Familial aggregation of cerebral malaria and severe malarial anemia.
BACKGROUND
The predominant manifestations of severe malaria in African children are cerebral malaria (CM) and severe malarial anemia (SMA). As a first step toward a family-based approach to identify the environmental and genetic pathways that contribute to severe malaria, we tested whether it aggregates within families.


METHODS
Family history of severe malaria was explored during face-to-face interviews with parents. Logistic regression was used to determine whether CM and SMA aggregate within individuals and within families. The pattern of familial aggregation was then expressed as familial odds ratios that were adjusted for relevant risk factors.


RESULTS
This study was of 2811 inhabitants of Bamako, Mali, clustered in 407 nuclear families. The probands were 136 children with severe malaria and 271 healthy children from the community. Within-person association of CM and SMA was significant (odds ratio, 6.15 [95% confidence interval (CI), 2.62-14.41]). Over a lifetime, with each additional affected relative, the odds of a person contracting CM increased by 1.98 times (95% CI, 1.59-2.45), and the odds of having SMA increased by 1.91 times (95% CI, 1.05-3.47). Over a lifetime, for a child whose sibling had a history of CM, the odds of having CM were 2.49 times greater (95% CI, 1.51-4.10) than the odds for a child whose sibling had no such history; for a child whose sibling had a history of SMA, the odds of having SMA were 4.92 times greater (95% CI, 1.21-19.9) than the odds for a child whose sibling had no such history.


CONCLUSIONS
Our data suggest strong familial aggregation of CM and SMA.
Ranque
Stéphane
S
Immunology and Genetics of Parasitic Diseases, Institut National de la Santé et de la Recherche Médicale U.399, Faculty of Medicine, Université de la Méditerranée, Marseilles, France. stephane.ranque@medecine.univ-mrs.fr
Safeukui
Innocent
I
Poudiougou
Belco
B
Traoré
Abdoulaye
A
Keita
Modibo
M
Traoré
Diamori
D
Diakité
Mahamadou
M
Cissé
Mahamadou B
MB
Keita
Marouf M
MM
Doumbo
Ogobara K
OK
Dessein
Alain J
AJ
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000235:genetics* / Q000469:parasitology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000235:genetics*; D016778:Malaria, Falciparum / Q000097:blood / Q000235:genetics* / Q000503:physiopathology; D008297:Male