title: Parasite polymorphism and severe malaria in Dakar (Senegal): a West African urban area.
abstract: 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.
authors.affiliation: Institut Pasteur de Dakar, Dakar, Senegal.
authors.forename: Ndeye Sakha
authors.initials: NS
authors.lastname: Bob
authors.forename: Bernard Marcel
authors.initials: BM
authors.lastname: Diop
authors.forename: Francois
authors.initials: F
authors.lastname: Renaud
authors.forename: Laurence
authors.initials: L
authors.lastname: Marrama
authors.forename: Patrick
authors.initials: P
authors.lastname: Durand
authors.forename: Adama
authors.initials: A
authors.lastname: Tall
authors.forename: Boubacar
authors.initials: B
authors.lastname: Ka
authors.forename: Marie Therese
authors.initials: MT
authors.lastname: Ekala
authors.forename: Christiane
authors.initials: C
authors.lastname: Bouchier
authors.forename: Odile
authors.initials: O
authors.lastname: Mercereau-Puijalon
authors.forename: Ronan
authors.initials: R
authors.lastname: Jambou
mesh_terms: 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
chemical_list: D013762:Tetrahydrofolate Dehydrogenase