title: Antibodies against malaria and Epstein-Barr virus in childhood Burkitt lymphoma: a case-control study in Uganda.
abstract: Burkitt lymphoma, a childhood tumor common in parts of sub-Saharan Africa, has been directly associated with Epstein-Barr virus (EBV) and indirectly with prevalence of malaria. We studied antibodies to both EBV and malaria in children diagnosed with this cancer in Uganda. We performed a case-control study of HIV-seronegative children (<or=15 years) admitted to hospital. Cases were diagnosed with Burkitt lymphoma and controls with non-malignant conditions or non-lymphatic cancers. Interviews were conducted and serological samples collected and, when possible, tested for both EBV and malaria. Adjusted odds ratios (ORs) for Burkitt lymphoma were estimated using unconditional logistic regression adjusting for sex, age, residential district, household income and tribe. The mean age of cases was 7 years and 61% were male. Compared to controls, cases were more likely to be reported having received more frequent treatment for malaria in the past year (OR = 2.0; p = 0.001) and less likely to be living in a home where insecticides were used (OR = 0.2; p < 0.0001). Odds ratios for Burkitt lymphoma in children increased with increasing antibody levels against EBV (p < 0.0001) and malaria (p = 0.05). Findings were similar for children residing in districts close to the capital city and in remote areas. Cases were 5 times more likely than controls to have raised levels of both EBV and malaria antibodies (OR = 5.0; p = 0.003). Our findings suggest that EBV and malaria may act synergistically in the pathogenesis of childhood Burkitt lymphoma. Malaria prevention measures may also prevent this childhood cancer.
authors.affiliation: Department of Public Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, United Kingdom. lucy.carpenter@dphpc.ox.ac.uk
authors.forename: Lucy M
authors.initials: LM
authors.lastname: Carpenter
authors.forename: Robert
authors.initials: R
authors.lastname: Newton
authors.forename: Delphine
authors.initials: D
authors.lastname: Casabonne
authors.forename: John
authors.initials: J
authors.lastname: Ziegler
authors.forename: Sam
authors.initials: S
authors.lastname: Mbulaiteye
authors.forename: Edward
authors.initials: E
authors.lastname: Mbidde
authors.forename: Henry
authors.initials: H
authors.lastname: Wabinga
authors.forename: Harold
authors.initials: H
authors.lastname: Jaffe
authors.forename: Valerie
authors.initials: V
authors.lastname: Beral
mesh_terms: D000818:Animals; D000913:Antibodies, Protozoan / Q000032:analysis*; D000914:Antibodies, Viral / Q000032:analysis*; D002051:Burkitt Lymphoma / Q000209:etiology* / Q000276:immunology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D016778:Malaria, Falciparum / Q000276:immunology; D008297:Male; D016017:Odds Ratio; D010963:Plasmodium falciparum / Q000276:immunology*; D014454:Uganda
chemical_list: D000913:Antibodies, Protozoan; D000914:Antibodies, Viral