title: Dynamic changes in white blood cell counts in uncomplicated Plasmodium falciparum and P. vivax malaria.
abstract: Total and differential white blood cell (WBC) counts are basic and essential indicators in any type of illness resulting from infection. In malaria, WBC counts are generally characterized as low to normal during treatment. WBC-counts data, before and during treatment with artemisinin derivatives, was gathered for patients with either Plasmodium falciparum or Plasmodium vivax infection (at 28-day follow-up), to investigate dynamic changes in WBC count. We analyzed and compared the WBC counts of 1,310 inpatients presenting with uncomplicated P. falciparum and P. vivax malaria at the Hospital for Tropical Diseases, in Bangkok, Thailand. Before-treatment, a statistically significant negative correlation was found between initial WBC count and highest temperature on admission. Before and during treatment, WBC counts were significantly lower in P. falciparum than P. vivax infection on days 0 and 7, but the numerical difference was small. We also found clinically significantly low WBC counts during the acute stages of both types of malaria, which subsequently normalized by day 28 follow-up. This finding has important clinical implications for the conventional method of estimating parasitemia using an assumed WBC count of 8,000 cells/microL. The most significant finding in our analysis is that WBC counts in acute P. falciparum and P. vivax malaria are significantly lower than previously assumed for estimating malaria-parasite density. However, these abnormalities returned to normal within several weeks after artemisinin-derivative-based treatment.
authors.affiliation: Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. tmntp@mahidol.ac.th
authors.forename: Noppadon
authors.initials: N
authors.lastname: Tangpukdee
authors.forename: Haur-Sen
authors.initials: HS
authors.lastname: Yew
authors.forename: Srivicha
authors.initials: S
authors.lastname: Krudsood
authors.forename: Nataya
authors.initials: N
authors.lastname: Punyapradit
authors.forename: Waraporn
authors.initials: W
authors.lastname: Somwong
authors.forename: Sornchai
authors.initials: S
authors.lastname: Looareesuwan
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kano
authors.forename: Polrat
authors.initials: P
authors.lastname: Wilairatana
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D007970:Leukopenia / Q000097:blood* / Q000469:parasitology; D016778:Malaria, Falciparum / Q000097:blood* / Q000188:drug therapy / Q000469:parasitology; D016780:Malaria, Vivax / Q000097:blood* / Q000188:drug therapy / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum; D010966:Plasmodium vivax; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin