Hematologic Parameters in Pediatric Uncomplicated Plasmodium falciparum Malaria in Sub-Saharan Africa

Piero Olliaro United Nations Children's Fund/United Nations Development Program/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland; Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford United Kingdom; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Pharmacy, University of Bamako, Bamako, Mali; Department of Medicine, University of California, San Francisco, California; National Malaria Control Programme, Kigali, Rwanda; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Parasitology, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal; Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso; Clinical Epidemiology and Public Health Unit, Centre for Health Studies, Centre de Recherche Publique–Santé, Strassen, Luxembourg; Drugs for Neglected Diseases Initiative, Geneva, Switzerland

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Abdoulaye Djimdé United Nations Children's Fund/United Nations Development Program/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland; Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford United Kingdom; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Pharmacy, University of Bamako, Bamako, Mali; Department of Medicine, University of California, San Francisco, California; National Malaria Control Programme, Kigali, Rwanda; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Parasitology, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal; Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso; Clinical Epidemiology and Public Health Unit, Centre for Health Studies, Centre de Recherche Publique–Santé, Strassen, Luxembourg; Drugs for Neglected Diseases Initiative, Geneva, Switzerland

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Grant Dorsey United Nations Children's Fund/United Nations Development Program/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland; Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford United Kingdom; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Pharmacy, University of Bamako, Bamako, Mali; Department of Medicine, University of California, San Francisco, California; National Malaria Control Programme, Kigali, Rwanda; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Parasitology, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal; Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso; Clinical Epidemiology and Public Health Unit, Centre for Health Studies, Centre de Recherche Publique–Santé, Strassen, Luxembourg; Drugs for Neglected Diseases Initiative, Geneva, Switzerland

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Corine Karema United Nations Children's Fund/United Nations Development Program/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland; Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford United Kingdom; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Pharmacy, University of Bamako, Bamako, Mali; Department of Medicine, University of California, San Francisco, California; National Malaria Control Programme, Kigali, Rwanda; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Parasitology, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal; Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso; Clinical Epidemiology and Public Health Unit, Centre for Health Studies, Centre de Recherche Publique–Santé, Strassen, Luxembourg; Drugs for Neglected Diseases Initiative, Geneva, Switzerland

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Andreas Mårtensson United Nations Children's Fund/United Nations Development Program/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland; Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford United Kingdom; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Pharmacy, University of Bamako, Bamako, Mali; Department of Medicine, University of California, San Francisco, California; National Malaria Control Programme, Kigali, Rwanda; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Parasitology, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal; Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso; Clinical Epidemiology and Public Health Unit, Centre for Health Studies, Centre de Recherche Publique–Santé, Strassen, Luxembourg; Drugs for Neglected Diseases Initiative, Geneva, Switzerland

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Jean-Louis Ndiaye United Nations Children's Fund/United Nations Development Program/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland; Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford United Kingdom; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Pharmacy, University of Bamako, Bamako, Mali; Department of Medicine, University of California, San Francisco, California; National Malaria Control Programme, Kigali, Rwanda; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Parasitology, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal; Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso; Clinical Epidemiology and Public Health Unit, Centre for Health Studies, Centre de Recherche Publique–Santé, Strassen, Luxembourg; Drugs for Neglected Diseases Initiative, Geneva, Switzerland

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Sodiomon B. Sirima United Nations Children's Fund/United Nations Development Program/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland; Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford United Kingdom; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Pharmacy, University of Bamako, Bamako, Mali; Department of Medicine, University of California, San Francisco, California; National Malaria Control Programme, Kigali, Rwanda; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Parasitology, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal; Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso; Clinical Epidemiology and Public Health Unit, Centre for Health Studies, Centre de Recherche Publique–Santé, Strassen, Luxembourg; Drugs for Neglected Diseases Initiative, Geneva, Switzerland

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Michel Vaillant United Nations Children's Fund/United Nations Development Program/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland; Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford United Kingdom; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Pharmacy, University of Bamako, Bamako, Mali; Department of Medicine, University of California, San Francisco, California; National Malaria Control Programme, Kigali, Rwanda; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Parasitology, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal; Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso; Clinical Epidemiology and Public Health Unit, Centre for Health Studies, Centre de Recherche Publique–Santé, Strassen, Luxembourg; Drugs for Neglected Diseases Initiative, Geneva, Switzerland

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Julien Zwang United Nations Children's Fund/United Nations Development Program/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland; Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford United Kingdom; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Pharmacy, University of Bamako, Bamako, Mali; Department of Medicine, University of California, San Francisco, California; National Malaria Control Programme, Kigali, Rwanda; Infectious Diseases Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Parasitology, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal; Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso; Clinical Epidemiology and Public Health Unit, Centre for Health Studies, Centre de Recherche Publique–Santé, Strassen, Luxembourg; Drugs for Neglected Diseases Initiative, Geneva, Switzerland

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DOI:
https://doi.org/10.4269/ajtmh.2011.11-0154
Volume/Issue:
Volume 85: Issue 4
Page(s):
619–625
Restricted access
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Hematologic changes in acute and convalescent uncomplicated Plasmodium falciparum malaria have not been well studied, particularly in young children in Africa. Hematologic data were obtained for 3,044 children less than five years of age in seven randomized controlled trials at 14 sites. Using paired analysis between day 28 and baseline in patients without parasitologic failure as a proxy for malaria-induced effects, we found a statistically significant but clinically modest increase in leukocyte counts (5%) resulting from a larger increase in neutrophils (43%) than the decrease in lymphocytes counts (–16%); levels of hemoglobin and platelets decreased (–13% and –49%, respectively). Multivariate random effects analysis showed trends during follow-up (increased levels of hemoglobin, platelets and lymphocytes, and decreased levels of leukocytes and neutrophils) and identified explanatory variables. The risk of neutropenia increased with follow-up time independent of treatment outcome, and was lower with age, higher baseline parasitemia, and artemisinin combination treatment. These analyses provides information on hematologic variations caused by malaria.

Author Notes

*Address correspondence to Piero Olliaro, Special Programme for Research and Training in Tropical Diseases, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland. E-mail: olliarop@who.int

Financial support: Julien Zwang was supported by a grant from the Drugs for Neglected Diseases Initiative for the analysis. This initiative is an independent, not-for-profit product developer in partnership working to research and develop new and improved treatments for neglected diseases. It sponsored one of the trials but had no role in the design and conduct of the analysis or interpretation of results reported in the article.

Disclosure: None of the authors have any conflicts of interest.

Authors' addresses: Piero Olliaro, Special Programme for Research and Training in Tropical Diseases, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland, E-mail: olliarop@who.int. Abdoulaye Djimdé, Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Pharmacy, University of Bamako, Bamako, Mali, E-mail: adjimde@mrtcbko.org. Grant Dorsey, Division of Infectious Diseases Department of Medicine, University of California, San Francisco, San Francisco CA, E-mail: gdorsey@medsfgh.ucsf.edu. Corine Karema, National Malaria Control Programme, Kigali, Rwanda, E-mail: ckarema@gmail.com. Andreas Mårtensson, Infectious Diseases Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden, E-mail: andreas.martensson@ki.se. Jean-Louis Ndiaye, Department of Parasitology, Faculty of Medicine, University Cheikh Anta Diop, Dakar, Senegal, E-mail: jlndiaye@yahoo.com. Sodiomon B. Sirima, Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso, E-mail: s.sirima.cnlp@fasonet.bf. Michel Vaillant, Clinical Epidemiology and Public Health Unit, Centre for Health Studies, Centre de Recherche Publique-Santé, 1A-B, Rue Thomas Edison L-1445, Strassen, Luxembourg, E-mail: michel.vaillant@crp-sante.lu. Julien Zwang, Drugs for Neglected Diseases Initiative, Geneva, Switzerland, 15 Chemin Louis-Dunant, 1202 Geneva, Switzerland, E-mail: zwang@free.fr.

Reprint requests: Piero Olliaro, Special Programme for Research and Training in Tropical Diseases, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland, E-mail: olliarop@who.int.

Copyright:
©The American Society of Tropical Medicine and Hygiene 2011
Received:
18 Mar 2011
|
Accepted:
19 May 2011
|
Published Online:
01 Oct 2011
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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