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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

Mònica ArmanInstitute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Center for Vaccine Development, University of Maryland, Baltimore, Maryland; Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali

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Ahmed RazaInstitute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Center for Vaccine Development, University of Maryland, Baltimore, Maryland; Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali

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Louisa J. TempestInstitute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Center for Vaccine Development, University of Maryland, Baltimore, Maryland; Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali

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Kirsten E. LykeInstitute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Center for Vaccine Development, University of Maryland, Baltimore, Maryland; Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali

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Mahamadou A. TheraInstitute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Center for Vaccine Development, University of Maryland, Baltimore, Maryland; Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali

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Abdoulaye KonéInstitute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Center for Vaccine Development, University of Maryland, Baltimore, Maryland; Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali

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Christopher V. PloweInstitute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Center for Vaccine Development, University of Maryland, Baltimore, Maryland; Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali

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Ogobara K. DoumboInstitute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Center for Vaccine Development, University of Maryland, Baltimore, Maryland; Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali

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J. Alexandra RoweInstitute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Center for Vaccine Development, University of Maryland, Baltimore, Maryland; Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali

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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 (F1,122 = 24.1, P < 0.001) but not with disease category (F2,122 = 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.

Author Notes

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@ed.ac.uk.
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