Mandala Wilson, Munyenyembe Alinane, Sulani Innocent, Soko Monica, Mallewa Jane, Hiestand Jasmin
Basic Sciences Department, Kamuzu University of Health Sciences, Blantyre, Malawi.
Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
J Blood Med. 2022 Sep 5;13:485-494. doi: 10.2147/JBM.S376476. eCollection 2022.
malaria has been linked with significant perturbations of the peripheral cell-mediated immune system during acute phase. Some of these changes include lower than normal platelet counts. Although the exact mechanisms that drive thrombocytopenia in malaria are not fully known, a number of hypotheses have been proposed. We conducted two sets of studies with one aimed at determining platelet counts in Malawian children, and the other in adults during acute malaria and a month post treatment.
We recruited a total of 113 HIV-uninfected children with acute malaria [n=54 with uncomplicated malaria (UCM), n=30 with severe malarial anemia (SMA), n=29 presenting with cerebral malaria (CM)]. We also recruited 42 HIV-uninfected healthy controls. Out of the 113 participants with malaria, 73 (65%) [n=34 (63%) UCM, n=21 (70%) SMA and n=18 (62%) CM] were successfully followed-up one month after treatment. A 5mL peripheral blood sample was collected for platelet count using HMX Haematological Analyzer analysis both at baseline (acute malaria) and at follow-up a month later. Platelet counts were also determined in blood samples of 106 HIV-uninfected adults, 47 of whom presented with UCM and 29 with severe malaria (SM) and these counts were compared to those of 30 healthy controls. Of the malaria cases, platelet counts for 44 UCM and 21 SM were determined again during follow-up a month after treatment.
In both children and adults, platelet counts were significantly lower during acute disease compared to the levels in the healthy controls with the lowest levels observed in CM (children) or SM (adults). These lower than normal levels increased close to normal levels a month post treatment.
malaria in Malawian children and adults was characterized by profound thrombocytopenia which recovered during convalescence.
疟疾与急性期外周细胞介导的免疫系统的显著紊乱有关。其中一些变化包括血小板计数低于正常水平。尽管导致疟疾血小板减少的确切机制尚不完全清楚，但已经提出了一些假说。我们进行了两组研究，一组旨在确定马拉维儿童的血小板计数，另一组则是在成人急性疟疾期间及治疗后一个月进行。
我们共招募了113名未感染艾滋病毒的急性疟疾儿童[54例无并发症疟疾（UCM），30例严重疟疾贫血（SMA），29例脑型疟疾（CM）]。我们还招募了42名未感染艾滋病毒的健康对照者。在113名疟疾参与者中，73名（65%）[34名（63%）UCM，21名（70%）SMA和18名（62%）CM]在治疗后一个月成功进行了随访。在基线（急性疟疾）和一个月后的随访时，采集5mL外周血样本，使用HMX血液分析仪分析血小板计数。还对106名未感染艾滋病毒的成年人的血液样本进行了血小板计数，其中47例患有UCM，29例患有严重疟疾（SM），并将这些计数与30名健康对照者的计数进行比较。在疟疾病例中，44例UCM和21例SM在治疗后一个月的随访期间再次测定了血小板计数。
在儿童和成人中，与健康对照者相比，急性疾病期间血小板计数均显著降低，在CM（儿童）或SM（成人）中观察到最低水平。这些低于正常水平在治疗后一个月接近正常水平。
马拉维儿童和成人的疟疾特征是严重血小板减少，在恢复期恢复。
