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Treatment of Chronic Asymptomatic Plasmodium falciparum Infection Does Not Increase the Risk of Clinical Malaria Upon Reinfection.
Clin Infect Dis. 2017 03 01; 64(5):645-653.CI

Abstract

Background

Chronic asymptomatic Plasmodium falciparum infections are common in endemic areas and are thought to contribute to the maintenance of malaria immunity. Whether treatment of these infections increases the subsequent risk of clinical episodes of malaria is unclear.

Methods

In a 3-year study in Mali, asymptomatic individuals with or without P. falciparum infection at the end of the 6-month dry season were identified by polymerase chain reaction (PCR), and clinical malaria risk was compared during the ensuing 6-month malaria transmission season. At the end of the second dry season, 3 groups of asymptomatic children were identified: (1) children infected with P. falciparum as detected by rapid diagnostic testing (RDT) who were treated with antimalarials (n = 104), (2) RDT-negative children whose untreated P. falciparum infections were detected retrospectively by PCR (n = 55), and (3) uninfected children (RDT/PCR negative) (n = 434). Clinical malaria risk during 2 subsequent malaria seasons was compared. Plasmodium falciparum-specific antibody kinetics during the dry season were compared in children who did or did not harbor asymptomatic P. falciparum infections.

Results

Chronic asymptomatic P. falciparum infection predicted decreased clinical malaria risk during the subsequent malaria season(s); treatment of these infections did not alter this reduced risk. Plasmodium falciparum-specific antibodies declined similarly in children who did or did not harbor chronic asymptomatic P. falciparum infection during the dry season.

Conclusions

These findings challenge the notion that chronic asymptomatic P. falciparum infection maintains malaria immunity and suggest that mass drug administration during the dry season should not increase the subsequent risk of clinical malaria.

Authors+Show Affiliations

Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA. Division of Infectious Diseases, Department of Medicine, Indianapolis University School of Medicine, Indiana.Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.University of California, Irvine, California, USA.University of California, Irvine, California, USA.University of California, Irvine, California, USA.University of California, Irvine, California, USA.Rocky Mountain Laboratory Research Technologies Section, Genomics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA.Department of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.University of California, Irvine, California, USA.Rocky Mountain Laboratory Research Technologies Section, Genomics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA.Department of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28362910

Citation

Portugal, Silvia, et al. "Treatment of Chronic Asymptomatic Plasmodium Falciparum Infection Does Not Increase the Risk of Clinical Malaria Upon Reinfection." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 64, no. 5, 2017, pp. 645-653.
Portugal S, Tran TM, Ongoiba A, et al. Treatment of Chronic Asymptomatic Plasmodium falciparum Infection Does Not Increase the Risk of Clinical Malaria Upon Reinfection. Clin Infect Dis. 2017;64(5):645-653.
Portugal, S., Tran, T. M., Ongoiba, A., Bathily, A., Li, S., Doumbo, S., Skinner, J., Doumtabe, D., Kone, Y., Sangala, J., Jain, A., Davies, D. H., Hung, C., Liang, L., Ricklefs, S., Homann, M. V., Felgner, P. L., Porcella, S. F., Färnert, A., ... Crompton, P. D. (2017). Treatment of Chronic Asymptomatic Plasmodium falciparum Infection Does Not Increase the Risk of Clinical Malaria Upon Reinfection. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 64(5), 645-653. https://doi.org/10.1093/cid/ciw849
Portugal S, et al. Treatment of Chronic Asymptomatic Plasmodium Falciparum Infection Does Not Increase the Risk of Clinical Malaria Upon Reinfection. Clin Infect Dis. 2017 03 1;64(5):645-653. PubMed PMID: 28362910.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of Chronic Asymptomatic Plasmodium falciparum Infection Does Not Increase the Risk of Clinical Malaria Upon Reinfection. AU - Portugal,Silvia, AU - Tran,Tuan M, AU - Ongoiba,Aissata, AU - Bathily,Aboudramane, AU - Li,Shanping, AU - Doumbo,Safiatou, AU - Skinner,Jeff, AU - Doumtabe,Didier, AU - Kone,Younoussou, AU - Sangala,Jules, AU - Jain,Aarti, AU - Davies,D Huw, AU - Hung,Christopher, AU - Liang,Li, AU - Ricklefs,Stacy, AU - Homann,Manijeh Vafa, AU - Felgner,Philip L, AU - Porcella,Stephen F, AU - Färnert,Anna, AU - Doumbo,Ogobara K, AU - Kayentao,Kassoum, AU - Greenwood,Brian M, AU - Traore,Boubacar, AU - Crompton,Peter D, PY - 2016/07/12/received PY - 2016/12/13/accepted PY - 2017/4/1/entrez PY - 2017/4/1/pubmed PY - 2017/12/23/medline KW - Plasmodium falciparum KW - asymptomatic KW - malaria KW - malaria/drug therapy KW - mass drug administration. SP - 645 EP - 653 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 64 IS - 5 N2 - Background: Chronic asymptomatic Plasmodium falciparum infections are common in endemic areas and are thought to contribute to the maintenance of malaria immunity. Whether treatment of these infections increases the subsequent risk of clinical episodes of malaria is unclear. Methods: In a 3-year study in Mali, asymptomatic individuals with or without P. falciparum infection at the end of the 6-month dry season were identified by polymerase chain reaction (PCR), and clinical malaria risk was compared during the ensuing 6-month malaria transmission season. At the end of the second dry season, 3 groups of asymptomatic children were identified: (1) children infected with P. falciparum as detected by rapid diagnostic testing (RDT) who were treated with antimalarials (n = 104), (2) RDT-negative children whose untreated P. falciparum infections were detected retrospectively by PCR (n = 55), and (3) uninfected children (RDT/PCR negative) (n = 434). Clinical malaria risk during 2 subsequent malaria seasons was compared. Plasmodium falciparum-specific antibody kinetics during the dry season were compared in children who did or did not harbor asymptomatic P. falciparum infections. Results: Chronic asymptomatic P. falciparum infection predicted decreased clinical malaria risk during the subsequent malaria season(s); treatment of these infections did not alter this reduced risk. Plasmodium falciparum-specific antibodies declined similarly in children who did or did not harbor chronic asymptomatic P. falciparum infection during the dry season. Conclusions: These findings challenge the notion that chronic asymptomatic P. falciparum infection maintains malaria immunity and suggest that mass drug administration during the dry season should not increase the subsequent risk of clinical malaria. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/28362910/Treatment_of_Chronic_Asymptomatic_Plasmodium_falciparum_Infection_Does_Not_Increase_the_Risk_of_Clinical_Malaria_Upon_Reinfection_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciw849 DB - PRIME DP - Unbound Medicine ER -