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LOW PREVALENCE OF AN ACUTE PHASE RESPONSE IN ASYMPTOMATIC CHILDREN FROM A MALARIA-ENDEMIC AREA OF PAPUA NEW GUINEA

HEATHER IMRIE, FREYA J. I. FOWKES, PASCAL MICHON, LIVINGSTONE TAVUL, JOHN C. REEDER, AND KAREN P. DAY^*

Levels of C-reactive protein (CRP), a classic marker for the acute phase response (APR), were measured in children with asymptomatic malaria infection in the Amele region of Papua New Guinea (PNG). Despite the presence of parasitemia, the prevalence of CRP levels consistent with an APR (CRP > 10 µg/mL) was very low (< 10%). Splenomegaly was significantly associated with increased parasitemia (P < 0.001) and CRP levels (P < 0.001), highlighting the importance of splenomegaly as an indicator of recent high density infection in this population. Multivariate analysis showed that CRP levels were significantly associated with splenomegaly, fever, hemoglobin, and age (P 0.002). CRP levels also increased with increasing parasitemia (P < 0.001) but remained < 3.5 µg/mL. The low levels of CRP indicate that children in the Amele modulate inflammation associated with malaria.

Received May 24, 2006. Accepted for publication October 12, 2006.

Financial support: This work was funded by the Wellcome Trust and the European Community (E.C. Grant IC18-CT98-0359).

^* Address correspondence to Karen Day, Department of Medical Parasitology, New York University School of Medicine, 341 East 25th Street, New York, NY 10010. E-mail: karen.day{at}med.nyu.edu

These authors contributed equally to the work.

Authors’ addresses: Heather Imrie and Peter Medawar, Building for Pathogen Research, Department of Zoology, South Parks Road, University of Oxford, Oxford OX1 3SY, UK, E-mail: heather.imrie{at}medawar.ox.ac.uk. Freya J. I. Fowkes and K. P. Day, Department of Medical Parasitology, New York University School of Medicine, 341 East 25th Street, New York, NY 10010, Telephone: 212-263-6800, Fax: 212-263-8116, E-mail: freya.fowkes{at}med.nyu.edu and Karen.day{at}med.nyu.edu. Pascal Michon, and Livingstone Tavul, Papua New Guinea Institute of Medical Research, PO Box 378, Madang 511, Papua New Guinea, Telephone: 675-852-2909, Fax: 675-852-3289, E-mail: pmichon{at}datec.net.pg and livingstone.tavul{at}pngimr.org.pg. John C. Reeder, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, EHP 441, Papua New Guinea, E-mail: john.reeder{at}pngimr.org.pg.