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Am. J. Trop. Med. Hyg., 80(1), 2009, pp. 146-151
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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Comparative Hematologic Analysis of Uncomplicated Malaria in Uniquely Different Regions of Unstable Transmission in Brazil and Colombia

Olga Caicedo, Oscar Ramirez, Maria P. G. Mourão, Jose Ziadec, Pilar Perez, João B. Santos, Francisco Quiñones, Maria G. C. Alecrim, Myriam Arévalo-Herrera, Marcus V. G. Lacerda*, AND Sócrates Herrera*
Malaria Vaccine and Drug Development Center, Cali, Colombia; Immunology Institute, School of Health, Valle State University, Cali, Colombia; Clinical Research Institute Fundación Clínica Valle del Lili, Cali, Colombia; San Andres Hospital, Tumaco, Colombia; Department of Nariño Health Service, Colombia; University of Brasília, Brazil; Tropical Medicine Foundation of Amazonas, Manaus, Brazil

Information on malaria-associated anemia in adult patients is scarce in South American populations. From 2004 to 2006, malaria patients 18 to 45 years of age were recruited in a descriptive cross-sectional study from two different towns: Manaus, in the Brazilian Amazon (120 patients) where Plasmodium falciparum incidence is lower ({approx}20%), and in Tumaco on the Colombian Pacific Coast (126 patients) where P. falciparum incidence is higher ({approx}90%). Relationships between hematologic parameters and independent variables were explored using cross-tabulations and multiple linear regression analyses. We found an inverse relationship of hemoglobin (Hb) levels with days of illness in both sites. In Manaus but not in Tumaco, red cell distribution width (RDW) was related to asexual parasitemia. Reticulocytes were higher in Plasmodium vivax infection in Tumaco. Only in Tumaco, two patients with P. falciparum infection presented with severe anemia (Hb < 7 g/dL). Etiologic factors associated with hematologic changes in malaria seem to be multifactorial. More studies are needed to clarify the anemia determinants in uncomplicated malaria in South America, where malaria transmission is mostly unstable.

Received August 25, 2008. Accepted for publication October 6, 2008.

Acknowledgments: We thank Dr. Tania Cruel from San Andres Hospital for her advice and collaboration during the evaluation of the patients, Miss Janeth Castillo from San Andres Hospital and Mrs. Raimunda Ericilda Soares de Araújo from the Tropical Medicine Foundation of Amazonas for their technical assistance. We also thank Dr. Donald Skillman for the linguistic review of the manuscript.

Financial support: This work was supported by the Colombian Institute for Science and Technology Development (COLCIENCIAS) (Grant 255/2005), a co-operation grant from COLCIENCIAS/ Brazilian National Council for Scientific and Technological Development (CNPq) (Grant 491217/2005-6), and by the Fogarty International Center (Grant 5-D43-TW005885-04).

* Address correspondence to Marcus V. G. Lacerda, Fundação de Medicina Tropical do Amazonas, Av. Pedro Teixeira, 25, 69040-000, Manaus, Amazonas, Brazil, E-mail: marcuslacerda{at}uol.com.br or to Sócrates Herrera, Instituto de Inmunología, Facultad de Medicina, Universidad del Valle, AA 25574, Cali, Colombia, E-mail: sherrera{at}inmuno.org.

Authors’ addresses: Olga Caicedo, Jose Ziadec, Pilar Perez, Francisco Quiñones, Myriam Arévalo-Herrera, and Sócrates Herrera, Instituto de Inmunología, Facultad de Medicina, Universidad del Valle, San Fernando, AA 25574, Cali, Colombia, Tel: 57-2-558-1931, Fax: 57-2-557-0449, E-mail: sherrera{at}inmuno.org. Oscar Ramírez, Clinical Research Institute Fundación Clínica Valle del Lili, Cali, Colombia, Tel: 57-2-331-9090. Maria P. G. Mourão, Maria G. C. Alecrim, and Marcus V. G. Lacerda, Fundação de Medicina Tropical do Amazonas, Av. Pedro Teixeira, 25, 69040-000, Manaus, Amazonas, Brazil, Tel/Fax: 55-92-3656-0620, E-mail: marcuslacerda{at}uol.com.br. João B. Santos, Núcleo de Medicina Tropical, Universidade de Brasília, Campus Darcy Ribeiro, 70904-970, Brasília, Brazil, Tel: 55-61-3273-5008, Fax: 55-61-3273-2811, E-mail: joaobarberino{at}yahoo.com.br.

Reprint requests: Sócrates Herrera, Instituto de Inmunología, Facultad de Medicina, Universidad del Valle, San Fernando, AA 25574, Cali, Colombia or Marcus Lacerda, Fundação de Medicina Tropical do Amazonas, Av. Pedro Teixeira, 25, 69040-000, Manaus, Amazonas, Brazil, E-mails: sherrera{at}inmuno.org and marcuslacerda{at}vol.com.br.






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Copyright © 2009 by the American Society of Tropical Medicine and Hygiene.