Association of helminth infection with decreased reticulocyte counts and hemoglobin concentration in Thai falciparum malaria.
Following a study showing an association between Ascaris and protection from cerebral malaria, we conducted a cross-sectional study comparing admission hemoglobin concentrations in relation to exposure to helminth infection in 2 separate groups of patients: 111 cerebral malaria cases and 180 mild Plasmodium falciparum malaria cases. Hookworm infections were excluded. Mean hemoglobin concentrations were significantly lower in helminth-infected patients compared to those without helminths, both in the cerebral malaria group (10.1+/-3 [n = 47] versus 11.2+/-2.4 g/dl [n = 64], P = 0.04) and the mild malaria group (11+/-2.5 [n = 89] vs 12.2+/-2.7 g/dl [n = 91], P = 0.004). Median reticulocyte counts, only available in the cerebral malaria group, were lower in helminth-infected patients compared to those without helminths (15,340/23,760 per microl, P = 0.03). Adjustments for confounders such as body mass index did not alter these associations. These data are consistent with a mechanism causing anemia linked to differences in the immune response of helminth-infected patients during malaria.
Nacher
M
M
Unité INSERM 511: Immunobiologie Cellulaire et Moleculaire des Infections Parasitaires, Faculté de médecine Pitié-Salpétrière, Paris, France. m_nacher@mailcity.com
Singhasivanon
P
P
Gay
F
F
Phumratanaprapin
W
W
Silachamroon
U
U
Looareesuwan
S
S
D000818:Animals; D003430:Cross-Sectional Studies; D006373:Helminthiasis / Q000097:blood* / Q000276:immunology; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D016779:Malaria, Cerebral / Q000097:blood* / Q000276:immunology / Q000469:parasitology; D016778:Malaria, Falciparum / Q000097:blood* / Q000276:immunology / Q000469:parasitology; D017701:Reticulocyte Count; D012189:Retrospective Studies; D013785:Thailand
D006454:Hemoglobins