Malaria-related Anaemia

doi:10.1016/S0169-4758(00)01774-9

Parasitology Today

Volume 16, Issue 11, 1 November 2000, Pages 469-476

Parasitology Today

https://doi.org/10.1016/S0169-4758(00)01774-9 Get rights and content

Abstract

Malaria infection in humans by Plasmodium species is associated with a reduction in haemoglobin levels, frequently leading to anaemia. Plasmodium falciparum causes the most severe and profound anaemia, with a significant risk of death. This cannot be explained simply by the direct destruction of parasitized red blood cells at the time of release of merozoites, a process shared by all these species. In this review, Clara Menendez, Alan Fleming and Pedro Alonso focus on recent advances in our knowledge of the pathophysiology, epidemiology, management and prevention of anaemia from falciparum malaria.

Section snippets

Pathophysiology

The anaemia of malaria is multifactorial, involving both the destruction of RBC and the decreased production of RBC (Table 1; Fig. 1). The relative contributions to anaemia by the various mechanisms differ according to the age, pregnancy state, antimalarial immune status and genetic constitution of infected individuals, and the local endemicity of malaria. In general, haemolysis is of greater importance in non-immune children experiencing acute malaria, whereas dyserythropoiesis is seen in

Plasmodium spp, folates and antifolate antimalarials

Plasmodium spp synthesize folate, and therefore, malarial parasitaemia raises the RBC folate of the host and negates the usefulness of its measurement in assessing the folate status of the host, without making a significant contribution to the metabolism of the host[6].

Recurrent malarial haemolysis stimulates erythroid hyperplasia, increases folate requirements and can lead to folate depletion and megaloblastic anaemia, which is often profound, especially during pregnancy[16]: in such patients

Iron deficiency, malaria and iron therapy

Iron deficiency and malaria often coincide in severely anaemic subjects. It has been postulated that malaria might contribute to iron depletion through decreasing intake during anorexia, reducing absorption and causing loss through haemoglobinuria[34]. These mechanisms have never been quantified, but are unlikely to be other than minor factors compared with low bioavailable iron in food and iron loss from hookworm.

Malaria attack rates were similar in iron-deficient and iron-sufficient Gambian

Epidemiology

Who is affected by malaria-related anaemia? The greatest burden of malarial anaemia is carried by young children and pregnant women in sub-Saharan Africa. Prevalence figures of anaemia (Hct ≤0.33) in the community in malaria-endemic areas of Africa vary between 31% and 90% in children[6], [40] and between 60% and 80% in pregnant women[41], [42]. The contribution of malaria to this anaemia is demonstrated by epidemiological observations of an increased number of hospital admissions with severe

Management

Blood transfusion. One recent study has shown that respiratory distress (defined as the presence of tachypnea and one or more of nasal flaring, indrawing, grunting or deep breathing) in life-threatening malaria is probably the consequence of lactic acidaemia and metabolic acidosis[2], [7], rather than an indication of incipient cardiac failure[2]. Severe anaemia is one factor contributing to the development of acidosis, and might be the chief factor where malarial anaemia is common, although

Conclusions

The increasing burden of malaria morbidity and mortality over the past years, the potential consequences of blood transfusion in the context of the AIDS epidemic, and the magnitude of the problem, which is imposing an enormous economic load on health services in many areas, are some of the reasons behind focusing the attention on one of the major clinical consequences of malaria infection, malarial anaemia.

The pathophysiology of malarial anaemia is even more complex than had been proposed, and

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In high transmission settings, most school-aged children harbour malaria parasites without showing symptoms, often leading to anaemia and possibly impaired psychomotor and cognitive abilities. We aimed to assess the effectiveness and safety of intermittent preventive treatment for malaria in school-aged children (IPTsc) living in highly endemic areas.
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Of the 1797 children scheduled for clinical screening, 1566 were enrolled and randomly allocated (526 to receive dihydroartemisinin–piperaquine, 527 to receive artesunate–amodiaquine, and 513 to receive standard of care). Due to COVID-19-related school closures, only two schools were visited at month 12 (135 children in the dihydroartemisinin–piperaquine group, 131 in the artesunate–amodiaquine group, and 118 in the control group). At month 12, compared with the control group, the change from baseline in mean haemoglobin concentration was increased by 0·5 g/dL (95% CI 0·2 to 0·8; p<0·0001) in the dihydroartemisinin–piperaquine group and 0·5 g/dL (0·2 to 0·7; p=0·0020) in the artesunate–amodiaquine group in the intention-to-treat analysis (with similar findings in the per protocol analysis). In the same period, in the intention-to-treat analysis, the prevalence of malaria parasitaemia increased from 28·5% (138 of 485 participants) to 33·6% (39 of 116) in the control group, but decreased from 28·0% (139 of 497) to 12·0% (15 of 125) in the dihydroartemisinin–piperaquine group (–21·6 percentage points [95% CI –31·9 to –11·3], p=0·0001 vs control at month 12) and from 24·7% (124 of 502) to 16·0% (20 of 125) in the artesunate–amodiaquine group (–17·6 percentage points [–28·4 to –6·9], p=0·0015). The decrease for artesunate–amodiaquine was larger in the per protocol analysis (–25·3 percentage points [–36·3 to –14·2], p<0·0001). The protective effect of IPTsc against malaria parasitaemia was 64% (95% CI 39 to 79; p<0·0001) for dihydroartemisinin–piperaquine and 52% (23 to 70; p=0·0015) for artesunate–amodiaquine in the intention-to-treat analysis, and was slightly higher on per protocol analysis. The protective effect against clinical malaria at month 12 was 20% (95% CI 9 to 29; p=0·0002) for dihydroartemisinin–piperaquine and 19% (8 to 28; p=0·0004) for artesunate–amodiaquine. No significant differences in any primary outcomes between the intervention and control groups were noted at month 20. Dihydroartemisinin–piperaquine and artesunate–amodiaquine were associated with a small number of mild adverse events, and there were no treatment-related serious adverse events or deaths.
IPTsc with dihydroartemisinin–piperaquine or artesunate–amodiaquine is a safe and effective approach to reducing malaria parasitaemia, clinical malaria, and related morbidities, and is feasible to implement through programmes delivered by schoolteachers.
Flemish Interuniversity Council (VLIRUOS), EU EDCTP2 programme (MaReCa project), and Global Minds 2019.
For the Swahili translation of the abstract see Supplementary Materials section.
Assessment of sperm quality in Plasmodium berghei NK65 infected mice treated with brimstone (Morinda lucida Benth) tree plant
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Malaria fever is a common infection in Nigeria while the uncontrolled usage of synthesized anti-malarial drugs might have contributed to the ineffectiveness of the male reproductive hormones and the sperm quality in humans. Brimstone plant called “Oruwo” by Yoruba tribe in Nigeria has been used locally for the treatment of symptomatic malaria with no information of its effect on sperm quality. This study sought to evaluate the anti-plasmodial activity, reproductive hormones and sperm quality of the aqueous extracts on mice infected with Plasmodium berghei NK65. Adult male mice were infected with Plasmodium berghei NK65 while infection was confirmed after 72 h.The mice were divided into 5 groups [group A control, group B infected and treated with 2.5mgkg/bwt chloroquine (standard drug), group C infected without treatment while groups D and E were given 200 and 400mg/kg btw of the extracts respectively]. The treatment was orally administered daily for 7 days and the parasitemia level was checked after which the mice were sacrificed and the semen collected for sperm characteristics [sperm count, sperm viability, sperm morphology and sperm motility] while the right testis was used for the in-vivo antioxidant assays The blood serum was used to assess reproductive hormones such as [serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH)] using standardized methods. The results reveal that treatment of Morinda lucida caused a significant (p < 0.05) increase in serum testosterone and a decrease in LH, FSH levels in a dose-dependent manner as well as an increase in sperm count, motility and viability with a significant restoration of sperm morphology as seen in the histopathology plate. This observation might be due to the properties of the plant polyphenolic compounds identified. In conclusion, this study was able to prove that Morinda lucida used in folk-lore medicine to treat symptomatic malaria also improves sperm functions better than synthetic drugs and could be further explored as a natural product in the pharma industry.
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ReviewMalaria-related Anaemia

Abstract

Section snippets

Pathophysiology

Plasmodium spp, folates and antifolate antimalarials

Iron deficiency, malaria and iron therapy

Epidemiology

Management

Conclusions

Baillière's Clin. Haematol.

Trans. R. Soc. Trop. Med. Hyg.

Lancet

Trans. R. Soc. Trop. Med. Hyg.

Blood

Trans. R. Soc. Trop. Med. Hyg.

Trans. R. Soc. Trop. Med. Hyg.

Lancet

Trans. R. Soc. Trop. Med. Hyg.

Trans. R. Soc. Trop. Med. Hyg.

Trans. R. Soc. Trop. Med. Hyg.

Acta Trop.

Trans. R. Soc. Trop. Med. Hyg.

Trans. R. Soc. Trop. Med.

Parasitol. Today

Parasitol. Today

Am. J. Clin. Nutr.

Clin. Haematol.

Trans. R. Soc. Trop. Med. Hyg.

Trans. R. Soc. Trop. Med. Hyg.

Lancet

Transfus. Sci.

Lancet

Trans. R. Soc. Trop. Med. Hyg.

Transfusion for respiratory distress in life-threatening childhood malaria

Am. J. Trop. Med. Hyg.

Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children

Q. J. Med.

Severe and complicated malaria, 2nd edition

Trans. R. Soc. Med. Hyg.

Malaria chemoprophylaxis with chloroquine in young Nigerian children. IV. Its effect on haematological measurements

Ann. Trop. Med. Parasitol.

Indicators of life-threatening malaria in African children

New Engl. J. Med.

The importance of anaemia in cerebral and uncomplicated falciparum malaria: role of complications, dyserythropoiesis and iron sequestration

Q. J. Med.

Erythrocyte sequestration and anaemia in severe falciparum malaria. Analysis of acute changes in venous hematocrit using a simple mathematical model

J. Clin. Invest.

African children with malaria in an area of intense P. falciparum transmission: features on admission to hospital and risk factors for death

Am. J. Trop. Med. Hyg.

Red blood cell deformability as a predictor of anemia in severe falciparum malaria

Am. J. Trop. Med. Hyg.

Haematological diseases in the tropics

Immune haemolysis associated with severe malarial anaemia

Trans. R. Soc. Trop. Med. Hyg.

Review
Malaria-related Anaemia