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Published on: July 17, 2014
Leukocyte counts in falciparum malaria in African children from an endemic area
A Sowunmi1, J A Akindele, M A Balogun
1Department of Pharmacology, University of Ibadan, Nigeria.
Insights
In Nigerian children with malaria, high white blood cell counts (leukocytosis) combined with high parasite levels (hyperparasitaemia) did not predict a poor prognosis. This combination is not a reliable indicator of severity in falciparum malaria.
Area of Science:
- * Hematology
- * Tropical Medicine
- * Pediatric Infectious Diseases
Background:
- * Malaria remains a significant public health concern, particularly in endemic regions of Africa.
- * Understanding hematological markers like total leukocyte count is crucial for assessing disease severity and prognosis in pediatric malaria.
- * Previous studies have yielded varied results on the relationship between leukocyte counts and malaria parasitemia.
Purpose of the Study:
- * To investigate the relationship between total leukocyte counts and the density of Plasmodium falciparum parasitemia in children.
- * To determine if the combination of hyperparasitemia and leukocytosis is a reliable indicator of poor prognosis in pediatric falciparum malaria.
- * To assess the prognostic value of combined hyperparasitemia and leukocytosis in African children from a malaria-endemic area.
Main Methods:
- * Total leukocyte counts were analyzed in 180 healthy children and 55 children with acute symptomatic falciparum malaria in southwestern Nigeria.
- * Leukocyte counts and distribution were compared between aparasitemic and parasitemic children.
- * The correlation between parasitemia density and total leukocyte counts was examined in symptomatic malaria cases, with stratification based on parasitemia levels.
Main Results:
- * Children without parasitemia were older with lower total leukocyte counts than parasitemic children, though not statistically significant.
- * A positive correlation between increasing parasitemia and leukocytosis was observed only at parasitemia levels of 10% or higher.
- * The combination of hyperparasitemia (>5%) and leukocytosis (>12 x 10(9)/L) occurred in 15% of children and was not associated with a poor prognosis.
Conclusions:
- * In African children from endemic areas, the combination of hyperparasitemia and leukocytosis is not a reliable indicator of severity or poor prognosis in falciparum malaria.
- * Leukocyte counts alone may not accurately reflect the disease status in asymptomatic or mildly symptomatic malaria.
- * Further research may be needed to identify more robust prognostic markers for pediatric falciparum malaria.
Abstract:
Total leukocyte counts were done in 180 apparently healthy rural school children aged 6-12 years in a malaria endemic area in southwestern Nigeria. Total leukocyte counts and their distribution in aparasitaemic and asymptomatic parasitaemic children were similar. Total leukocyte counts, and the relationship between the density of parasitaemic and total leukocyte counts were studied in 55 consecutive children presenting with acute symptomatic falciparum malaria. Children without parasitaemia were older and had lower total leukocyte counts when compared with children with parasitaemia (7.61 +/- 4.11 x 10(9)/L Vs 9.04 +/- 5.0 x 10(9)/L), but the difference was not statistically significant (P > 0.05). In non-hyperparasitaemic children and in hyperparasitaemic children with percentage infected red cells < 10%, there was poor correlation between density of parasitaemia and total leukocyte counts. However, at > or = 10% parasitaemia, there was a positive correlation (r = 0.55; P = 0.032) between increasing parasitaemia and leukocytosis. Combination of hyperparasitaemia ( > 5% parasitaemia) and leukocytosis ( > 12 x 10(9)/L) occurred in 15% of the children and was not a poor prognostic index in the absence of other evidence of severe or complicated disease, as response to oral mefloquine was prompt. This would suggest that in African children from an endemic area, this combination is not a reliable indicator of severity or poor prognosis in falciparum malaria.
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