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LETTER TO THE EDITOR

Dear Sir:

Gérardin and others¹ in a hospital-based study carried out in Senegal reported that thrombocytopenia in African children can predict the severity of malaria caused by Plasmodium falciparum and the prognosis of the disease. In this study, a significant association between median platelet counts and malarial death was found. These investigators concluded that thrombocytopenia could be used as a valid prognostic indicator for P. falciparum malaria in African children living in areas of low transmission.

We wish to express our concern regarding the validity of applying such findings in all settings. We believe that in countries where the prevalence of human immunodeficiency virus (HIV) is high (i.e., 10% or more), the positive predictive value of thrombocytopenia for a poor outcome of malaria still remains to be established. Indeed, thrombocytopenia associated with HIV is a common finding^2,3 that is immunemediated and clinically expressed through purpura. Moreover, immune thrombocytopenia as a complication of infection with HIV frequently occurs in childhood.⁴ In neonates, thrombocytopenia is used as a marker of exposure to HIV in utero. In a cross-sectional study carried out in South Africa, 34 neonates exposed to HIV (HIV-positive by an enzyme-linked immunosorbent assay) were identified. Sixteen (47%) had thrombocytopenia and no underlying cause other than HIV was identified.⁵ Thrombocytopenia has also been described as a common manifestation in children up to 13 years of age in a systematic review on HIV infection in children.⁶

As the prevalence of HIV infection continues to increase in many African malaria-endemic countries, HIV infection should be considered as a major confounding factor in the association between thrombocytopenia and poor outcome of P. falciparum malaria in children.

1. Gérardin P, Rogier C, Ka AS, Jouvencel P, Brousse V, Imbert P, 2002. Prognostic value of thrombocytopenia in African children with falciparum malaria. Am J Trop Med Hyg 66: 686–691.[Abstract]
2. Gillis S, Eldor A, 1998. Immune thrombocytopenic purpura in adults: clinical aspects. Baillieres Clin Haematol 11: 361–372.[Web of Science][Medline]
3. Scaradavou A, 2002. HIV-related thrombocytopenia. Blood Rev 16: 73–76.[Web of Science][Medline]
4. Monpoux F, Kurzenne J, Sirvent N, Cottalorda J, Boutte P, 1999. Partial splenectomy in a child with human immunodeficiency virus-related immune thrombocytopenia. J Pediatr Hematol Oncol 21: 441–443.[Web of Science][Medline]
5. Roux W, Pieper C, Cotton M, 2001. Thrombocytopenia as marker for HIV exposure in the neonate. J Trop Pediatr 47: 208–210.[Abstract/Free Full Text]
6. Hoernle E, Reid T, 1995. Human immunodeficiency virus infection in children. Am J Health Syst Pharm 52: 961–979.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by MOERMAN, F. Articles by D’ALESSANDRO, U. Search for Related Content PubMed PubMed Citation Articles by MOERMAN, F. Articles by D’ALESSANDRO, U.