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Platelet-Mediated Clumping of Plasmodium falciparum–Infected Erythrocytes Is Associated with High Parasitemia but Not Severe Clinical Manifestations of Malaria in African Children

Platelet-mediated clumping of Plasmodium falciparum–infected erythrocytes is an adhesive phenotype commonly found in field isolates that has previously been associated with severe malaria. Here, clumping was assessed in 131 isolates from Malian children. The clumping phenotype was seen in 6% (N = 51) of uncomplicated malaria, 24% (N = 51) of severe malaria, and 45% (N = 29) of high parasitemia non-severe malaria isolates. Multivariate analysis indicated that clumping was strongly positively associated with parasitemia (F_1,122 = 24.1, P < 0.001) but not with disease category (F_2,122 = 1.8, P = 0.17). Therefore platelet-mediated clumping in Malian P. falciparum isolates is primarily associated with high parasitemia and not with severe clinical manifestations of malaria.

Received February 22, 2007. Accepted for publication April 13, 2007.

Acknowledgments: We are grateful to the Bandiagara Malaria Project team for assistance and to the patients and their parents for participation in the study.

Financial support: This work was supported by the Wellcome Trust (Senior Research Fellowship to JAR, Grant 067431) and the NIH (Contract N01-AI-85346). MA is a recipient of a fellowship from Fundación Ramón Areces (Spain).

Disclosure: None of the authors have commercial or other associations that might pose a conflict of interest.

^* Address correspondence to J. Alexandra Rowe, Institute of Immunology and Infection Research, University of Edinburgh, West Mains Rd, Edinburgh, EH9 3JT UK. E-mail: alex.rowe{at}ed.ac.uk

Authors’ addresses: Mònica Arman, Ahmed Raza and J. Alexandra Rowe, Institute of Immunology and Infection Research, University of Edinburgh, West Mains Rd, Edinburgh, EH9 3JT, UK, Tel 44-131-650-5492, Fax 44-131-650-6564, Email Alex.Rowe{at}ed.ac.uk. Louisa J. Tempest, Institute of Evolutionary Biology, University of Edinburgh, West Mains Rd, Edinburgh, EH9 3JT, UK, Fax 44-131-650-6564. Kirsten E. Lyke and Christopher V. Plowe, Malaria Section, Center for Vaccine Development, University of Maryland School of Medicine, 685 West Baltimore St, HSF1-480, Baltimore MD 21201, Fax 410-706-6205. Mahamadou A. Thera, Abdoulaye Kone and Ogobara K. Doumbo, Malaria Research and Training Center, Département d’Epidémiologie des Affections Parasitaires, Faculté de Médecine, de Pharmacie et d’Odonto-Stomatologie, BP 1805 Bamako, Mali, Telephone/Fax: 223-222-8109.

Reprint requests: J. Alexandra Rowe, Institute of Immunology and Infection Research, University of Edinburgh, West Mains Rd, Edinburgh, EH9 3JT UK. E-mail: alex.rowe{at}ed.ac.uk.