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The Effect of Frequent Exposure to P. falciparum, HIV-Infection and Other Co-Morbidities on Development of Severe Malaria in Malawian Adults

Authors Munyenyembe AU, Gausi K, Hiestand J, Mallewa J, Mandala W

Received 6 September 2019

Accepted for publication 27 December 2019

Published 7 January 2020 Volume 2020:13 Pages 63—68


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Professor Suresh Antony

Alinane U Munyenyembe, 1 Kamunkhwala Gausi, 1 Jasmin Hiestand, 2 Jane Mallewa, 2 Wilson Mandala 1, 3

1Malawi-Liverpool Wellcome Trust, Blantyre, Malawi; 2Medicine Department, College of Medicine, Blantyre, Malawi; 3Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi

Correspondence: Wilson Mandala; Alinane U Munyenyembe
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P. O. Box 30096, Blantyre, Malawi
Tel/Fax +265 995 450 785
; Tel +265991456331

Aim: Plasmodium falciparum malaria predominantly affects children residing in endemic areas. However, recently a significant number of Malawian adults, who otherwise should have attained some malaria-specific immunity, have been observed to succumb to either uncomplicated malaria (UM) or severe malaria (SM). In addition, it is still unknown whether HIV is a contributing factor to SM in Malawian non-pregnant adults. We conducted this study to determine clinical and demographic features that characterize Malawian adults presenting with UM or SM.
Methods: Study participants were recruited when they presented at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi with UM or SM and had their demographic details recorded after consenting to participate in the study. Malaria infection was confirmed by Malaria Rapid Diagnostic Test (MRDT) and malaria slide microscopy. A venous blood sample was collected before treatment for various analyses.
Results: Both HIV-infected and HIV-uninfected participants were at risk of presenting with either UM or SM although there were more (37%) SM cases among those who were HIV-infected compared to those who were HIV-uninfected (28%) but the difference was not significant but similar numbers of UM cases (61% for HIV-uninfected and 60% for HIV-infected). Previous visit to areas of high malaria transmission was not associated with presenting with either UM or SM. HIV/malaria co-infected participants were more likely to be found with a positive blood culture result (Diphtheriods, Stenotophomonas maltophilia, Salmonella typhimurium and Staphylococcus aureus) and were at a higher risk of dying compared to HIV-uninfected malaria patients.
Conclusion: Although HIV-infection was associated with high mortality in those co-infected with HIV and malaria, recurrent malaria episodes and having other diseases co-existing with malaria infection were the main factors associated with the development of SM in this study cohort. Further studies need to be done to determine how the host immunity is affected in those co-infected with HIV and malaria.

Keywords: Plasmodium falciparum malaria, HIV-infection, Malawian adults

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