Impact of Multiplicity of Plasmodium falciparum Infection on Clinical Disease in Malawi

Dominique Earland Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;

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Andrea G. Buchwald Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;

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Alick Sixpence Malaria Alert Centre, Communicable Disease Action Centre, University of Malawi College of Medicine, Blantyre, Malawi;

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Mabvuto Chimenya Malaria Alert Centre, Communicable Disease Action Centre, University of Malawi College of Medicine, Blantyre, Malawi;

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Milius Damson Malaria Alert Centre, Communicable Disease Action Centre, University of Malawi College of Medicine, Blantyre, Malawi;

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Karl B. Seydel College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan

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Don P. Mathanga Malaria Alert Centre, Communicable Disease Action Centre, University of Malawi College of Medicine, Blantyre, Malawi;

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Terrie E. Taylor College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan

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Miriam K. Laufer Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland;

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Multiplicity of infection (MOI), the number of unique Plasmodium falciparum parasite genotypes found in one infected individual, may contribute to the development of clinical malaria disease. However, the independent contribution of MOI and parasite density to clinical disease has not been well characterized. We conducted a two-year longitudinal cohort study of adults and children in a high-transmission setting in Malawi to test the hypothesis that increased MOI was independently associated with clinical disease, after accounting for parasite density. Of 1,062 episodes of infection, 477 (44.9%) were associated with symptoms. After controlling for repeated measures within an individual, key demographic factors, and parasite density, there was no association between MOI and clinical disease (OR = 1.02, 95% CI: 0.70–1.51). Although the limited ability to discern MOI in low-density asymptomatic infections may have impacted our results, we conclude that MOI is not an independent risk factor for clinical disease.

Author Notes

Address correspondence to Miriam K. Laufer, 685 W. Baltimore St., HSF-1 Rm. 480, Baltimore, MD 21201. E-mail: mlaufer@som.umaryland.edu

Disclosure: The material and content in this manuscript are original. The study was approved by the ethical review committee of the University of Malawi College of Medicine and University of Maryland College of Medicine.

Financial support: This work was supported by the National Institutes of Health Malawi International Center of Excellence for Malaria Research grant [U19AI089683], the National Institute of Allergy and Infectious Disease [K24AI114996]. This research was also supported by the University of Maryland, Baltimore, Postbaccalaureate Research Education Program [R25GM113262].

Authors’ addresses: Dominique Earland, Andrea G. Buchwald, and Miriam K. Laufer, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, E-mails: dearland@som.umaryland.edu, andreabuchwald@umaryland.edu, and mlaufer@som.umaryland.edu. Alick Sixpence, Mabvuto Chimenya, Milius Damson, and Don P. Mathanga, Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi, E-mails: asixpence@mac.medcol.mw, mschim06@gmail.com, milliusd@gmail.com, and dmathang@mac.medcol.mw. Karl B. Seydel and Terrie E. Taylor, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, E-mails: seydel@msu.edu and ttmalawi@msu.edu.

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