ml/kg). Next, TBVe was corrected for the degree of anaemia to obtain the functional TBV (TBVf). The correction factor consisted of the rate ‘Hb of the child divided by the reference Hb’; both the lowest (‘best case’) and highest (‘worst case’) reference Hb values were used. Next, the exact volume that a 3.8 % proportion of this TBVf would present was calculated and this volume was compared to the blood volumes that were intended to be sampled.ResultsWhen applied to the Burkina Faso cohort, the simulation exercise pointed out that in 5.3 % (best case) and 11.4 % (worst case) of children the blood volume intended to be sampled would exceed the volume as defined by the 3.8 % safety guideline. Highest proportions would be in the age groups 2–6 months (19.0 %; worst scenario) and 6 months–2 years (15.7 %; worst case scenario). A positive rapid diagnostic test for P. falciparum was associated with an increased risk of violating the safety guideline in the worst case scenario (p = 0.016).ConclusionsBlood sampling in children for research in P. falciparum endemic settings may easily violate the proposed safety guideline when applied to TBVf. Ethical committees and researchers should be wary of this and take appropriate precautions.

Asymptomatic Plasmodium falciparum infection in children is associated with increased auto-antibody production, high IL-10 plasma levels and antibodies to merozoite surface protein 3.

BackgroundMechanisms of acquired protection to malaria in asymptomatic Plasmodium falciparum carriers are only partially understood. Among them, the role plays by the self-reactive antibodies has not been clarified yet. In this study, the relationship between repertoires of circulating self-reactive and parasite-specific immunoglobulin G (IgG), their correlation with cytokine levels, and their association with protection against malaria was investigated in asymptomatic Plasmodium falciparum-infected Gabonese children.MethodsThe diversity of P. falciparum-specific antibody repertoire was analysed using a protein micro-array immunoassay, the total auto-antibody repertoire by quantitative immunoblotting and circulating cytokine levels were measured by ELISA in endemic controls (EC) and P. falciparum-infected children from Gabon with asymptomatic (AM) or mild malaria (MM). The association of self- and parasite-specific antibody repertoires with circulating cytokines was evaluated using single linkage hierarchical clustering, Kruskal – Wallis tests and Spearman’s rank correlation.ResultsChildren with AM exhibited an IgG response to merozoite surface protein 3 (MSP3) but not to MSP1-19, although their levels of total P. falciparum-specific IgG were similar to those in the MM group. Moreover, the asymptomatic children had increased levels of autoantibodies recognising brain antigens. In addition, a correlation between IL-10 levels and parasite load was found in AM and MM children. These two groups also exhibited significant correlations between plasma levels of IL-10 and IFN-γ with age and with total plasma IgG levels. IL-10 and IFN-γ levels were also associated with auto-antibody responses in AM.ConclusionsAltogether, these results indicate that a self-reactive polyclonal response associated with increased IgG to MSP3 and high plasma levels of IL-10 and IFN-γ may contribute to protective immune mechanisms triggered in asymptomatic P. falciparum infection in Gabonese children.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0658-7) contains supplementary material, which is available to authorized users.

Metabolic Signature Profiling as a Diagnostic and Prognostic Tool in Pediatric Plasmodium falciparum Malaria.

Background. Accuracy in malaria diagnosis and staging is vital to reduce mortality and post infectious sequelae. In this study, we present a metabolomics approach to diagnostic staging of malaria infection, specifically Plasmodium falciparum infection in children. Methods. A group of 421 patients between 6 months and 6 years of age with mild and severe states of malaria with age-matched controls were included in the study, 107, 192, and 122, individuals, respectively. A multivariate design was used as basis for representative selection of 20 patients in each category. Patient plasma was subjected to gas chromatography-mass spectrometry analysis, and a full metabolite profile was produced from each patient. In addition, a proof-of-concept model was tested in a Plasmodium berghei in vivo model where metabolic profiles were discernible over time of infection. Results. A 2-component principal component analysis revealed that the patients could be separated into disease categories according to metabolite profiles, independently of any clinical information. Furthermore, 2 subgroups could be identified in the mild malaria cohort who we believe represent patients with divergent prognoses. Conclusions. Metabolite signature profiling could be used both for decision support in disease staging and prognostication.

Fatal cerebral malaria: a venous efflux problem.

Most Plasmodium falciparum-infected children with cerebral malaria (CM) die from respiratory arrest, but the underlying pathology is unclear. Here we present a model in which the ultimate cause of death from CM is severe intracranial hypertension. Dynamic imaging of mice infected with P. berghei ANKA, an accepted model for experimental CM, revealed that leukocyte adhesion impairs the venous blood flow by reducing the functional lumen of postcapillary venules (PCV). The resulting increase in intracranial pressure (ICP) exacerbates cerebral edema formation, a hallmark of both murine and pediatric CM. We propose that two entirely different pathogenetic mechanisms—cytoadherence of P. falciparum-infected erythrocytes in pediatric CM and leukocyte arrest in murine CM—result in the same pathological outcome: a severe increase in ICP leading to brainstem herniation and death from respiratory arrest. The intracranial hypertension (IH) model unifies previous hypotheses, applies to human and experimental CM alike, eliminates the need to explain any selective recognition mechanism Plasmodium might use to target multiple sensitive sites in the brain, and explains how an intravascular parasite can cause so much neuronal dysfunction.

Limited Genetic Diversity and Low Multiplicity of Plasmodium falciparum Infections in Children with Severe Malaria in Lafia, North-central Nigeria

Background/Purpose Malaria remains one of the most devastating parasitic diseases in the world. Its pathogenesis is still not clearly understood, although there are indications that several factors between the parasites, the host, and the environment may be involved. In malaria-endemic regions, Plasmodium falciparum infection is characterized by extensive genetic diversity. Describing this diversity provides important information about the local epidemiology of malaria and is crucial for understanding the parasite population structure and virulence, and for evaluating the impact of malaria control measures. The objective of this study was to characterize the genetic diversity of P. falciparum isolates in children with severe malaria by using polymerase chain reaction (PCR) genotyping of the highly polymorphic merozoite surface protein 2 (MSP-2) gene as a molecular marker. Methods One hundred and sixteen children who presented with symptoms of severe malaria and who had microscopically confirmed P. falciparum monoinfection were enrolled in the study after they satisfied the inclusion criteria. Parasite DNA was extracted from the blood spot on to filter paper and analyzed by genotyping the MSP-2 gene using allele-specific nested PCR. Results Twenty-six distinct MSP-2 alleles (13 FC27 alleles and 13 3D7 alleles) were detected in the study population. However, isolates of the 3D7 alleles were predominant in the population (55%), compared to isolates of the FC27 alleles (45%). However, this difference was not statistically significant. The multiplicity of infection (MOI) by P. falciparum was 1.3. Most isolates (66%) were monoclonal infections with one distinguishable clone per infected child. Conclusion The present data suggest a low complexity of P. falciparum infection in isolates of individuals with severe malaria in the study population. The data also show that most infections were monoclonal. Furthermore, no specific genotype was associated with severe malaria in this study.

Statins Decrease Neuroinflammation and Prevent Cognitive Impairment after Cerebral Malaria

Cerebral malaria (CM) is the most severe manifestation of Plasmodium falciparum infection in children and non-immune adults. Previous work has documented a persistent cognitive impairment in children who survive an episode of CM that is mimicked in animal models of the disease. Potential therapeutic interventions for this complication have not been investigated, and are urgently needed. HMG-CoA reductase inhibitors (statins) are widely prescribed for cardiovascular diseases. In addition to their effects on the inhibition of cholesterol synthesis, statins have pleiotropic immunomodulatory activities. Here we tested if statins would prevent cognitive impairment in a murine model of cerebral malaria. Six days after infection with Plasmodium berghei ANKA (PbA) mice displayed clear signs of CM and were treated with chloroquine, or chloroquine and lovastatin. Intravital examination of pial vessels of infected animals demonstrated a decrease in functional capillary density and an increase in rolling and adhesion of leukocytes to inflamed endothelium that were reversed by treatment with lovastatin. In addition, oedema, ICAM-1, and CD11b mRNA levels were reduced in lovastatin-treated PbA-infected mice brains. Moreover, HMOX-1 mRNA levels are enhanced in lovastatin-treated healthy and infected brains. Oxidative stress and key inflammatory chemokines and cytokines were reduced to non-infected control levels in animals treated with lovastatin. Fifteen days post-infection cognitive dysfunction was detected by a battery of cognition tests in animals rescued from CM by chloroquine treatment. In contrast, it was absent in animals treated with lovastatin and chloroquine. The outcome was similar in experimental bacterial sepsis, suggesting that statins have neuroprotective effects in severe infectious syndromes in addition to CM. Statin treatment prevents neuroinflammation and blood brain barrier dysfunction in experimental CM and related conditions that are associated with cognitive sequelae, and may be a valuable adjuvant therapeutic agent for prevention of cognitive impairment in patients surviving an episode of CM.

A direct comparison of real time PCR on plasma and blood to detect Plasmodium falciparum infection in children

BackgroundEstimation of Plasmodium falciparum parasitaemia can vary with the method used and time of sampling. Quantitative real time PCR (qPCR) on whole blood or plasma samples has previously been shown to be more sensitive than thick film microscopy. However the efficiencies of each method have not been compared using samples obtained from infants less than one year old.MethodsA multiple of statistical approaches were used to compare the performance of qPCR on whole blood or plasma to detect the 18 S ribosomal gene of P. falciparum in 548 samples from children aged 2.5 or 24 months. Parasite prevalence in matched samples was compared using Mcnemar’s test and agreement of positive results quantified as Kappa scores. Parasite prevalences between different age groups were compared by Fisher’s test. Results from analyses by thick film microscopy were also available from children at 24 months and their correlation to each qPCR method examined by the Spearman’s test. Finally the association of P. falciparum infection with the incidence of multiple malaria episodes from contact to 24 months of age was evaluated using negative binomial regression.ResultsThese analyses showed that qPCR from whole blood detected approximately 3-fold more cases of infection than plasma qPCR. Both qPCR methods agreed well with each other although qPCR from plasma had a greater agreement with microscopy (96.85%) than did qPCR from blood (69.7%). At 24 months the prevalence of infection detected by all methods was associated with anaemia (p < 0.05).ConclusionsThe data presented here demonstrates that low levels of parasitaemia are better detected by qPCR using parasite DNA from whole blood than from plasma. However plasma samples provide a viable substitute when parasite smears are unavailable.

Changes in the levels of cytokines, chemokines and malaria-specific antibodies in response to Plasmodium falciparum infection in children living in sympatry in Mali

BackgroundThe Fulani are known to be less susceptible to Plasmodium falciparum malaria as reflected by lower parasitaemia and fewer clinical symptoms than other sympatric ethnic groups. So far most studies in these groups have been performed on adults, which is why little is known about these responses in children. This study was designed to provide more information on this gap.MethodsCirculating inflammatory factors and antibody levels in children from the Fulani and Dogon ethnic groups were measured. The inflammatory cytokines; interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12p70, tumor necrosis factor (TNF) and the chemokines; regulated on activation normal T cell expressed and secreted (RANTES), monokine-induced by IFN-gamma (MIG), monocyte chemotactic protein (MCP)-1 and IFN-gamma-inducible protein (IP)-10 were measured by cytometric bead arrays. The levels of interferon (IFN)-alpha, IFN-gamma and malaria-specific antibodies; immunoglobulin (Ig) G, IgM and IgG subclasses (IgG1-IgG4) were measured by ELISA.ResultsThe results revealed that the Fulani children had higher levels of all tested cytokines compared to the Dogon, in particular IFN-gamma, a cytokine known to be involved in parasite clearance. Out of all the tested chemokines, only MCP-1 was increased in the Fulani compared to the Dogon. When dividing the children into infected and uninfected individuals, infected Dogon had significantly lower levels of RANTES compared to their uninfected peers, and significantly higher levels of MIG and IP-10 as well as MCP-1, although the latter did not reach statistical significance. In contrast, such patterns were not seen in the infected Fulani children and their chemokine levels remained unchanged upon infection compared to uninfected counterparts. Furthermore, the Fulani also had higher titres of malaria-specific IgG and IgM as well as IgG1-3 subclasses compared to the Dogon.ConclusionsTaken together, this study demonstrates, in accordance with previous work, that Fulani children mount a stronger inflammatory and antibody response against P. falciparum parasites compared to the Dogon and that these differences are evident already at an early age. The inflammatory responses in the Fulani were not influenced by an active infection which could explain why less clinical symptoms are seen in this group.

Control Using Genetically Modified Insects Poses Problems for Regulators

Control Using Genetically Modified Insects Poses Problems for Regulators

Assessment of exposure to Plasmodium falciparum transmission in a low endemicity area by using multiplex fluorescent microsphere-based serological assays

BackgroundThe evaluation of malaria transmission intensity is a crucial indicator for estimating the burden of malarial disease. In this respect, entomological and parasitological methods present limitations, especially in low transmission areas. The present study used a sensitive multiplex assay to assess the exposure to Plasmodium falciparum infection in children living in an area of low endemicity. In three Senegalese villages, specific antibody (IgG) responses to 13 pre-erythrocytic P. falciparum peptides derived from Lsa1, Lsa3, Glurp, Salsa, Trap, Starp, Csp and Pf11.1 proteins were simultaneously evaluated before (June), at the peak (September) and after (December) the period of malaria transmission, in children aged from 1 to 8 years.ResultsCompared to other antigens, a high percentage of seropositivity and specific antibody levels were detected with Glurp, Salsa1, Lsa3NR2, and Lsa1J antigens. The seropositivity increased with age for all tested antigens. Specific IgG levels to Glurp, Salsa1, Lsa3NR2, and Lsa1J were significantly higher in P. falciparum infected children compared to non-infected and this increase is significantly correlated with parasite density.ConclusionThe multiplex assay represents a useful technology for a serological assessment of rapid variations in malaria transmission intensity, especially in a context of low parasite rates. The use of such combined serological markers (i.e. Glurp, Lsa1, Lsa3, and Salsa) could offer the opportunity to examine these variations over time, and to evaluate the efficacy of integrated malaria control strategies.

Recrudescent Plasmodium falciparum infections in children in an endemic area following artemisinin–based combination treatments: Implications for disease control

Objective To evaluate the features and risk factors associated with recrudescent infections that arose following artemisinin-based combination drug treatment of the primary infections. Methods The clinical features and risk factors associated with subsequent recrudescence of primary Plasmodium falciparum infections were evaluated in 37 of 877 children following artesunate or artemisinin-based combination treatments (ACTs). Recrudescence was determined by polymerase chain reaction. Results Compared to children with sensitive infections, children with recrudescent infections had significantly higher gametocytaemia and proportion with parasitaemia >50 000/μL. Compared with primary infections, recrudescent infections that arose from primary infections were accompanied by significantly fewer symptoms, lower body temperatures and asexual parasitaemias. In age- and gender-matched children with and without recrudescence, declines in parasitaemias following treatment were monoexponential but elimination half-life of parasitaemia was significantly longer in children with recrudescence. In a multiple regression model, at enrolment, 3 factors were independent risk factors for subsequent recrudescence of primary infections: parasitaemia ⩾50 000/μL [adjusted odds ratio (AOR)=2.63, 95% confidence interval ( CI): 1.17-5.90, P=0.018], parasite clearance time ⩾2 days (AOR=2.47, 95% CI: 1.24-4.90, P=0.04) and treatment with artesunate compared with ACTs (AOR=2.35, 95% CI: 1.08-5.12, P=0.03). Conclusions Recrudescent infections following artesunate or ACTs differ significantly from the primary infections from which they arose and have implications for malaria control efforts in Sub-Saharan Africa where ACTs are now first-line treatments.

Haematological changes and recovery associated with treated and untreated Plasmodium falciparum infection in children in the Mount Cameroon Region

Pre-hospital antimalarial treatment of febrile children remains a significant common practice among individuals in the Mount Cameroon region. To evaluate the effect of routinely administered monotherapy sulphadoxine pyrimethamine (SP), treatment using amodiaquine artesunate (AQAS) combination therapy and untreated malaria on haematological and parasitological parameters, 332 malaria positive subjects were assigned to three groups comprising 138 children treated with AQAS, 43 treated with SP and 151 untreated. The changes and recovery in red cell indices, white blood cell and differential and platelets counts were compared. The highest haematological recovery (39.1%) occurred in the AQAS treatment group. The majority (94%) of the untreated cases never achieved haematological recovery even though there was spontaneous clearance of parasites in some cases. Haematological insult was greatest in untreated children followed by those treated with SP, the 1.1 - 3 year age group whether or not they received treatment and in those with high parasitaemia. Delayed parasite clearance observed in the untreated and SP treatment group may be responsible for the occurrence of haematological insult. Treatment type and parasitological cure was associated with haematological recovery. Prompt use of effective arthemisinin combination therapy reduced the burden of malaria, hence the greater clinical and haematological benefits observed in our study. Key words: Malaria, children, anaemia, haemoglobin, treatment, haematological recovery.

Genetic Diversity of Plasmodium falciparum Strains in Children under Five Years of Age in Southeastern Tanzania~!2009-10-12~!2010-01-12~!2010-05-05~!

Strain diversity may play a role in delaying development of protective immunity in endemic areas. We evaluated genetic diversity of Plasmodium falciparum infected children before being treated with Sulphadoxine Pyrimethamine (SP) and Coartem™ in Southeastern Tanzania. Allelic diversity of P. falciparum strains were determined in order to further assist in correct estimation of recrudescent and new infections. P. falciparum isolated from 300 children aged 1-59 months was used in the study, where nested PCR followed by Restriction Fragment Length Polymorphism (RFLP) of highly polymorphic Merozoite surface protein 2 (msp2) was employed to understand the genetic diversity of the parasites population. Frequency of msp2 gene alleles was calculated and further associated with multiplicity of infection of children under five years of age. A total of 71 and 83 different msp2 alleles were found in Rufiji and Ulanga districts respectively. Children infected with either FC27 or 3D7 allelic type in Rufiji were 42% single, 55.3% double and 2.7% triple, while in Ulanga, 36.7% single, 62% double and 1.3% triple infections. Mean numbers of multiplicity of infections (MOI) in Rufiji and Ulanga were 1.6 and 1.3, respectively. These findings show a high genetic diversity of P. falciparum strains in study areas and low MOI could reflect production of susceptible parasites that immune response can accommodate or can be cleared by the drugs. Furthermore, 3D7 allelic type of msp2 gene was more prevalent than FC27 in Ulanga district, indicating association between msp2 allelic type and disease severity, hence predict possible vaccine candidate in the future.