Increased Plasmodium falciparum Gametocyte Production in Mixed Infections with P. malariae

J. Teun Bousema Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; Kenya Medical Research Institute, Nairobi, Kenya; Human Health Division, International Centre of Insect Physiology and Ecology, Nairobi, Kenya; Unité de Recherche 016, Institut de Recherche pour le Développement, Ouagadougou, Burkina Faso

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Chris J. Drakeley Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; Kenya Medical Research Institute, Nairobi, Kenya; Human Health Division, International Centre of Insect Physiology and Ecology, Nairobi, Kenya; Unité de Recherche 016, Institut de Recherche pour le Développement, Ouagadougou, Burkina Faso

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Petra F. Mens Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; Kenya Medical Research Institute, Nairobi, Kenya; Human Health Division, International Centre of Insect Physiology and Ecology, Nairobi, Kenya; Unité de Recherche 016, Institut de Recherche pour le Développement, Ouagadougou, Burkina Faso

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Theo Arens Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; Kenya Medical Research Institute, Nairobi, Kenya; Human Health Division, International Centre of Insect Physiology and Ecology, Nairobi, Kenya; Unité de Recherche 016, Institut de Recherche pour le Développement, Ouagadougou, Burkina Faso

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Rein Houben Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; Kenya Medical Research Institute, Nairobi, Kenya; Human Health Division, International Centre of Insect Physiology and Ecology, Nairobi, Kenya; Unité de Recherche 016, Institut de Recherche pour le Développement, Ouagadougou, Burkina Faso

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Sabah A. Omar Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; Kenya Medical Research Institute, Nairobi, Kenya; Human Health Division, International Centre of Insect Physiology and Ecology, Nairobi, Kenya; Unité de Recherche 016, Institut de Recherche pour le Développement, Ouagadougou, Burkina Faso

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Louis C. Gouagna Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; Kenya Medical Research Institute, Nairobi, Kenya; Human Health Division, International Centre of Insect Physiology and Ecology, Nairobi, Kenya; Unité de Recherche 016, Institut de Recherche pour le Développement, Ouagadougou, Burkina Faso

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Henk Schallig Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; Kenya Medical Research Institute, Nairobi, Kenya; Human Health Division, International Centre of Insect Physiology and Ecology, Nairobi, Kenya; Unité de Recherche 016, Institut de Recherche pour le Développement, Ouagadougou, Burkina Faso

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Robert W. Sauerwein Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; KIT Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands; Kenya Medical Research Institute, Nairobi, Kenya; Human Health Division, International Centre of Insect Physiology and Ecology, Nairobi, Kenya; Unité de Recherche 016, Institut de Recherche pour le Développement, Ouagadougou, Burkina Faso

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Plasmodium falciparum and P. malariae occur endemically in many parts of Africa. Observations from malariotherapy patients suggest that co-infection with P. malariae may increase P. falciparum gametocyte production. We determined P. falciparum gametocyte prevalence and density by quantitative nucleic acid sequence-based amplification (QT-NASBA) after antimalarial treatment of Kenyan children with either P. falciparum mono-infection or P. falciparum and P. malariae mixed infection. In addition, we analyzed the relationship between mixed species infections and microscopic P. falciparum gametocyte prevalence in three datasets from previously published studies. In Kenyan children, QT-NASBA gametocyte density was increased in mixed species infections (P = 0.03). We also observed higher microscopic prevalences of P. falciparum gametocytes in mixed species infections in studies from Tanzania and Kenya (odds ratio = 2.15, 95% confidence interval = 0.99–4.65 and 2.39, 1.58–3.63) but not in a study from Nigeria. These data suggest that co-infection with P. malariae is correlated with increased P. falciparum gametocytemia.

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