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Introduction:
Thrombocytopenia is a common complication in malaria patients. The relationship between abnormal platelet profile and clinical status in malaria patients is unclear. In low and unstable endemic regions where vivax malaria predominates, the hematologic profiles of malaria patients and their clinical utility are poorly understood. The...
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... the 564 (65.4%) patients with PC values below 150,000 platelets/µL, thrombocytopenia was classifi ed in 4 categories ( Table 2). Signifi cant thrombocytopenia (<50,000 platelets/µL) was observed in 93 (11%) patients, which included 2% with <25,000 platelets/µL. ...
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Citations
... first and second weeks is significant (p < 0.05). A study conducted by Martinez-Salazer et al. [9] in 2014 included 311 patients with P. vivax infection. They found that patients with severe thrombocytopenia exhibited higher parasitemia than those without thrombocytopenia. ...
Introduction
Malaria, a common parasitic disease in tropical regions, produces hematological changes in patients. In the present study, we compare hematologic recovery between the chloroquine and artemether-lumefantrine treatment groups of patients with Plasmodium vivax malaria.
Methodology
This was a cross-sectional observational study comparing hematological parameters, including total and differential white blood cell counts, and platelet counts between two patient groups: one group with 48 patients receiving chloroquine, and the other with 47 patients receiving the artemether-lumefantrine combination. Both groups received primaquine to combat the hypnozoite stage.
Results
The rate of platelet count recovery was significantly faster in patients treated with the artemether-lumefantrine combination (p-value 0.002). Rates of recovery of the total white blood cell count and neutrophil count were faster with the artemether-lumefantrine combination, while the recovery of the lymphocyte count was faster in patients treated with chloroquine. However, these changes were statistically insignificant (p-values = 0.69, 0.42, and 0.65, respectively).
Conclusion
Based on hematological recovery, artemisinin combination therapy may be preferred over treatment with chloroquine in cases of P. vivax malaria. However, factors such as the adverse effect profile, cost-effectiveness, and chloroquine resistance need to be considered for the practical applicability of the same.
... (Hanson et al., 2015;Khan et al., 2012;Kumbhar et al., n.d.;Lacerda et al., 2011;Muwonge et al., 2013;Punnath et al., 2019;Saravu et al., 2011) However, in a retrospective analyse conducted in Colombia on 846 cases of malaria, higher parasites were found in the blood leading to severe thrombocytopenia, but found no positive correlation on severity with thrombocytopenia, more positive correlation with liver function. (Martínez-Salazar & Tobón-Castaño, 2014). In addition, platelets have an important role to control parasitemia where platelets bind to red blood cells infected by plasmodium so that parasite lysis. ...
Thrombocytopenia is one of the most frequent side effects of both Plasmodium vivax and Plasmodium falciparum malaria, despite the fact that it is not a sign of severe malaria. However, few studies said that thrombocytopenia would early recognition of severe malaria. Moreover, thrombocytes play a significant part in inflammatory response during malaria. In these cases, present malaria falciparum and vivax with thrombocytopenia without bleeding and any severe malaria. The case diagnosis with a rapid diagnostic test of malaria and peripheral blood examination.
... Platelet count <150,000 platelets/µL was classified as thrombocytopenia. 27 Anemia was considered to be so when the hemoglobin was < 11 g/dL. The samples were categorized as platelet counts less than <150,000 platelets/µL and more than 150,000 platelets/µL. ...
Malaria is a global threat and a never-ending battle without appropriate identification and differentiation of the parasite species. This work compared the diagnostic methods including the thick film microscopy technique, quantitative buffy coat, and polymerase chain reaction. The inaccuracy of species determination by microscopy and the consequent treatment regime underlines the necessity to upgrade routine diagnostic methods with molecular techniques. In the study, 436 samples were collected; venous blood was processed for the quantitative buffy coat technique followed by classical Giemsa staining of thin and thick smears and nested Polymerase Chain Reaction (nPCR) for the genus-specific region of Plasmodium targeting 18S rDNA followed by species-specific identification. Of 436 samples screened for malaria, results in PCR showed 78.7% (100/127) to be P. vivax, 4.8% (6/127) as P. falciparum and 16.5% (21/127) to be mixed infection (P. vivax + P. falciparum). The prevalence of malaria was 0.29, and there was good concordance between the methods for detecting Plasmodium (Kappa:0.77). In our investigation, nested PCR and TFM exhibited a sensitivity of 97.7% and a specificity of 100% for malaria detection compared to QBC. Clinical parameters- thrombocytopenia and anemia, were compared in this study. A positive association was observed between thrombocytopenia and malaria (p<0.05), but the association between anemia and malaria infection remains unclear. Primer cross-reactions were also observed in the primer sequence of P. ovale and P. knowlesi, but sequencing confirmed it as P. vivax and the study of phylogeny paved a new way in analyzing the relatedness of the sequences.
... 26 In this study, the median platelet count was significantly reduced in malaria-infected adult patients as compared to apparently healthy individuals (P <0.001). This result was similar to the finds reported in Thailand, 8 Colombia, 27 Nigeria, 28 and Ethiopia. 29 The decrease in platelet counts with The median value of MPV was significantly lower in malaria-infected adult patients than in apparently healthy adults, in agreement with a study conducted in Ghana 32 but in contrast with studies conducted in Brazil, 15 Sudan, 33 and Uganda. ...
... This finding is also explained by concomitant thrombocytopenia. 37 The median value of PDW during this study was found to be significantly higher in malaria-infected adult patients, which was in agreement with studies conducted in Colombia, 27 Thailand, 8 and Sudan. 33,38 The higher PDW values in malaria can be explained by the bone marrow formation of megakaryocytes to make amends for the low absolute platelet count during acute malaria infection. ...
... These early released platelets are larger in size, and the stimulation of megakaryocytes within the marrow by thrombopoietin in response to low platelets produces larger platelets as their nucleus becomes hyper-lobulated with the next polymer. 27 The MPV had a weak positive correlation with PDW (r = 0.275; p = 0.008) and PCT (r = 0.235; p = 0.023) which was in accordance with the study conducted in Mangalore. 43 Mean platelet volume reflects platelet size, whereas PDW reflects variability in platelet size and is taken into account as a marker of platelet function and activation. ...
Background:
Malaria is a major public health problem with the highest morbidity and mortality in developing countries. Hematological changes play a great role in malaria pathogenesis through platelets and platelet parameters. However, the changes in platelet parameters are not clearly described in Ethiopia. Therefore, this study aimed to compare platelet parameters and their correlation with parasitemia among malaria-infected adult patients and healthy adults.
Methods:
An institutional-based comparative cross-sectional study was conducted involving 186 (93 malaria-infected patients and 93 healthy adults) study participants using a convenient sampling technique at Jinella health center, Harar, Eastern Ethiopia, from July 10-August 10, 2022. Five milliliters of venous blood were collected from each study participant, and platelet parameters were analyzed using a Unicel (DxH 800) automated hematologic analyzer. A drop of blood was taken from malaria-suspected patients for blood film preparation. Results between two groups were compared using the Mann-Whitney U-test. Spearman's rank correlation coefficient was used to evaluate the relationships between two continuous variables. A P-value of < 0.05 was considered statistically significant.
Results:
Platelet, plateletcrit, and mean platelet volume of malaria-infected patients were significantly lower as compared with healthy adults (103 x103cells/μL vs 268 x103cells/μL, 0.13 fl vs 0.23 fl, and 9.6 fl vs 15.3 fl), respectively). Conversely, platelet distribution width and platelet large cell ratio were higher in malaria-infected patients than healthy adults (19.2% vs 15.3% and 0.35% vs 0.29%), respectively). Parasitemia levels had a moderately inverse correlation with platelet count (r= -0.419) and a weakly positive correlation with mean platelet volume (r=0.278).
Conclusion:
The platelet, plateletcrit, and mean platelet volume of malaria-infected patients were significantly lower as compared with healthy adults. Malaria parasitemia had a moderate inverse correlation with platelet count and a weak positive correlation with mean platelet volume. Thrombocytopenia and alteration of platelet parameters should be considered in malaria patients.
... In patients with acute Plasmodium vivax infection, the frequency of PLT counts under 150,000/µL can vary in different populations [33]. In this study, thrombocytopenia was present in 58% of patients, which agrees with previous reports in Colombia [5,34]. ...
Background
Thrombocytopenia is frequent in Plasmodium vivax malaria but the role of platelets in pathogenesis is unknown. Our study explores the platelet (PLT) proteome from uncomplicated P. vivax patients, to fingerprint molecular pathways related to platelet function. Plasma levels of Platelet factor 4 (PF4/CXCL4) and Von Willebrand factor (VWf), as well as in vitro PLTs— P. vivax infected erythrocytes ( Pv -IEs) interactions were also evaluated to explore the PLT response and effect on parasite development.
Methods
A cohort of 48 patients and 25 healthy controls were enrolled. PLTs were purified from 5 patients and 5 healthy controls for Liquid Chromatography–Mass spectrometry (LC–MS/MS) analysis. Plasma levels of PF4/CXCL4 and VWf were measured in all participants. Additionally, P. vivax isolates (n = 10) were co-cultured with PLTs to measure PLT activation by PF4/CXCL4 and Pv- IE schizonts formation by light microscopy.
Results
The proteome from uncomplicated P. vivax patients showed 26 out of 215 proteins significantly decreased. PF4/CXCL4 was significantly decreased followed by other proteins involved in platelet activation, cytoskeletal remodeling, and endothelial adhesion, including glycoprotein V that was significantly decreased in thrombocytopenic patients. In contrast, acute phase proteins, including SERPINs and Amyloid Serum A1 were increased. High levels of VWf in plasma from patients suggested endothelial activation while PF4/CXCL4 plasma levels were similar between patients and controls. Interestingly, high levels of PF4/CXCL4 were released from PLTs— Pv -IEs co-cultures while Pv -IEs schizont formation was inhibited.
Conclusions
The PLT proteome analyzed in this study suggests that PLTs actively respond to P. vivax infection. Altogether, our findings suggest important roles of PF4/CXCL4 during uncomplicated P. vivax infection through a possible intracellular localization. Our study shows that platelets are active responders to P. vivax infection, inhibiting intraerythrocytic parasite development. Future studies are needed to further investigate the molecular pathways of interaction between platelet proteins found in this study and host response, which could affect parasite control as well as disease progression.
... Thrombocytopenia was one of the main manifestations in individuals with P. vivax infections; as previously reported in other studies [28,29]. Platelet levels were negatively correlated with levels of CXCL10, a chemokine that is produced in response to IFN-γ, attracts immune cells to the inflammation focal point and its high concentration has been associated to severity in diseases with different etiology, including malaria, both in experimental models and in patients with P. falciparum infections [30]. ...
Cytokines and chemokines are immune response molecules that display diverse functions, such as inflammation and immune regulation. In Plasmodium vivax infections, the uncontrolled production of these molecules is thought to contribute to pathogenesis and has been proposed as a possible predictor for disease complications. The objective of this study was to evaluate the cytokine profile of P . vivax malaria patients with different clinical outcomes to identify possible immune biomarkers for severe P . vivax malaria. The study included patients with non-severe (n = 56), or severe (n = 50) P . vivax malaria and healthy controls (n = 50). Patient plasma concentrations of IL-4, IL-2, CXCL10, IL-1β, TNF-α, CCL2, IL-17A, IL-6, IL-10, IFN-γ, IL-12p70, CXCL8 and active TGF-β1 were determined through flow cytometry. The levels of several cytokines and chemokines, CXCL10, IL-10, IL-6, IL-4, CCL2 and IFN-γ were found to be significantly higher in severe, compared to non-severe P . vivax malaria patients. Severe thrombocytopenia was positively correlated with IL-4, CXCL10, IL-6, IL-10 and IFN-γ levels, renal dysfunction was related to an increase in IL-2, IL-1β, IL-17A and IL-8, and hepatic impairment with CXCL10, MCP-1, IL-6 and IFN-γ. A Lasso regression model suggests that IL-4, IL-10, CCL2 and TGF-β might be developed as biomarkers for severity in P . vivax malaria. Severe P . vivax malaria patients present specific cytokine and chemokine profiles that are different from non-severe patients and that could potentially be developed as biomarkers for disease severity.
... The study also stated that the platelet count did not differ based on the type of infecting species, indicating that there was a similar pathomechanism between Plasmodium falciparum and Plasmodium vivax infections. 35 However, the results of this study are not in line with research by Arif et al., (2016) in India which states that there is a significant relationship between the types of Plasmodium falciparum and Plasmodium vivax with the degree of thrombocytopenia (p <0.001). In that study, mild thrombocytopenia was generally associated with Plasmodium vivax (52.8%) than Plasmodium falciparum infection (10.71%), whereas severe thrombocytopenia was more common with Plasmodium falciparum infection (46.43%) than Plasmodium vivax infection ( 8.34%). ...
Malaria is a tropical infectious disease with high morbidity and mortality rates. In malaria, various kinds of haematological complications can arise, one of which is thrombocytopenia. Thrombocytopenia is most commonly encountered during acute malaria infection with varying degrees observed in both Plasmodium falciparum and Plasmodium vivax infections. The purpose of this study was to determine the relationship between the types of Plasmodium falciparum and Plasmodium vivax with the degree of thrombocytopenia in malaria patients at the Ratu Aji Putri Botung Penajam Paser Utara Hospital. This research is an observasional analytic study with cross sectional method. The data was taken by using purposive sampling method from the medical records of malaria patients hospitalized in Ratu Aji Putri Botung Penajam Paser Utara Hospital in the period of January 2013 - August 2018. Data analysis used the Chi-square test. Of the 310 malaria patients who were study subjects, 60,3% (n = 187) were infected with Plasmodium falciparum and 39,7% (n = 123) were infected with Plasmodium vivax. Most of the research subjects were male (95,8%) who were dominated by adults (56,5%). As many as 90% of malaria patients experienced thrombocytopenia with mild, moderate, and severe thrombocytopenia respectively 29,4% ; 56,6% ; 14,0%. Severe thrombocytopenia was more common in falciparum malaria patients (16,4%). The statistical test result for the type of Plasmodium with the degree of thrombocytopenia were p = 0,139. It was concluded that there was no relationship between the types of Plasmodium falciparum and Plasmodium vivax with the degree of thrombocytopenia in malaria patients. Keywords: Malaria, Plasmodium, Degree of Thrombocytopenia
... This reflection indicates that there was a significant association between species of malaria and degree of thrombocytopenia [36]. Thus, the difference frequency of thrombocytopenia between PF and PV infections arose from the different mechanisms by which the pathophysiology of thrombocytopenia is mediated, i.e., clumping in PF and medullar suppression in PV [37]. A better understanding of these mechanisms is still needed, not only by parasite species but also the magnitude of thrombocytopenia depending on the disease severity and degree of parasitemia. ...
... The PCT, MPV, and PDW were significantly lower in the PV cases compared with the PF cases. On the other hand, the PCT was higher in mixed infections compared with PV infections, and the PDW was lower in mixed infections compared with PF infections [37]. Plateletcrit is considered as markers of platelet activation and altered in different clinical conditions including malaria infection. ...
Purpose:
Platelet parameter alteration such as platelet count and platelet indices are more common than in other blood cell lines due to diverse causative pathophysiological mechanisms in severe malaria infection. In malaria patients, no more studies evaluated platelet indices in relation to disease severity and prognosis. Therefore, this review assessed the current scientific knowledge on the potential role of platelet indices for the diagnostic marker of severe malaria infection.
Results:
Hence, after reviewing recent literatures, elevation of mean platelet volume and platelet distribution width in addition to decreased plateletcrit and platelet counts is the known potential risk factor associated with warning signs of severe malaria. Thus, thrombocytopenia < 150 × 109/L, MPV ≥ 9.05 fL, and PDW ≥ 14.550% as well as significantly higher P-LCR and decrease in PCT are shown significant sensitivity and specificity as they are used as diagnostic and prognostic values in severe malaria infection.
Conclusion:
Platelet indices are useful predictors of malaria severity. Immature platelet fraction (IPF%) is raised in the case of severe malaria, and it was significantly more useful than MPV. Advanced research will further investigate the platelet index abnormality associated with specific age and gender among specific malaria species.
... Plasmodium vivax-induced severe thrombocytopenia (PvST), characterized by platelet counts below 50,000 per mm 3 of blood, is a common clinical complication in P. vivax malaria (Martinez-Salazar and Tobon-Castano, 2014;Naing and Whittaker, 2018;Punnath et al., 2019). The mechanisms leading to PvST are unclear but may be related to platelet activation, consumption and/or phagocytosis (Lacerda et al., 2011;Coelho et al., 2013;Essien and Emagha, 2014). ...
Severe thrombocytopenia can be a determinant factor in the morbidity of Plasmodium vivax, the most widespread human malaria parasite. Although immune mechanisms may drive P. vivax-induced severe thrombocytopenia (PvST), the current data on the cytokine landscape in PvST is scarce and often conflicting. Here, we hypothesized that the analysis of the bidirectional circuit of inflammatory mediators and their regulatory miRNAs would lead to a better understanding of the mechanisms underlying PvST. For that, we combined Luminex proteomics, NanoString miRNA quantification, and machine learning to evaluate an extensive array of plasma mediators in uncomplicated P. vivax patients with different degrees of thrombocytopenia. Unsupervised clustering analysis identified a set of PvST-linked inflammatory (CXCL10, CCL4, and IL-18) and regulatory (IL-10, IL-1Ra, HGF) mediators. Among the mediators associated with PvST, IL-6 and IL-8 were critical to discriminate P. vivax subgroups, while CCL2 and IFN-γ from healthy controls. Supervised machine learning spotlighted IL-10 in P. vivax-mediated thrombocytopenia and provided evidence for a potential signaling route involving IL-8 and HGF. Finally, we identified a set of miRNAs capable of modulating these signaling pathways. In conclusion, the results place IL-10 and IL-8/HGF in the center of PvST and propose investigating these signaling pathways across the spectrum of malaria infections.
... This is the case of a study carried out in Papua Indonesia, whose patients with P. falciparum infection without a history of previous malaria presented lower levels of platelets, a finding that was not reported for P. vivax infections in that study population (Lampah et al., 2014). For this study, thrombocytopenia presented a negative correlation with parasitaemia (r − 0.2223, p 0.0220, data not shown), and was the most frequent finding in patients with liver dysfunction, similar to what was previously reported by other researchers (Fazil et al., 2013;Martínez-Salazar and Tobón-Castaño, 2014). The mechanism involved in thrombocytopenia that is observed in patients with malaria is not clear, there are a variety of hypotheses that include platelet sequestration by the spleen during the removal of parasitized cells, platelet auto-aggregation, circulation of anti-platelet antibodies and the alteration in thrombopoietin synthesis that derives from the cytokines action (M. ...
Plasmodium vivax has high morbidity, it is the Plasmodium species with the greatest worldwide distribution, and its ability to trigger severe symptoms is currently recognized. The present study aims to compare the clinical and epidemiological characteristics of patients with P. vivax malaria, with and without complication criteria, in an endemic area for malaria transmission in northeast Colombia. A descriptive cross-sectional study was carried out between 2017 and 2019, patients with P.vivax severe malaria (n = 50), non-severe malaria (n = 56) and healthy controls (n = 50) were included. Sociodemographic, clinical, hematological, and biochemical characteristics were analyzed. Clinical follow-up was carried out in a group of patients with severe malaria. The statistical analysis was carried out in GraphPad Prism; the Chi-square test analyzed categorical variables, comparisons of variables for the three groups were carried out by the Kruskal-Wallis test and comparison between two groups by the Mann-Whitney test. A multiple correspondence analysis described the relationship between variables, which was carried out through the R software. One hundred fifty-six individuals were linked to the study, 76 women and 80 men, between 3 and 71 years old. For 50% of the patients, it was their first malaria episode; 42% of the patients classified with severe malaria required hospitalization, compared to 7.1% of the patients with non-severe malaria. Parasitaemia was similar in both clinical groups; however, 10% of severe patients presented high parasitemia, between 20,000-135,000. The most frequent clinical characteristics in patients with severe malaria were severe thrombocytopenia in 54%, hypoglycemia in 48%, and liver and kidney failure in 30%. Biochemical and hematological parameters returned to normal in 90% of the patients with severe malaria on the third day after starting treatment. Thrombocytopenia, hypoglycemia, and liver and kidney dysfunctions were the most frequent P. vivax malaria complications in this study. Hemoglobin concentration and parasite count were not related to the clinical condition of patients. Thrombocytopenia was the most frequent finding in patients with malaria, and its severity presented an inverse relationship with the number of previous malaria episodes.
