Plasma parasitemia as assessed by quantitative PCR in relation to clinical disease severity in African adults with falciparum malaria with and without HIV co-infection.

Autor: Berg A; Department of Medicine, Stavanger University Hospital, PO Box 8100, 4068, Stavanger, Norway. aaseberg@lyse.net., Patel S; Department of Medicine, Central Hospital of Maputo, Maputo, Mozambique., Tellevik MG; Norwegian National Advisory Unit On Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway., Haanshuus CG; Norwegian National Advisory Unit On Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway., Dalen I; Department of Research, Stavanger University Hospital, 4011, Stavanger, Norway., Otterdal K; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372, Oslo, Norway., Ueland T; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372, Oslo, Norway.; K. G. Jepsen Inflammatory Research Centre, University of Oslo, 0424, Oslo, Norway.; Faculty of Medicine, University of Oslo, 0316, Oslo, Norway.; Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway., Moyo SJ; Department of Clinical Science, University of Bergen, 5021, Bergen, Norway.; Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania., Aukrust P; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372, Oslo, Norway.; K. G. Jepsen Inflammatory Research Centre, University of Oslo, 0424, Oslo, Norway.; Faculty of Medicine, University of Oslo, 0316, Oslo, Norway.; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, 0372, Oslo, Norway., Langeland N; Norwegian National Advisory Unit On Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway.; Department of Clinical Science, University of Bergen, 5021, Bergen, Norway.; Haraldsplass Deaconess Hospital, Bergen, Norway.
Jazyk: angličtina
Zdroj: Infection [Infection] 2020 Jun; Vol. 48 (3), pp. 367-373. Date of Electronic Publication: 2020 Feb 19.
DOI: 10.1007/s15010-020-01399-3
Abstrakt: Purpose: When 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.
Methods: In 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.
Results: Of 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.
Conclusions: This 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.
Databáze: MEDLINE
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