Parasite polymorphism and severe malaria in Dakar (Senegal): a West African urban area.
BACKGROUND
Transmission of malaria in West African urban areas is low and healthcare facilities are well organized. However, malaria mortality remains high. We conducted a survey in Dakar with the general objective to establish who died from severe malaria (SM) in urban areas (particularly looking at the age-groups) and to compare parasite isolates associated with mild or severe malaria.


RESULTS
The current study included mild- (MM) and severe malaria (SM) cases, treated in dispensaries (n = 2977) and hospitals (n = 104), We analysed Pfdhfr/Pfcrt-exon2 and nine microsatellite loci in 102 matched cases of SM and MM. Half of the malaria cases recorded at the dispensaries and 87% of SM cases referred to hospitals, occurred in adults, although adults only accounted for 26% of all dispensary consultations. This suggests that, in urban settings, whatever the reason for this adult over-representation, health-workers are forced to take care of increasing numbers of malaria cases among adults. Inappropriate self treatment and mutations in genes associated with drug resistance were found associated with SM in adults. SM was also associated with a specific pool of isolates highly polymorphic and different from those associated with MM.


CONCLUSIONS
In this urban setting, adults currently represent one of the major groups of patients attending dispensaries for malaria treatment. For these patients, despite the low level of transmission, SM was associated with a specific and highly polymorphic pool of parasites which may have been selected by inappropriate treatment.
Bob
Ndeye Sakha
NS
Institut Pasteur de Dakar, Dakar, Senegal.
Diop
Bernard Marcel
BM
Renaud
Francois
F
Marrama
Laurence
L
Durand
Patrick
P
Tall
Adama
A
Ka
Boubacar
B
Ekala
Marie Therese
MT
Bouchier
Christiane
C
Mercereau-Puijalon
Odile
O
Jambou
Ronan
R
D000293:Adolescent; D000328:Adult; D000818:Animals; D002648:Child; D005260:Female; D006801:Humans; D015810:Linkage Disequilibrium; D008288:Malaria / Q000453:epidemiology* / Q000401:mortality / Q000469:parasitology*; D008297:Male; D018895:Microsatellite Repeats; D008875:Middle Aged; D009154:Mutation; D010963:Plasmodium falciparum / Q000235:genetics*; D011110:Polymorphism, Genetic; D012675:Senegal; D013762:Tetrahydrofolate Dehydrogenase / Q000235:genetics*; D014505:Urban Population
D013762:Tetrahydrofolate Dehydrogenase