Plasmodium vivax infection: a major determinant of severe anaemia in infancy
Plasmodium vivax infection: a major determinant of severe anaemia in infancy
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DOI：
10.1186/s12936-016-1373-8
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发表时间：
2016-06-16
期刊：
影响因子：
3
通讯作者：
Douglas, Nicholas M.
中科院分区：
文献类型：
--
作者：
Kenangalem, Enny;Karyana, Muhammad;Douglas, Nicholas M.
背景：非洲以外的大多数疟疾流行国家是恶性疟原虫和间日疟原虫共同流行的国家。这两个物种造成的贫血在社会上的比较负担是不完全的characteristic.Methods：一个三阶段，横截面，社区调查被用来确定中度或重度贫血（血红蛋白< 7克/分升）的比例专利P.间日疟原虫，恶性疟原虫和混合寄生虫病在巴布亚，印度尼西亚。调整后的人群归因分数由多变量logistic回归模型计算。调查了825户家庭，共5255名住户，其中3890人（74%）在场并提供了血液样本。恶性疟原虫寄生虫血症出现在8.1%（n = 315）的参与者中，间日疟原虫感染出现在6.4%（n = 250）中，混合感染出现在1.9%（n = 72）中。总体而言，与无寄生虫血症的患者相比，恶性疟原虫导致血红蛋白平均降低1.16 g/dL [95%置信区间（95% CI）0.91，1.41 g/dL]。间日疟原虫和混合感染的相应值分别为0.66 g/dL（95% CI 0.35，0.96）和1.25 g/dL（0.71，1.80）。总体而言，估计社区中血红蛋白浓度< 7 g/dL的16.7%（95% CI 8.52，24.2%）可归因于未闭寄生虫血症。婴儿和1-5岁儿童的分数分别为34.4%（95%CI-3.30，58.3%）和23.2%（95%CI 3.34，39.0%）。与恶性疟原虫相比，间日疟原虫与婴儿贫血的可归因分数（27.6%）高出三倍以上相关。（95% CI-3.20，49.2%）与7.94%（-5.87，20.0%）]。结论：尽管疟疾的地方性程度相对较低，但在巴布亚南部的所有社区贫血病例中，疟疾占很大比例。与其良好的声誉相反，间日疟原虫是婴儿期贫血的一个重要和可预防的风险因素，这是免疫力发展之前疾病复发的可能后果。
Background: Most malarious countries outside of Africa are co-endemic for Plasmodium falciparum and Plasmodium vivax. The comparative burden of anaemia in the community caused by these two species is incompletely characterized.Methods: A three-stage, cross-sectional, community survey was used to determine the proportion of moderate or severe anaemia (haemoglobin < 7 g/dL) attributable to patent P. vivax, P. falciparum and mixed parasitaemia in Papua, Indonesia. Adjusted population-attributable fractions were calculated from multivariable logistic regression models. Eight hundred and twenty-five households were surveyed with a total of 5255 occupants, 3890 (74 %) of whom were present and provided a blood sample. Plasmodium falciparum parasitaemia was present in 8.1 % (n = 315) of participants, P. vivax in 6.4 % (n = 250) and mixed infections in 1.9 % (n = 72). Overall, P. falciparum was associated with a mean reduction in haemoglobin of 1.16 g/dL compared to those without patent parasitaemia [95 % confidence interval (95 % Cl) 0.91, 1.41 g/dL]. The corresponding values for P. vivax and mixed infections were 0.66 g/dL (95 % Cl 0.35, 0.96) and 1.25 g/dL (0.71, 1.80), respectively. Overall, 16.7 % (95 % Cl 8.52, 24.2 %) of haemoglobin concentrations < 7 g/dL in the community were estimated to be attributable to patent parasitaemia. The fractions for infants and 1-5 years old were 34.4 % (95 % Cl-3.30, 58.3 %) and 23.2 % (95 % Cl 3.34, 39.0 %), respectively. Plasmodium vivax was associated with a greater than threefold higher attributable fraction of anaemia in infants compared with P. falciparum [27.6 % (95 % Cl-3.20, 49.2 %) versus 7.94 % (-5.87, 20.0 %)].Conclusion: Despite comparatively low-level endemicity, malaria is associated with a significant proportion of all cases of community anaemia in southern Papua. Contrary to its benign reputation, P. vivax is an important and preventable risk factor for anaemia during infancy-a probable consequence of relapsing disease prior to the development of immunity.