title: Plasmodium Parasitemia Associated With Increased Survival in Ebola Virus-Infected Patients.
abstract: The ongoing Ebola outbreak in West Africa has resulted in 28 646 suspected, probable, and confirmed Ebola virus infections. Nevertheless, malaria remains a large public health burden in the region affected by the outbreak. A joint Centers for Disease Control and Prevention/National Institutes of Health diagnostic laboratory was established in Monrovia, Liberia, in August 2014, to provide laboratory diagnostics for Ebola virus.
  
  
  
  All blood samples from suspected Ebola virus-infected patients admitted to the Médecins Sans Frontières ELWA3 Ebola treatment unit in Monrovia were tested by quantitative real-time polymerase chain reaction for the presence of Ebola virus and Plasmodium species RNA. Clinical outcome in laboratory-confirmed Ebola virus-infected patients was analyzed as a function of age, sex, Ebola viremia, and Plasmodium species parasitemia.
  
  
  
  The case fatality rate of 1182 patients with laboratory-confirmed Ebola virus infections was 52%. The probability of surviving decreased with increasing age and decreased with increasing Ebola viral load. Ebola virus-infected patients were 20% more likely to survive when Plasmodium species parasitemia was detected, even after controlling for Ebola viral load and age; those with the highest levels of parasitemia had a survival rate of 83%. This effect was independent of treatment with antimalarials, as this was provided to all patients. Moreover, treatment with antimalarials did not affect survival in the Ebola virus mouse model.
  
  
  
  Plasmodium species parasitemia is associated with an increase in the probability of surviving Ebola virus infection. More research is needed to understand the molecular mechanism underlying this remarkable phenomenon and translate it into treatment options for Ebola virus infection.
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Kyle
authors.initials: K
authors.lastname: Rosenke
authors.affiliation: Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda Commissioned Corps, US Public Health Service, Rockville, Maryland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Adjemian
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Munster
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marzi
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Darryl
authors.initials: D
authors.lastname: Falzarano
authors.affiliation: Center for Global Health, Division of Global Health Protection, Centers for Disease Control and Prevention.
authors.forename: Clayton O
authors.initials: CO
authors.lastname: Onyango
authors.affiliation: Kenya Medical Research Institute, Center for Global Health Research, Nairobi.
authors.forename: Melvin
authors.initials: M
authors.lastname: Ochieng
authors.affiliation: Center for Global Health, Division of Global Health Protection, Centers for Disease Control and Prevention.
authors.forename: Bonventure
authors.initials: B
authors.lastname: Juma
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fischer
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Prescott
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: David
authors.initials: D
authors.lastname: Safronetz
authors.affiliation: Kenya Medical Research Institute, Center for Global Health Research, Nairobi.
authors.forename: Victor
authors.initials: V
authors.lastname: Omballa
authors.affiliation: Kenya Medical Research Institute, Center for Global Health Research, Nairobi.
authors.forename: Collins
authors.initials: C
authors.lastname: Owuor
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hoenen
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Allison
authors.initials: A
authors.lastname: Groseth
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Martellaro
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Neeltje
authors.initials: N
authors.lastname: van Doremalen
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Galina
authors.initials: G
authors.lastname: Zemtsova
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Self
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Trenton
authors.initials: T
authors.lastname: Bushmaker
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Kristin
authors.initials: K
authors.lastname: McNally
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rowe
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Emery
authors.affiliation: Rocky Mountain Veterinary Branch, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Rocky Mountain Laboratories, National Institutes of Health, Hamilton, Montana.
authors.forename: Friederike
authors.initials: F
authors.lastname: Feldmann
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Brandi N
authors.initials: BN
authors.lastname: Williamson
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Sonja M
authors.initials: SM
authors.lastname: Best
authors.affiliation: Ministry of Health and Social Welfare/Incident Management System, Monrovia, Liberia.
authors.forename: Tolbert G
authors.initials: TG
authors.lastname: Nyenswah
authors.affiliation: Special Pathogens Program, Public Health Agency of Canada, Winnipeg, Manitoba.
authors.forename: Allen
authors.initials: A
authors.lastname: Grolla
authors.affiliation: Special Pathogens Program, Public Health Agency of Canada, Winnipeg, Manitoba.
authors.forename: James E
authors.initials: JE
authors.lastname: Strong
authors.affiliation: Special Pathogens Program, Public Health Agency of Canada, Winnipeg, Manitoba.
authors.forename: Gary
authors.initials: G
authors.lastname: Kobinger
authors.affiliation: Liberian Institute for Biomedical Research, Charlesville.
authors.forename: Fatorma K
authors.initials: FK
authors.lastname: Bolay
authors.affiliation: Cytokine Biology Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Kathryn C
authors.initials: KC
authors.lastname: Zoon
authors.affiliation: Médecins Sans Frontières, Operational Center, Brussels, Belgium.
authors.forename: Jorgen
authors.initials: J
authors.lastname: Stassijns
authors.affiliation: Médecins Sans Frontières, Operational Center, Brussels, Belgium.
authors.forename: Ruggero
authors.initials: R
authors.lastname: Giuliani
authors.affiliation: Médecins Sans Frontières, Operational Center, Brussels, Belgium.
authors.forename: Martin
authors.initials: M
authors.lastname: de Smet
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Nichol
authors.affiliation: Center for Global Health, Division of Global Health Protection, Centers for Disease Control and Prevention.
authors.forename: Barry
authors.initials: B
authors.lastname: Fields
authors.affiliation: Médecins Sans Frontières, Operational Center, Brussels, Belgium.
authors.forename: Armand
authors.initials: A
authors.lastname: Sprecher
authors.affiliation: Ministry of Health and Social Welfare/Incident Management System, Monrovia, Liberia.
authors.forename: Moses
authors.initials: M
authors.lastname: Massaquoi
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Heinz
authors.initials: H
authors.lastname: Feldmann
authors.affiliation: Laboratory of Virology, Division of Intramural Research, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana.
authors.forename: Emmie
authors.initials: E
authors.lastname: de Wit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D004195:Disease Models, Animal; D029043:Ebolavirus / Q000235:genetics; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology*; D008297:Male; D051379:Mice; D008875:Middle Aged; D059208:Parasite Load; D018512:Parasitemia; D010961:Plasmodium / Q000235:genetics; D015996:Survival Rate; D019562:Viral Load; D055815:Young Adult
keywords: coinfection; ebolavirus; plasmodium; survival