title: Multiplicity of infection and genetic diversity of Plasmodium falciparum isolates from patients with uncomplicated and severe malaria in Gezira State, Sudan.
abstract: Multiplicity and genetic diversity of Plasmodium falciparum infection might play a role in determining the clinical outcome of malaria infection and could be a fair reflection of the disease transmission rate. This study investigated the genetic diversity of P. falciparum and multiplicity of infection in relation to the severity of malaria and age of patients in Gezira State, Sudan.
  
  
  
  A cross-sectional health facilities-based survey was conducted in Gezira State, Sudan in January 2012. A total of 140 P. falciparum malaria patients diagnosed with microscopy and confirmed using nested PCR were recruited and classified into uncomplicated malaria and severe malaria states according to the standard WHO criteria. DNA was extracted and MSP1 and MSP2 allelic families were determined using nested PCR.
  
  
  
  The overall multiplicity of infection (MOI) was 2.25 and 2.30 and 2.15 for uncomplicated and severe malaria respectively. There were no statistically significant differences between uncomplicated and severe malaria (SM) patient groups in MOI with regard to MSP1, MSP2 and overall MOI (Mann-Whitney U-test; all P < 0.05). The predominant MSP1 allelic families were MAD20 for uncomplicated malaria and RO33 for severe malaria. The distribution of both FC27 and IC1/3D7 MSP2 allelic families were approximately the same across disease severity. One hundred and eleven P. falciparum isolates (81 %) consisted of multiple genotypes; 71/90 (78.9 %) in uncomplicated malaria and 40/50 (85.1 %) in severe malaria patient groups. Neither MSP1 nor MSP2 allelic families showed association with malaria severity. No statistically significant differences in multiplicity of infection were observed between different age groups.
  
  
  
  In this study the majority of P. falciparum isolates from uncomplicated and severe malaria patients consisted of multiple genotypes. Further molecular epidemiological studies delineate the link between P. falciparum genotype with the malaria phenotype in different regions are encouraged.
authors.affiliation: Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan. mahdi@iend.org.
authors.forename: Muzamil
authors.initials: M
authors.lastname: Mahdi Abdel Hamid
authors.affiliation: Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan.
authors.forename: Arwa F
authors.initials: AF
authors.lastname: Elamin
authors.affiliation: Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan.
authors.forename: Musab M Ali
authors.initials: MM
authors.lastname: Albsheer
authors.affiliation: Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
authors.forename: Abdelmohaymin A A
authors.initials: AA
authors.lastname: Abdalla
authors.affiliation: Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan.
authors.forename: Nouh S
authors.initials: NS
authors.lastname: Mahgoub
authors.affiliation: Department of Parasitology and Medical Entomology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan.
authors.forename: Shaza O
authors.initials: SO
authors.lastname: Mustafa
authors.affiliation: Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
authors.forename: Mohamed SiddigEltayeb
authors.initials: MS
authors.lastname: Muneer
authors.affiliation: Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
authors.forename: Mutaz
authors.initials: M
authors.lastname: Amin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000235:genetics; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000469:parasitology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000235:genetics*; D015800:Protozoan Proteins / Q000235:genetics / Q000378:metabolism; D013397:Sudan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D016054:DNA, Protozoan; D015800:Protozoan Proteins
keywords: Genetic diversity; MSP1; MSP2; Multiplicity of infection; Plasmodium falciparum; Severity; Sudan