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Uncomplicated Plasmodium vivax malaria: mapping the proteome from circulating platelets. Clin Proteomics 2022; 19:1. [PMID: 34991449 PMCID: PMC8903537 DOI: 10.1186/s12014-021-09337-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 12/21/2021] [Indexed: 01/07/2023] Open
Abstract
Background Thrombocytopenia is frequent in Plasmodium vivax malaria but the role of platelets in pathogenesis is unknown. Our study explores the platelet (PLT) proteome from uncomplicated P. vivax patients, to fingerprint molecular pathways related to platelet function. Plasma levels of Platelet factor 4 (PF4/CXCL4) and Von Willebrand factor (VWf), as well as in vitro PLTs—P. vivax infected erythrocytes (Pv-IEs) interactions were also evaluated to explore the PLT response and effect on parasite development. Methods A cohort of 48 patients and 25 healthy controls were enrolled. PLTs were purified from 5 patients and 5 healthy controls for Liquid Chromatography–Mass spectrometry (LC–MS/MS) analysis. Plasma levels of PF4/CXCL4 and VWf were measured in all participants. Additionally, P. vivax isolates (n = 10) were co-cultured with PLTs to measure PLT activation by PF4/CXCL4 and Pv-IE schizonts formation by light microscopy. Results The proteome from uncomplicated P. vivax patients showed 26 out of 215 proteins significantly decreased. PF4/CXCL4 was significantly decreased followed by other proteins involved in platelet activation, cytoskeletal remodeling, and endothelial adhesion, including glycoprotein V that was significantly decreased in thrombocytopenic patients. In contrast, acute phase proteins, including SERPINs and Amyloid Serum A1 were increased. High levels of VWf in plasma from patients suggested endothelial activation while PF4/CXCL4 plasma levels were similar between patients and controls. Interestingly, high levels of PF4/CXCL4 were released from PLTs—Pv-IEs co-cultures while Pv-IEs schizont formation was inhibited. Conclusions The PLT proteome analyzed in this study suggests that PLTs actively respond to P. vivax infection. Altogether, our findings suggest important roles of PF4/CXCL4 during uncomplicated P. vivax infection through a possible intracellular localization. Our study shows that platelets are active responders to P. vivax infection, inhibiting intraerythrocytic parasite development. Future studies are needed to further investigate the molecular pathways of interaction between platelet proteins found in this study and host response, which could affect parasite control as well as disease progression. Supplementary Information The online version contains supplementary material available at 10.1186/s12014-021-09337-7.
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Abstract
BACKGROUND Plasmodium vivax infects an estimated 7 million people every year. Previously, vivax malaria was perceived as a benign condition, particularly when compared to falciparum malaria. Reports of the severe clinical impacts of vivax malaria have been increasing over the last decade. METHODS AND FINDINGS We describe the main clinical impacts of vivax malaria, incorporating a rapid systematic review of severe disease with meta-analysis of data from studies with clearly defined denominators, stratified by hospitalization status. Severe anemia is a serious consequence of relapsing infections in children in endemic areas, in whom vivax malaria causes increased morbidity and mortality and impaired school performance. P. vivax infection in pregnancy is associated with maternal anemia, prematurity, fetal loss, and low birth weight. More than 11,658 patients with severe vivax malaria have been reported since 1929, with 15,954 manifestations of severe malaria, of which only 7,157 (45%) conformed to the World Health Organization (WHO) diagnostic criteria. Out of 423 articles, 311 (74%) were published since 2010. In a random-effects meta-analysis of 85 studies, 68 of which were in hospitalized patients with vivax malaria, we estimated the proportion of patients with WHO-defined severe disease as 0.7% [95% confidence interval (CI) 0.19% to 2.57%] in all patients with vivax malaria and 7.11% [95% CI 4.30% to 11.55%] in hospitalized patients. We estimated the mortality from vivax malaria as 0.01% [95% CI 0.00% to 0.07%] in all patients and 0.56% [95% CI 0.35% to 0.92%] in hospital settings. WHO-defined cerebral, respiratory, and renal severe complications were generally estimated to occur in fewer than 0.5% patients in all included studies. Limitations of this review include the observational nature and small size of most of the studies of severe vivax malaria, high heterogeneity of included studies which were predominantly in hospitalized patients (who were therefore more likely to be severely unwell), and high risk of bias including small study effects. CONCLUSIONS Young children and pregnant women are particularly vulnerable to adverse clinical impacts of vivax malaria, and preventing infections and relapse in this groups is a priority. Substantial evidence of severe presentations of vivax malaria has accrued over the last 10 years, but reporting is inconsistent. There are major knowledge gaps, for example, limited understanding of the underlying pathophysiology and the reason for the heterogenous geographical distribution of reported complications. An adapted case definition of severe vivax malaria would facilitate surveillance and future research to better understand this condition.
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Affiliation(s)
| | - Prabin Dahal
- Infectious Diseases Data Observatory–IDDO, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Laos
- Lao–Oxford–Mahosot Hospital–Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao–Oxford–Mahosot Hospital–Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos
- * E-mail:
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Bienz M, Morin-Ben Abdallah S, Greenaway C, Pelletier JS, Caplan S, Knecht H. Severe Cystic Echinococcosis-Associated Immune Thrombocytopenic Purpura: A Case Report. J Hematol 2021; 10:71-75. [PMID: 34007368 PMCID: PMC8110226 DOI: 10.14740/jh789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/18/2021] [Indexed: 12/24/2022] Open
Abstract
We present a case of immune thrombocytopenic purpura (ITP), which leads to the diagnosis of severe cystic echinococcosis. Our patient presented with platelets of 5 × 109/L, and investigations uncovered multiple large echinococcal hepatic cysts, the largest of which measured 19.4 × 15 × 12 cm, and peritoneal implants. While initially refractory to prednisone and immunoglobulins, the ITP responded to dexamethasone. The echinococcosis was treated with albendazole followed by surgical resection of all lesions. Our patient’s disease course has evolved favorable since his initial treatment with an isolated episode of recurrent thrombocytopenia 2 years later, and has remained in remission for the past 2 years. While a causal association between echinococcosis and ITP cannot be confirmed, this case is a reminder of the importance of remaining inquisitive for atypical potential triggers of ITP. We also present a review of the limited literature on the association of parasitic infections and ITP.
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Affiliation(s)
- Marc Bienz
- Division of Hematology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Sami Morin-Ben Abdallah
- Division of Hematology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Christina Greenaway
- Division of Infectious Diseases, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Jean Sebastien Pelletier
- Division of General Surgery, Department of Surgery, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Stephen Caplan
- Division of Hematology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Hans Knecht
- Division of Hematology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
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Affiliation(s)
- Brendan J. McMorran
- Department of Immunology and Infectious Disease; John Curtin School of Medical Research; Australian National University; Canberra Australia
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Antinori S, Corona A, Ridolfo AL, Galimberti L, Ricaboni D, Milazzo L, Corbellino M. Imported Plasmodium vivax malaria with severe thrombocytopaenia: can it be severe malaria or not? Malar J 2016; 15:105. [PMID: 26893220 PMCID: PMC4759958 DOI: 10.1186/s12936-016-1150-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/04/2016] [Indexed: 01/20/2023] Open
Abstract
Background Thrombocytopaenia is the most frequent malaria-associated haematologic alteration observed with all five Plasmodium parasites causing disease in humans. Although not included in the World Health Organization criteria for severe Plasmodium falciparum malaria, severe thrombocytopaenia has been increasingly mentioned as an indicator of P. vivax malaria severity. Case Here, it is described a case of imported P. vivax malaria in a 37-year old man from Pakistan who presented with severe thrombocytopaenia (5 × 109/L). He was admitted to the intensive care unit and initially treated with a 1-day course of intravenous quinine followed by oral chloroquine and primaquine. The patient’s platelet count increased as early as 4 hours after treatment inception and the clinical course was favourable and uneventful. Discussion This case report, along with a review of published cases focusing on the relationship between thrombocytopaenia and severe P. vivax malaria, suggests that the prognostic role of severe thrombocytopaenia is ambiguous in absence of severe haemorraghic complications and its use as diagnostic criterion of malaria severity may lead to overestimation of severe P. vivax malaria cases. Conclusion Due to the lack of high quality studies it is at present unclear if severe thrombocytopaenia in the setting of P. vivax malaria should be considered indicative of severe malaria.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
| | | | - Anna Lisa Ridolfo
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
| | - Laura Galimberti
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
| | - Davide Ricaboni
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
| | - Laura Milazzo
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
| | - Mario Corbellino
- Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy.
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Ketema T, Bacha K, Alemayehu E, Ambelu A. Incidence of Severe Malaria Syndromes and Status of Immune Responses among Khat Chewer Malaria Patients in Ethiopia. PLoS One 2015; 10:e0131212. [PMID: 26173100 PMCID: PMC4501669 DOI: 10.1371/journal.pone.0131212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/30/2015] [Indexed: 12/22/2022] Open
Abstract
Although more emphasis has been given to the genetic and environmental factors that determine host vulnerability to malaria, other factors that might have a crucial role in burdening the disease have not been evaluated yet. Therefore, this study was designed to assess the effect of khat chewing on the incidence of severe malaria syndromes and immune responses during malaria infection in an area where the two problems co-exist. Clinical, physical, demographic, hematological, biochemical and immunological data were collected from Plasmodium falciparum mono-infected malaria patients (age ≥ 10 years) seeking medication in Halaba Kulito and Jimma Health Centers. In addition, incidences of severe malaria symptoms were assessed. The data were analyzed using SPSS (version 20) software. Prevalence of current khat chewer malaria patients was 57.38% (95%CI =53-61.56%). Malaria symptoms such as hyperpyrexia, prostration and hyperparasitemia were significantly lower (P<0.05) among khat chewer malaria patients. However, relative risk to jaundice and renal failure were significantly higher (P<0.05) in khat chewers than in non-khat chewer malaria patients. Longer duration of khat use was positively associated with incidence of anemia. IgM and IgG antibody titers were significantly higher (P<0.05) among khat chewer malaria patients than among malaria positive non-chewers. Although levels of IgG subclasses in malaria patients did not show significant differences (P>0.05), IgG3 antibody was significantly higher (P<0.001) among khat chewer malaria patients. Moreover, IgM, IgG, IgG1and IgG3 antibodies had significant negative association (P<0.001) with parasite burden and clinical manifestations of severe malaria symptoms, but not with severe anemia and hypoglycemia. Additionally, a significant increment (P<0.05) in CD4+ T-lymphocyte population was observed among khat users. Khat might be an important risk factor for incidence of some severe malaria complications. Nevertheless, it can enhance induction of humoral immune response and CD4+ T-lymphocyte population during malaria infection. This calls for further investigation on the effect of khat on parasite or antigen-specifc protective malaria immunity and analysis of cytokines released upon malaria infection among khat chewers.
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Affiliation(s)
- Tsige Ketema
- Department of Environmental Health Sciences and Technology, College of Health Sciences, Jimma University, Jimma, Ethiopia
- Department of Biology,College of Natural Sciences, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Ketema Bacha
- Department of Biology,College of Natural Sciences, Jimma University, Jimma, Ethiopia
| | - Esayas Alemayehu
- School of Civil and Environmental Engineering, Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Argaw Ambelu
- Department of Environmental Health Sciences and Technology, College of Health Sciences, Jimma University, Jimma, Ethiopia
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Subramaniam KS, Skinner J, Ivan E, Mutimura E, Kim RS, Feintuch CM, Portugal S, Anastos K, Crompton PD, Daily JP. HIV Malaria Co-Infection Is Associated with Atypical Memory B Cell Expansion and a Reduced Antibody Response to a Broad Array of Plasmodium falciparum Antigens in Rwandan Adults. PLoS One 2015; 10:e0124412. [PMID: 25928218 PMCID: PMC4415913 DOI: 10.1371/journal.pone.0124412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/13/2015] [Indexed: 11/18/2022] Open
Abstract
HIV infected individuals in malaria endemic areas experience more frequent and severe malaria episodes compared to non HIV infected. This clinical observation has been linked to a deficiency in antibody responses to Plasmodium falciparum antigens; however, prior studies have only focused on the antibody response to <0.5% of P. falciparum proteins. To obtain a broader and less-biased view of the effect of HIV on antibody responses to malaria we compared antibody profiles of HIV positive (HIV+) and negative (HIV-) Rwandan adults with symptomatic malaria using a microarray containing 824 P. falciparum proteins. We also investigated the cellular basis of the antibody response in the two groups by analyzing B and T cell subsets by flow cytometry. Although HIV malaria co-infected individuals generated antibodies to a large number of P. falciparum antigens, including potential vaccine candidates, the breadth and magnitude of their response was reduced compared to HIV- individuals. HIV malaria co-infection was also associated with a higher percentage of atypical memory B cells (MBC) (CD19+CD10-CD21-CD27-) compared to malaria infection alone. Among HIV+ individuals the CD4+ T cell count and HIV viral load only partially explained variability in the breadth of P. falciparum-specific antibody responses. Taken together, these data indicate that HIV malaria co-infection is associated with an expansion of atypical MBCs and a diminished antibody response to a diverse array of P. falciparum antigens, thus offering mechanistic insight into the higher risk of malaria in HIV+ individuals.
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Affiliation(s)
- Krishanthi S. Subramaniam
- Vector Biology Department, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Jeff Skinner
- Malaria Infection Biology and Immunity Unit, Laboratory of Immunogenetics, NIAID/NIH, Bethesda, Maryland, United States of America
| | - Emil Ivan
- Department of Biomedical Laboratory Sciences, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
| | - Eugene Mutimura
- Regional Alliance for Sustainable Development, Kigali, Rwanda
| | - Ryung S. Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Catherine M. Feintuch
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Silvia Portugal
- Malaria Infection Biology and Immunity Unit, Laboratory of Immunogenetics, NIAID/NIH, Bethesda, Maryland, United States of America
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Peter D. Crompton
- Malaria Infection Biology and Immunity Unit, Laboratory of Immunogenetics, NIAID/NIH, Bethesda, Maryland, United States of America
| | - Johanna P. Daily
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
- * E-mail:
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Ketema T, Yohannes M, Alemayehu E, Ambelu A. Effect of chronic khat (Catha edulis, Forsk) use on outcome of Plasmodium berghei ANKA infection in Swiss albino mice. BMC Infect Dis 2015; 15:170. [PMID: 25886020 PMCID: PMC4392739 DOI: 10.1186/s12879-015-0911-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/23/2015] [Indexed: 12/22/2022] Open
Abstract
Background The objective of this study was to explore effects of khat (Catha edulis) on outcome of rodent malaria infection and its anti-plasmodial activities on Plasmodium berghei ANKA (PbA). Methods Female Swiss albino mice were orally treated with crude khat (Catha edulis) extracts (100, 200 and 300 mg/kg) on a daily basis for 4 weeks prior to PbA infection. Physical, clinical, hematological, biochemical and histo-pathological features of the mice were assessed. In addition, in vivo anti-plasmodial activities of khat were evaluated. Results The finding of this study showed that khat use was strongly associated with increment of levels of liver and kidney biomarkers, leucopenia, severe anemia, rise in level of inflammation biomarkers: C-reactive protein (CRP), uric acid (UA), increased monocyte-lymphocyte count ratio (MLCR), manifestation of cerebral malaria symptoms such as ataxia, paralysis and deviation of the head but with no pulmonary edema. Significantly lower level of parasitemia (P < 0.05), rectal temperature, but, high level of hemoglobin were observed at the early stage of the PbA infection in khat treated mice than the control. With extension of the treatment period, however, drastic increments were observed in parasite load and rectal temperature although there was reduction in hemoglobin (Hb) level. Moreover, khat showed poor anti-plasmodial activity with <10% parasite suppression activity and lack protection against major malaria symptoms. The significant reduction (P < 0.01) of hematological parameters during PbA infection strengthen the notion that hematological parameters could be good predictors of severe malaria complications in human. Conclusions In mice model treated with khat prior to infection with the rodent malaria parasite, khat was found to worsen manifestation of most malaria complications. Furthermore, the same plant showed poor in vivo anti-plasmodial activity and protection against major malaria symptoms.
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Affiliation(s)
- Tsige Ketema
- Department of Environmental Health Sciences and Technology, College of Health Sciences, Jimma University, Jimma, Ethiopia. .,Department of Biology, College of Natural Sciences, Jimma University, Jimma, Ethiopia.
| | - Moti Yohannes
- Department of Microbiology and Veterinary Public Health, College of Agriculture and Veterinary Medicine, Jimma University, Jimma, Ethiopia.
| | - Esayas Alemayehu
- School of Civil and Environmental Engineering, Jimma University Institute of Technology, Jimma, Ethiopia.
| | - Argaw Ambelu
- Department of Environmental Health Sciences and Technology, College of Health Sciences, Jimma University, Jimma, Ethiopia.
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Raza A, Khan MS, Ghanchi NK, Raheem A, Beg MA. Tumour necrosis factor, interleukin-6 and interleukin-10 are possibly involved in Plasmodium vivax-associated thrombocytopaenia in southern Pakistani population. Malar J 2014; 13:323. [PMID: 25128199 PMCID: PMC4141950 DOI: 10.1186/1475-2875-13-323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 08/05/2014] [Indexed: 12/03/2022] Open
Abstract
Background In Pakistan, Plasmodium vivax is endemic causing approximately 70% of the malaria cases. A number of haematological changes, especially thrombocytopaenia have been reported for P. vivax. Several host factors including cell-mediated immune cells, such as IL-1, IL-6 and IL-10 have been documented for P. vivax-induced thrombocytopaenia. However, study on correlation of cytokines and thrombocytopaenia in P. vivax, particularly in patients with severe signs and symptoms has not been reported from Pakistan. Methods A case control study to correlate TNF, IL-6 and IL-10 in healthy controls and thrombocytopaenic P. vivax-infected patients (both uncomplicated and complicated cases) from southern Pakistan was carried out during January 2009 to December 2011. One Hundred and eighty two patients presenting with microscopy-confirmed asexual P. vivax mono-infection and 100 healthy controls were enrolled in the study at Aga Khan University Hospital, Karachi. Enzyme-linked immunosorbent assay (ELISA) was performed for determination of TNF, IL-6 and IL-10 levels. Results Out of 182 cases, mild thrombocytopaenia (platelet count 100,000-150,000 mm3) was observed in ten (5.5%), moderate (50,000-100,000 mm3) in 93 (51.1%), and profound thrombocytopaenia (<50,000 mm3) was detected in 79 (43.4%) patients. IL-6 and IL-10 levels were found approximately three-fold higher in the mild cases compared to healthy controls. Two-fold increase in TNF and IL-10 (p < 0.0001) was observed in profound thrombocytopaenic when compared with moderate cases, while IL-6 was not found to be significantly elevated. Conclusion Cytokines may have a possible role in P. vivax-induced thrombocytopaenia in Pakistani population. Findings from this study give first insight from Pakistan on the role of cytokines in P.vivax-associated thrombocytopaenia. However, further studies are required to understand the relevance of cytokines in manifestations of thrombocytopaenia in P. vivax malaria.
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Affiliation(s)
| | | | | | | | - Mohammad A Beg
- Department of Pathology and Microbiology, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
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Coelho HCC, Lopes SCP, Pimentel JPD, Nogueira PA, Costa FTM, Siqueira AM, Melo GC, Monteiro WM, Malheiro A, Lacerda MVG. Thrombocytopenia in Plasmodium vivax malaria is related to platelets phagocytosis. PLoS One 2013; 8:e63410. [PMID: 23723981 PMCID: PMC3665752 DOI: 10.1371/journal.pone.0063410] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/02/2013] [Indexed: 12/15/2022] Open
Abstract
Background Although thrombocytopenia is a hematological disorder commonly reported in malarial patients, its mechanisms are still poorly understood, with only a few studies focusing on the role of platelets phagocytosis. Methods and Findings Thirty-five malaria vivax patients and eight healthy volunteers (HV) were enrolled in the study. Among vivax malaria patients, thrombocytopenia (<150,000 platelets/µL) was found in 62.9% (22/35). Mean platelet volume (MPV) was higher in thrombocytopenic patients as compared to non- thrombocytopenic patients (p = 0.017) and a negative correlation was found between platelet count and MPV (r = −0.483; p = 0.003). Platelets from HV or patients were labeled with 5-chloromethyl fluorescein diacetate (CMFDA), incubated with human monocytic cell line (THP-1) and platelet phagocytosis index was analyzed by flow cytometry. The phagocytosis index was higher in thrombocytopenic patients compared to non-thrombocytopenic patients (p = 0.042) and HV (p = 0.048). A negative correlation was observed between platelet count and phagocytosis index (r = −0.402; p = 0.016). Platelet activation was assessed measuring the expression of P-selectin (CD62-P) in platelets’ surface by flow cytometry. No significant difference was found in the expression of P-selectin between thrombocytopenic patients and HV (p = 0.092). After evaluating the cytokine profile (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ and IL-17) in the patients’ sera, levels of IL-6, IL-10 and IFN-γ were elevated in malaria patients compared to HV. Moreover, IL-6 and IL-10 values were higher in thrombocytopenic patients than non-thrombocytopenic ones (p = 0.044 and p = 0.017, respectively. In contrast, TNF-α levels were not different between the three groups, but a positive correlation was found between TNF-α and phagocytosis index (r = −0.305; p = 0.037). Conclusion/Significance Collectively, our findings indicate that platelet phagocytosis may contribute to thrombocytopenia found in vivax malaria. Finally, we believe that this study opens new avenues to explore the mechanisms involved in platelet dysfunction, commonly found in vivax malaria patients.
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Affiliation(s)
- Helena Cristina C. Coelho
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | - João Paulo D. Pimentel
- Instituto Leônidas e Maria Deane, Fiocruz, Manaus, Amazonas, Brazil
- Fundação de Hematologia e Hemoterapia do Amazonas, Manaus, Amazonas, Brazil
| | | | | | - André M. Siqueira
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Gisely C. Melo
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Wuelton M. Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
| | - Adriana Malheiro
- Universidade Federal do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Hematologia e Hemoterapia do Amazonas, Manaus, Amazonas, Brazil
| | - Marcus V. G. Lacerda
- Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
- * E-mail:
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Bhattacharjee P, Dubey S, Gupta VK, Agarwal P, Mahato MP. The clinicopathologic manifestations of Plasmodium vivax malaria in children: a growing menace. J Clin Diagn Res 2013; 7:861-7. [PMID: 23814729 DOI: 10.7860/jcdr/2013/5652.2960] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 02/11/2013] [Indexed: 11/24/2022]
Abstract
CONTEXT Today, India faces increasing morbidity and mortality due to malaria, which is a global health burden. Plasmodium vivax which was once considered to have a benign course, is now being increasingly associated with complicated malaria. Studies which have been done on the increasing virulence of P. Vivax in children, are exceptionally rare. AIMS This study has addressed some of the hitherto unanswered questions, such as: This study has tried to explore the wide spectrum of severe illnesses which are associated with P.vivax malaria in children.Other co-morbid conditions, which include a co-infection with P.falciparum, have been excluded with great care, to assess the increased virulence of P. Vivax.The present study was focused on the paediatric population with a large sample size of 168 subjects. SETTINGS AND DESIGN This was an observational retrospective analysis on the clinicopathologic manifestations of the paediatric cases which were admitted with severe malaria due to a mono-infection with Plasmodium vivax, in a tertiary-care centre in the national capital region, India. METHODS AND MATERIAL The diagnosis of the mono-infection with P. Vivax malaria was established by making peripheral blood films (PBFs) and by doing rapid diagnostic tests. The severe forms of malaria were categorized as per the World Health Organization guidelines and the clinical and laboratory findings in these cases of complicated malaria were studied. STATISTICS A descriptive statistical analysis was done by using the SPSS software and an Excel worksheet. RESULTS This comprehensive study revealed a multisystem involvement. Abdominal manifestations were observed in 75(45.8%) cases (which included hepatosplenomegaly, hepatomegaly, splenomegaly and ascites) and hepatic dysfunction and jaundice were observed in 28(16.7%) cases. The haematological tests showed moderate to severe anaemia in 151(89.9%) cases and thrombocytopaenia in 138(82.1%) cases. Petechiae were noted in 45(26.8%) cases and a gross bleeding was noted in 9(5.3%) cases. The respiratory findings which included tachypnoea, pleural effusions and ARDS were observed in 22(13.1%) cases. Renal dysfunction was noted clinically in 20(11.9%) cases and biochemically in 16(9.5%) cases. Shock was observed in 7(4.1%) cases, cerebral malaria was observed in 10(5.9%) cases and hypoglycaemia was observed in 5(3%) cases. Multi-organ dysfunction was detected in 11(6.54%) cases. The complications were more severe in the younger children (0-5 years). CONCLUSIONS A mono-infection with P. Vivax may lead to severe malaria and this increased virulence has resulted in the changing picture of P. Vivax malaria, leading to a spectrum of complications which are similar to those which are traditionally associated with P. Falciparum.
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Yadav D, Chandra J, Dutta AK. Benign tertian malaria: how benign is it today? Indian J Pediatr 2012; 79:525-7. [PMID: 21706239 DOI: 10.1007/s12098-011-0514-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/15/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Dinesh Yadav
- Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India
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Yadav D, Chandra J, Aneja S, Kumar V, Kumar P, Dutta AK. Changing profile of severe malaria in north Indian children. Indian J Pediatr 2012; 79:483-7. [PMID: 22090254 DOI: 10.1007/s12098-011-0603-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To look for profile of severe malaria and contribution of vivax infection to malarial morbidity in North Indian children. METHODS Detailed clinical, biochemical and hematological characteristics of children hospitalized with severe malaria over last 3 y were recorded. Presence of malarial parasite on peripheral smear and/or positive antigen test was considered as diagnostic for malaria. RESULTS A total of 131(55.3%) patients with Plasmodium vivax (Pv), 79 (33.3%) with Plasmodium falciparum (Pf) and 27 (11.4%) with mixed infections were admitted. Cerebral malaria, severe anemia and shock were significantly more frequently observed in Pf group, while hepatic, renal, respiratory, and bleeding complications were more commonly seen in Pv patients. Malaria mortality was highest in mixed infection (11.1%), followed by Pf (7.6%) and Pv (3%) group. CONCLUSIONS Severe and fatal vivax malaria is an emerging recognized entity and challenges the perception of Pv as a benign disease. Further clinical studies and molecular research is required to understand emergence of severe malaria in vivax mono-infection.
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Affiliation(s)
- Dinesh Yadav
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.
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Serum proteome analysis of vivax malaria: An insight into the disease pathogenesis and host immune response. J Proteomics 2011; 75:3063-80. [PMID: 22086083 DOI: 10.1016/j.jprot.2011.10.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/24/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
Abstract
Vivax malaria is the most widely distributed human malaria resulting in 80-300 million clinical cases every year. It causes severe infection and mortality but is generally regarded as a benign disease and has not been investigated in detail. The present study aimed to perform human serum proteome analysis in a malaria endemic area in India to identify potential serum biomarkers for vivax malaria and understand host response. The proteomic analysis was performed on 16 age and gender matched subjects (vivax patients and control) in duplicate. Protein extraction protocols were optimized for large coverage of the serum proteome and to obtain high-resolution data. Identification of 67 differentially expressed and statistically significant (Student's t-test; p<0.05) protein spots was established by MALDI-TOF/TOF mass spectrometry. Many of the identified proteins such as apolipoprotein A and E, serum amyloid A and P, haptoglobin, ceruloplasmin, and hemopexin are interesting from a diagnostic point of view and could further be studied as potential serum biomarkers. The differentially expressed serum proteins in vivax malaria identified in this study were subjected to functional pathway analysis using multiple software, including Ingenuity Pathway Analysis (IPA), Protein ANalysis THrough Evolutionary Relationships (PANTHER) and Database for Annotation, Visualization and Integrated Discovery (DAVID) functional annotation tool for better understanding of the biological context of the identified proteins, their involvement in various physiological pathways and association with disease pathogenesis. Functional pathway analysis of the differentially expressed proteins suggested the modulation of multiple vital physiological pathways, including acute phase response signaling, complement and coagulation cascades, hemostasis and vitamin D metabolism pathway due to this parasitic infection. This article is part of a Special Issue entitled: Proteomics: The clinical link.
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Lacerda MVG, Mourão MPG, Coelho HCC, Santos JB. Thrombocytopenia in malaria: who cares? Mem Inst Oswaldo Cruz 2011; 106 Suppl 1:52-63. [DOI: 10.1590/s0074-02762011000900007] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/26/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Maria Paula Gomes Mourão
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Brasil; Universidade do Estado do Amazonas, Brasil; Universidade Nilton Lins, Brasil
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Singh H, Parakh A, Basu S, Rath B. Plasmodium vivax malaria: is it actually benign? J Infect Public Health 2011; 4:91-5. [PMID: 21663878 DOI: 10.1016/j.jiph.2011.03.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 03/07/2011] [Accepted: 03/09/2011] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Plasmodium vivax (Pv) malaria is being increasingly recognized as a cause of severe malaria in children. OBJECTIVES To describe the various severe manifestations associated with vivax malaria by retrospective analysis of records. METHODS Children between the ages of 0 and 18 years with a confirmed diagnosis of Pv malaria monoinfection done by peripheral blood film (PBF) and/or rapid diagnostic test (RDT) admitted between June and September 2009 were included. Their clinical, hematological and biochemical manifestations were analyzed. RESULTS Twenty-three patients of Pv malaria were retrospectively analyzed. Thrombocytopenia was present in 22 (96%) patients with counts less than 50,000/ μL in 9 patients. Severe anemia (hgb<5mg/dl) was present in 8 (34%) patients. Cerebral malaria was present in 3 patients. Liver enzymes were elevated (>3 times normal) in 4 (17.3%) patients while jaundice (bilirubin>2.5mg/dl) was present in 2 patients (total bilirubin 5.2mg/dl and 14.3mg/dl). Renal dysfunction (creatinine>3mg/dl) was present in 6 (26%) patients with 2 patients showing severely deranged renal functions (blood urea 168 mg/dl, 222 mg/dl and serum creatinine 5.0mg/dl, 5.6 mg/dl, respectively). Hypernatremia was present in one patient. One patient expired within 12h of presentation because of severely deranged hepatic and renal dysfunction. CONCLUSION Pv malaria can lead to unusual and fatal complications. All new guidelines should include "Severe Vivax malaria" as a clinical entity. Further research into the etiopathogenesis and treatment would be important.
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Affiliation(s)
- Harpal Singh
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India. dr
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Kochar DK, Das A, Kochar A, Middha S, Acharya J, Tanwar GS, Gupta A, Pakalapati D, Garg S, Saxena V, Subudhi AK, Boopathi PA, Sirohi P, Kochar SK. Thrombocytopenia in Plasmodium falciparum, Plasmodium vivax and mixed infection malaria: a study from Bikaner (Northwestern India). Platelets 2010; 21:623-7. [PMID: 21050055 DOI: 10.3109/09537104.2010.505308] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The occurrence, relation and magnitude of thrombocytopenia in different species of malaria are not clearly defined. This study included 1,064 patients admitted with malaria to study thrombocytopenia (platelet count <150,000 /cumm) in Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) mono infection and mixed infection (Pf + Pv). The species diagnosis was done by peripheral blood film (PBF) and rapid diagnostic test (RDT). Validation by polymerase chain reaction (PCR) was done only in patients with severe thrombocytopenia (platelet count <20,000 /cumm). The breakup of patients was 525 (49.34%) Pf, 460 (43.23%) Pv and 79 (7.42%) mixed malaria (Pf + Pv). Thrombocytopenia was observed in 24.6% (262/1064) patients. The risk was greatest in the mixed infections in comparison to monoinfection individually (43.04% [34/79]; mixed vs Pv monoinfection: Odds Ratio [OR] = 1.675 [95% Confidence Interval (CI) 1.029-2.726], p < 0.0366; mixed vs Pf monoinfection: OR=3.911 [95% CI 2.367-6.463], p < 0.0001). Pv monoinfection (31.09% [143/460]) had greater risk compared to Pf monoinfection (16.19% [85/525]; OR = 2.335 [95% CI 1.722-3.167], p < 0.0001). The occurrence of severe thrombocytopenia was also higher in Pv monoinfection (18.18% [26/143]) in comparison to either Pf monoinfection (10.59% [9/85], OR = 1.877 (95% CI 0.834-4.223)) or mixed infection (11.76% [4/34]; OR = 1.667 (95% CI 0.540-5.142) but this association was statistically not significant. Six patients (3 Pv, 2 Pf and 1 mixed) developed severe epistaxis requiring platelet transfusion. There was no relation between parasite density and platelet count as many patients with severe thrombocytopenia had parasite density similar to patients without thrombocytopenia. We found that the association of thrombocytopenia was statistically more significant with P. vivax monoinfection as compared to P. falciparum.
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George P, Alexander LM. A study on the clinical profile of complicated Plasmodium vivax mono–infections. ASIAN PAC J TROP MED 2010. [DOI: 10.1016/s1995-7645(10)60135-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Bhatia V, Bhatia J. Severe thrombocytopenia with bleeding manifestations in two children secondary to Plasmodium vivax. Platelets 2010; 21:307-9. [DOI: 10.3109/09537100903518278] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cox D, McConkey S. The role of platelets in the pathogenesis of cerebral malaria. Cell Mol Life Sci 2010; 67:557-68. [PMID: 20091081 PMCID: PMC11115904 DOI: 10.1007/s00018-009-0211-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 11/05/2009] [Indexed: 01/31/2023]
Abstract
Malaria is a major cause of morbidity and mortality in the developing world and cerebral malaria is responsible for the majority of malaria-associated deaths. There is a strong association between thrombocytopenia and outcome in malaria, suggesting a role for platelets in the pathogenesis of malaria. This thrombocytopenia is likely due to platelet activation possibly through an interaction between PfEMP1 on plasmodium and CD36 on platelets. Platelet activation by plasmodium has two potential consequences. It can lead to the formation of micro-aggregates of infected red blood cells and platelets which can occlude blood vessels and it also leads to binding to and activation of the endothelium.
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Affiliation(s)
- Dermot Cox
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
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Kwak BO, Chung S, Kim KS. A case of Plasmodium vivax malaria occurring during a school excursion to Pocheon-gun. KOREAN JOURNAL OF PEDIATRICS 2010. [DOI: 10.3345/kjp.2010.53.1.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Byung Ok Kwak
- Department of Pediatrics, School of Medicine, Konkuk University, Seoul, Korea
| | - Sochung Chung
- Department of Pediatrics, School of Medicine, Konkuk University, Seoul, Korea
| | - Kyo Sun Kim
- Department of Pediatrics, School of Medicine, Konkuk University, Seoul, Korea
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Taylor WRJ, Widjaja H, Basri H, Ohrt C, Taufik T, Tjitra E, Baso S, Fryauff D, Hoffman SL, Richie TL. Changes in the total leukocyte and platelet counts in Papuan and non Papuan adults from northeast Papua infected with acute Plasmodium vivax or uncomplicated Plasmodium falciparum malaria. Malar J 2008; 7:259. [PMID: 19094197 PMCID: PMC2642516 DOI: 10.1186/1475-2875-7-259] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Accepted: 12/18/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited data on the evolution of the leukocyte and platelet counts in malaria patients. METHODS In 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. RESULTS The mean Day 0 WCC (n = 152) was 6.492 (range 2.1-13.4) x 10(9)/L and was significantly lower in the Papuans compared to the non Papuans: 5.77 x 10(9)/L vs. 6.86 x 10(9)/L, difference = -1.09 [(95% CI -0.42 to -1.79 x 10(9)/L), P = 0.0018]. 14 (9.2%) and 9 (5.9%) patients had leukopaenia (<4.0 x 10(9)/L) and leukocytosis (>10.0 x 10(9)/L), respectively. By Day 28, the mean WCC increased significantly (P = 0.0003) from 6.37 to 7.47 x 10(9)/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) x 10(9)/L and rose significantly to 186.308 x 10(9)/L by Day 28 (P < 0.0001). There was a corresponding fall in patient proportions with thrombocytopaenia (<150 x 10(9)/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 x 10(9)/L) vs. falciparum (122.125 x 10(9)/L) patients. CONCLUSION Changes 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.
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Francischetti IMB. Does activation of the blood coagulation cascade have a role in malaria pathogenesis? Trends Parasitol 2008; 24:258-63. [PMID: 18467176 DOI: 10.1016/j.pt.2008.03.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Revised: 02/06/2008] [Accepted: 03/04/2008] [Indexed: 11/30/2022]
Abstract
Plasmodium falciparum infection is often associated with a procoagulant state. Recent identification of tissue factor in the brain endothelium of patients who have died from cerebral malaria casts new light on our understanding of the coagulation disorder found in P. falciparum infection. It has also been revealed that parasitized red blood cells support the assembly of multimolecular coagulation complexes. Tissue factor expression by the endothelium and amplification of the coagulation cascade by parasitized red blood cells and/or activated platelets (particularly at sequestration sites) have crucial roles in mounting and sustaining a coagulation-inflammation cycle which contributes to organ dysfunction and coma in falciparum malaria.
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Affiliation(s)
- Ivo M B Francischetti
- Vector Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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Francischetti IMB, Seydel KB, Monteiro RQ. Blood coagulation, inflammation, and malaria. Microcirculation 2008; 15:81-107. [PMID: 18260002 DOI: 10.1080/10739680701451516] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Malaria remains a highly prevalent disease in more than 90 countries and accounts for at least 1 million deaths every year. Plasmodium falciparum infection is often associated with a procoagulant tonus characterized by thrombocytopenia and activation of the coagulation cascade and fibrinolytic system; however, bleeding and hemorrhage are uncommon events, suggesting that a compensated state of blood coagulation activation occurs in malaria. This article (i) reviews the literature related to blood coagulation and malaria in a historic perspective, (ii) describes basic mechanisms of coagulation, anticoagulation, and fibrinolysis, (iii) explains the laboratory changes in acute and compensated disseminated intravascular coagulation (DIC), (iv) discusses the implications of tissue factor (TF) expression in the endothelium of P. falciparum infected patients, and (v) emphasizes the procoagulant role of parasitized red blood cells (RBCs) and activated platelets in the pathogenesis of malaria. This article also presents the Tissue Factor Model (TFM) for malaria pathogenesis, which places TF as the interface between sequestration, endothelial cell (EC) activation, blood coagulation disorder, and inflammation often associated with the disease. The relevance of the coagulation-inflammation cycle for the multiorgan dysfunction and coma is discussed in the context of malaria pathogenesis.
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Affiliation(s)
- Ivo M B Francischetti
- Vector Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-8132, USA.
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Kim JS, Oh JS, Chang EA, Bae SY, Nam DH, Lee CH, Yang JH, Lee CK, Lee WJ, Kim HC, Klein TA, Lim CS, Kim YK. Alteration of platelet counts and lipid profiles after treatment of acute Plasmodium vivax. Acta Trop 2008; 106:39-43. [PMID: 18304498 DOI: 10.1016/j.actatropica.2008.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 10/12/2007] [Accepted: 01/13/2008] [Indexed: 12/13/2022]
Abstract
During malaria infections, thrombocytopenia and low cholesterol levels are frequently observed changes. We compared these changes in patients admitted with fevers and infected with Plasmodium vivax, patients admitted with fevers with respiratory/urinary infections and afebrile normal (control) non-infected volunteers. Changes in the platelet count and lipid parameters are reported for malaria patients after treatment with hydroxychloroquine and primaquine for acute P. vivax malaria. Of a total 141 participants, 55 patients were diagnosed with malaria (positive blood smear) prior to treatment. Compared to the normal (n=52) and non-malaria fever groups (n=34), there was a significant decrease in five hematologic indices (white blood cell, red blood cell, hemoglobin, hematocrit and platelet) and three lipid parameters (total cholesterol, HDL-c and LDL-c) in the vivax malaria group at day 0 (pre-treatment). Following treatment, the platelet counts returned to normal limits (P<0.05) from 91,058/microL on day 0 to 246,833/microL by day 17 after treatment. However, changes in the lipid parameters of malaria patients showed a slow recovery to normal limits compared to the platelet counts. The HDL-c and LDL-c remained low for 1 month after treatment but increased at 3 and 6 months post-treatment. At 12 months after treatment, the levels of two lipid parameters had fully recovered to the normal limits. Thus, special attention should be applied when interpreting laboratory blood profiles of malaria patients, especially platelet and lipid based tests, until full recovery after treatment.
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Rodríguez-Morales AJ, Sánchez E, Vargas M, Piccolo C, Colina R, Arria M, Franco-Paredes C. Occurrence of Thrombocytopenia in Plasmodium vivax Malaria. Clin Infect Dis 2005; 41:130-1. [PMID: 15937782 DOI: 10.1086/430837] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Perez MT, Morand J, Bush LM, Crankshaw K, Sudduth NC. Hematological Laboratory Findings in Patients of an Autochthonous Plasmodium vivax Malaria Outbreak. Lab Med 2004. [DOI: 10.1309/mud0eeg6bvayjxpy] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Lacerda MVG, Alexandre MAA, Santos PD, Arcanjo ARL, Alecrim WD, Alecrim MGC. Idiopathic thrombocytopenic purpura due to vivax malaria in the Brazilian Amazon. Acta Trop 2004; 90:187-90. [PMID: 15177145 DOI: 10.1016/j.actatropica.2003.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Revised: 09/16/2003] [Accepted: 12/09/2003] [Indexed: 11/22/2022]
Abstract
We describe a rare case of idiopathic thrombocytopenic purpura (ITP) triggered by Plasmodium vivax infection. The patient developed thrombocytopenia and bleeding associated with three episodes of malaria, and became dependent on corticosteroid therapy. The mechanisms by which this parasite evokes thrombocytopenia remain obscure.
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Affiliation(s)
- M V G Lacerda
- Laboratory of Malaria, Tropical Medicine Foundation of Amazonas, Avenida Pedro Teixeira 25, 69.040-000 Manaus, Amazonas, Brazil.
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Song HH, O SO, Kim SH, Moon SH, Kim JB, Yoon JW, Koo JR, Hong KS, Lee MG, Kim DJ, Shin DH, Kang SH, Choi MG, Lee KH. Clinical features of Plasmodium vivax malaria. Korean J Intern Med 2003; 18:220-4. [PMID: 14717229 PMCID: PMC4531638 DOI: 10.3904/kjim.2003.18.4.220] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Since its reemergence in 1993, a number of cases of Plasmodium vivax malaria have been reported in Korea. We analyzed the cases of malaria patients living in Chuncheon and its neighboring communities, to characterize its clinical manifestations and laboratory findings, and to identify any differences between our clinical findings and those of previous studies. METHODS We reviewed the clinical records of cases that were confirmed as malaria by peripheral blood smear at Chuncheon Sacred Heart Hospital from July 1998 to September 2001. RESULTS Forty-four cases were included in the study. All patients were infected with Plasmodium vivax, and presented with high fever; however, tertian fever developed in only 15 patients (35.7%). A number of cases showed various symptoms, which included headache, abdominal pain, nausea and vomiting. Of the 44 cases identified, 41 (93.2%) developed malaria between June and September. Thrombocytopenia was a prominent finding in 75% of the cases at diagnosis, but resolved during or after therapy. Other laboratory abnormalities such as, anemia, elevated transamines, coagulopathies, and elevated lactose dehydrogenase (LDH) were also noted. Cerebrospinal fluid (CSF) studies were performed in five cases, one of which showed pleocytosis in the CSF. CONCLUSION We noted only 15 patients (35.7%) with tertian fever; the other patients showed variable fever patterns. Thrombocytopenia was the most prominent laboratory finding. Therefore, we suggest that malaria should be included in the differential diagnosis of febrile diseases with an onset between June to and September, regardless of the pattern of the fever.
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Affiliation(s)
- Hun Ho Song
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea.
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MESH Headings
- Antimalarials/therapeutic use
- Autoantibodies/blood
- Chloroquine/therapeutic use
- Erythrocyte Transfusion
- Humans
- Malaria, Cerebral/complications
- Malaria, Cerebral/drug therapy
- Malaria, Cerebral/immunology
- Malaria, Falciparum/complications
- Malaria, Falciparum/drug therapy
- Malaria, Falciparum/immunology
- Male
- Middle Aged
- Platelet Membrane Glycoproteins/immunology
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Purpura, Thrombocytopenic, Idiopathic/therapy
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Scott CS, Van Zyl D, Ho E, Ruivo L, Mendelow B, Coetzer TL. Thrombocytopenia in patients with malaria: automated analysis of optical platelet counts and platelet clumps with the Cell Dyn CD4000 analyser. CLINICAL AND LABORATORY HAEMATOLOGY 2002; 24:295-302. [PMID: 12358891 DOI: 10.1046/j.1365-2257.2002.00466.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Platelet counts and automated detection of platelet clumps were evaluated by optical analysis with the Abbott CD4000 analyser (Abbott Diagnostics, Santa Clara, CA, USA) in this South African study of 828 samples referred for malaria investigations. Based on microscopy (Micro) and rapid tests (RT) for HRP2 protein and parasite-associated LDH, malaria negative samples (n = 417) were defined as Micro-, RT-. Convalescent cases (n = 64) were Micro-, RT+ and had a recent record of positive microscopy. Malaria positive cases were subdivided into Micro+ (n = 315) and Micro-, RT+, PCR+ (polymerase chain reaction) (n = 32) subgroups. The mean platelet count for Micro+ cases (89.7 x 10(9)/l) was significantly lower than both the malaria negative (mean 212.6 x 10(9)/l) and convalescent malaria (mean 152.8 x 10(9)/l) groups; 89% of microscopy positive cases were thrombocytopenic (< 150 x 10(9)/l) and 30% had severe thrombocytopenia (< 50 x 10(9)/l). For comparison, 32% of the 417 malaria negative samples were thrombocytopenic and 6% of these were severe. Two thirds of samples with parasitaemia above 10% had platelet counts of < 50 x 10(9)/l while the counts were largely independent of parasite numbers when the parasitaemia was below 10%. Thirty percent of samples with microscopically detectable parasites had a PltClmp flag compared to 13% of the malaria negative group but, when the actual platelet count was taken into account, it became apparent that appearance of the flag was primarily associated with thrombocytopenia per se rather than malaria status. In most samples with a PltClmp flag, the CD4000 optical platelet clump 'signature' was indicative of small platelet aggregates and giant platelets. Morphological examination confirmed the presence of varying numbers of small platelet aggregates (3-12 individual platelets), often together with increased giant platelets, in many samples with a PltClmp flag. The observations suggest that while patients with malaria may be predisposed to the development of thrombocytopenia, a reduced platelet count in some patients may also be due in part to pseudo-thrombocytopenia.
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Affiliation(s)
- C S Scott
- Department of Molecular Medicine and Haematology, South African Institute for Medical Research, University of the Witwatersrand, Johannesburg, South Africa.
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Bommart S, Ponge T, Marjolet M, Barrier JH. Un mystère épais. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC. Disorders of Hemostasis. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Jain P, Kumar R, Kumar L, Gujral S, Singh HP, Gupta S, Goel S. Chronic myeloid leukemia complicated by megaloblastic anemia and malaria: An unusual association confounding the assessment of the phase of CML. MEDICAL AND PEDIATRIC ONCOLOGY 1999; 33:403-4. [PMID: 10491551 DOI: 10.1002/(sici)1096-911x(199910)33:4<403::aid-mpo11>3.0.co;2-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P Jain
- Unit of Laboratory Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
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