Plasmodium falciparum multiple infections, disease severity and host characteristics in malaria affected travellers returning from Africa

Research output: Contribution to journalArticle

Abstract

Background: The pathogenesis of malaria is the result of complex interactions between parasites, host and environment. Several studies have assessed the role of genetic characteristics of Plasmodium falciparum infection in the clinical severity of malaria infection comparing different genotypic determinants in mild and severe cases. The genes encoding the polymorphic merozoite surface proteins 1 (msp-1) and 2 (msp-2) and the dihydrofolate reductase (dhfr) of malaria parasites have been extensively used as markers to investigate the genetic diversity and the population structure of P. falciparum. The aim of this study was to assess the epidemiological, clinical, host- and parasite-related determinant factor of the genetic diversity of P. falciparum infections in travellers returning to Italy. Methods: Between 1998 and 2001, we have retrospectively studied 64 inpatients all returning from African malaria-endemic countries. Designation of severe malaria was determined by using the World Health Organization (WHO) definition. P. falciparum infections detected by species-specific PCR were genotyped at the msp-1 and msp-2 loci and clones were determined. PCR and enzyme-digestion methods were used to screen the mutation occurring at codon 108. Results: Multiple P. falciparum genotypes were detected in 32 patients (50%). The number of genotypes was correlated to different host characteristics. No association was found between allelic number of msp-1 or msp-2 and season of travel, absence of antimalarial prophylaxis, length of stay or blood parasitemia. At multiple analysis adjusted for few confounding variables, two variables showed a significant association with multiplicity of P. falciparum genotypes: male gender (p=0.018) and severity of disease (p=0.044). Conclusion: In our study all but one patients with severe malaria had a infection with a multiplicity of P. falciparum clones. At multivariate analysis the male gender, and the occurrence of severe malaria were significanly more commonly detected in patients affected by imported malaria with multiple clones.

Original languageEnglish
Pages (from-to)205-209
Number of pages5
JournalTravel Medicine and Infectious Disease
Volume6
Issue number4
DOIs
Publication statusPublished - Jul 2008

Fingerprint

Plasmodium falciparum
Malaria
Infection
Merozoite Surface Protein 1
Clone Cells
Genotype
Parasites
Host-Parasite Interactions
Polymerase Chain Reaction
Tetrahydrofolate Dehydrogenase
Confounding Factors (Epidemiology)
Parasitemia
Antimalarials
Codon
Italy
Inpatients
Digestion
Length of Stay
Multivariate Analysis
Mutation

Keywords

  • Africa
  • Disease severity
  • Imported malaria
  • Italy
  • P. falciparum multiple infections
  • Travellers

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{7debcb5e9bfb4a1d90f4cacf571571b3,
title = "Plasmodium falciparum multiple infections, disease severity and host characteristics in malaria affected travellers returning from Africa",
abstract = "Background: The pathogenesis of malaria is the result of complex interactions between parasites, host and environment. Several studies have assessed the role of genetic characteristics of Plasmodium falciparum infection in the clinical severity of malaria infection comparing different genotypic determinants in mild and severe cases. The genes encoding the polymorphic merozoite surface proteins 1 (msp-1) and 2 (msp-2) and the dihydrofolate reductase (dhfr) of malaria parasites have been extensively used as markers to investigate the genetic diversity and the population structure of P. falciparum. The aim of this study was to assess the epidemiological, clinical, host- and parasite-related determinant factor of the genetic diversity of P. falciparum infections in travellers returning to Italy. Methods: Between 1998 and 2001, we have retrospectively studied 64 inpatients all returning from African malaria-endemic countries. Designation of severe malaria was determined by using the World Health Organization (WHO) definition. P. falciparum infections detected by species-specific PCR were genotyped at the msp-1 and msp-2 loci and clones were determined. PCR and enzyme-digestion methods were used to screen the mutation occurring at codon 108. Results: Multiple P. falciparum genotypes were detected in 32 patients (50{\%}). The number of genotypes was correlated to different host characteristics. No association was found between allelic number of msp-1 or msp-2 and season of travel, absence of antimalarial prophylaxis, length of stay or blood parasitemia. At multiple analysis adjusted for few confounding variables, two variables showed a significant association with multiplicity of P. falciparum genotypes: male gender (p=0.018) and severity of disease (p=0.044). Conclusion: In our study all but one patients with severe malaria had a infection with a multiplicity of P. falciparum clones. At multivariate analysis the male gender, and the occurrence of severe malaria were significanly more commonly detected in patients affected by imported malaria with multiple clones.",
keywords = "Africa, Disease severity, Imported malaria, Italy, P. falciparum multiple infections, Travellers",
author = "Emanuele Nicastri and Paglia, {Maria Grazia} and Carlo Severini and Piero Ghirga and Nazario Bevilacqua and Pasquale Narciso",
year = "2008",
month = "7",
doi = "10.1016/j.tmaid.2008.01.001",
language = "English",
volume = "6",
pages = "205--209",
journal = "Travel Medicine and Infectious Disease",
issn = "1477-8939",
publisher = "Elsevier USA",
number = "4",

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TY - JOUR

T1 - Plasmodium falciparum multiple infections, disease severity and host characteristics in malaria affected travellers returning from Africa

AU - Nicastri, Emanuele

AU - Paglia, Maria Grazia

AU - Severini, Carlo

AU - Ghirga, Piero

AU - Bevilacqua, Nazario

AU - Narciso, Pasquale

PY - 2008/7

Y1 - 2008/7

N2 - Background: The pathogenesis of malaria is the result of complex interactions between parasites, host and environment. Several studies have assessed the role of genetic characteristics of Plasmodium falciparum infection in the clinical severity of malaria infection comparing different genotypic determinants in mild and severe cases. The genes encoding the polymorphic merozoite surface proteins 1 (msp-1) and 2 (msp-2) and the dihydrofolate reductase (dhfr) of malaria parasites have been extensively used as markers to investigate the genetic diversity and the population structure of P. falciparum. The aim of this study was to assess the epidemiological, clinical, host- and parasite-related determinant factor of the genetic diversity of P. falciparum infections in travellers returning to Italy. Methods: Between 1998 and 2001, we have retrospectively studied 64 inpatients all returning from African malaria-endemic countries. Designation of severe malaria was determined by using the World Health Organization (WHO) definition. P. falciparum infections detected by species-specific PCR were genotyped at the msp-1 and msp-2 loci and clones were determined. PCR and enzyme-digestion methods were used to screen the mutation occurring at codon 108. Results: Multiple P. falciparum genotypes were detected in 32 patients (50%). The number of genotypes was correlated to different host characteristics. No association was found between allelic number of msp-1 or msp-2 and season of travel, absence of antimalarial prophylaxis, length of stay or blood parasitemia. At multiple analysis adjusted for few confounding variables, two variables showed a significant association with multiplicity of P. falciparum genotypes: male gender (p=0.018) and severity of disease (p=0.044). Conclusion: In our study all but one patients with severe malaria had a infection with a multiplicity of P. falciparum clones. At multivariate analysis the male gender, and the occurrence of severe malaria were significanly more commonly detected in patients affected by imported malaria with multiple clones.

AB - Background: The pathogenesis of malaria is the result of complex interactions between parasites, host and environment. Several studies have assessed the role of genetic characteristics of Plasmodium falciparum infection in the clinical severity of malaria infection comparing different genotypic determinants in mild and severe cases. The genes encoding the polymorphic merozoite surface proteins 1 (msp-1) and 2 (msp-2) and the dihydrofolate reductase (dhfr) of malaria parasites have been extensively used as markers to investigate the genetic diversity and the population structure of P. falciparum. The aim of this study was to assess the epidemiological, clinical, host- and parasite-related determinant factor of the genetic diversity of P. falciparum infections in travellers returning to Italy. Methods: Between 1998 and 2001, we have retrospectively studied 64 inpatients all returning from African malaria-endemic countries. Designation of severe malaria was determined by using the World Health Organization (WHO) definition. P. falciparum infections detected by species-specific PCR were genotyped at the msp-1 and msp-2 loci and clones were determined. PCR and enzyme-digestion methods were used to screen the mutation occurring at codon 108. Results: Multiple P. falciparum genotypes were detected in 32 patients (50%). The number of genotypes was correlated to different host characteristics. No association was found between allelic number of msp-1 or msp-2 and season of travel, absence of antimalarial prophylaxis, length of stay or blood parasitemia. At multiple analysis adjusted for few confounding variables, two variables showed a significant association with multiplicity of P. falciparum genotypes: male gender (p=0.018) and severity of disease (p=0.044). Conclusion: In our study all but one patients with severe malaria had a infection with a multiplicity of P. falciparum clones. At multivariate analysis the male gender, and the occurrence of severe malaria were significanly more commonly detected in patients affected by imported malaria with multiple clones.

KW - Africa

KW - Disease severity

KW - Imported malaria

KW - Italy

KW - P. falciparum multiple infections

KW - Travellers

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