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Jackeline Pérez-Vega M, Manuel Corral-Ruiz G, Galán-Salinas A, Silva-García R, Mancilla-Herrera I, Barrios-Payán J, Fabila-Castillo L, Hernández-Pando R, Enid Sánchez-Torres L. Acute lung injury is prevented by monocyte locomotion inhibitory factor in an experimental severe malaria mouse model. Immunobiology 2024; 229:152823. [PMID: 38861873 DOI: 10.1016/j.imbio.2024.152823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024]
Abstract
Acute lung injury caused by severe malaria (SM) is triggered by a dysregulated immune response towards the infection with Plasmodium parasites. Postmortem analysis of human lungs shows diffuse alveolar damage (DAD), the presence of CD8 lymphocytes, neutrophils, and increased expression of Intercellular Adhesion Molecule 1 (ICAM-1). P. berghei ANKA (PbA) infection in C57BL/6 mice reproduces many SM features, including acute lung injury characterized by DAD, CD8+ T lymphocytes and neutrophils in the lung parenchyma, and tissular expression of proinflammatory cytokines and adhesion molecules, such as IFNγ, TNFα, ICAM, and VCAM. Since this is related to a dysregulated immune response, immunomodulatory agents are proposed to reduce the complications of SM. The monocyte locomotion inhibitory factor (MLIF) is an immunomodulatory pentapeptide isolated from axenic cultures of Entamoeba hystolitica. Thus, we evaluated if the MLIF intraperitoneal (i.p.) treatment prevented SM-induced acute lung injury. The peptide prevented SM without a parasiticidal effect, indicating that its protective effect was related to modifications in the immune response. Furthermore, peripheral CD8+ leukocytes and neutrophil proportions were higher in infected treated mice. However, the treatment prevented DAD, CD8+ cell infiltration into the pulmonary tissue and downregulated IFNγ. Moreover, VCAM-1 expression was abrogated. These results indicate that the MLIF treatment downregulated adhesion molecule expression, impeding cell migration and proinflammatory cytokine tissular production, preventing acute lung injury induced by SM. Our findings represent a potential novel strategy to avoid this complication in various events where a dysregulated immune response triggers lung injury.
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Affiliation(s)
- Martha Jackeline Pérez-Vega
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico; Posgrado en Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Gerardo Manuel Corral-Ruiz
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico; Posgrado en Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Adrian Galán-Salinas
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Raúl Silva-García
- Unidad de Investigación Médica en Inmunología, Hospital de Pediatría, CMN-Siglo XXI, IMSS, Ciudad de México, Mexico
| | - Ismael Mancilla-Herrera
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Ciudad de México, Mexico
| | - Jorge Barrios-Payán
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | | | - Rogelio Hernández-Pando
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico.
| | - Luvia Enid Sánchez-Torres
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico.
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Ojueromi OO, Oboh G, Ademosun AO. Nigella sativa-Fortified Cookies Ameliorate Oxidative Stress, Inflammatory and Immune Dysfunction in Plasmodium berghei-Infected Murine Model. J Med Food 2024; 27:552-562. [PMID: 38935918 DOI: 10.1089/jmf.2023.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Malaria impedes the ability of primary cells of the immune system to generate an efficacious inflammatory and immune response. Black seed (Nigella sativa) is a core dietary supplement and food additive in folklore. This study investigated the antioxidant, immunomodulatory, and anti-inflammatory effects of N. sativa cookies in Plasmodium berghei-infected mice. Aqueous extract of black seed was prepared, and the total phenol and flavonoid contents were determined. The mice were infected with standard inoculum of the strain NK65 P. berghei. The mice weight and behavioral changes were observed. The mice were fed with the N. sativa cookies (2.5%, 5%, and 10%) and 10 mg/kg chloroquine for 5 consecutive days after the infection was established. The reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase, catalase, and hematological parameters (red cell indices, leukocytes, and its differentials) in the infected mice were determined. The inflammatory mediators, C-reactive protein (CRP), and myeloperoxidase (MPO) were also assayed. The result revealed that black seed had a total phenol content of 18.73 mgGAE/g and total flavonoid content of 0.36 mgQUE/g. The infected mice treated with N. sativa cookies showed significantly decreased parasitaemia, MDA, and ROS levels. Furthermore, the results showed significant suppression in proinflammatory mediators (CRP and MPO) levels and enhanced antioxidant status of infected mice treated with N. sativa. The study suggests that N. sativa could function as nutraceuticals in the management of Plasmodium infection associated with inflammatory and immunomodulatory disorders.
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Affiliation(s)
- Opeyemi O Ojueromi
- Functional Foods and Nutraceuticals Unit, Department of Biochemistry, Federal University of Technology, Akure, Nigeria
- Department of Pure and Applied Sciences, Precious Cornerstone University, Ibadan, Nigeria
| | - Ganiyu Oboh
- Functional Foods and Nutraceuticals Unit, Department of Biochemistry, Federal University of Technology, Akure, Nigeria
| | - Ayokunle O Ademosun
- Functional Foods and Nutraceuticals Unit, Department of Biochemistry, Federal University of Technology, Akure, Nigeria
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Uribe-Querol E, Rosales C. Neutrophils versus Protozoan Parasites: Plasmodium, Trichomonas, Leishmania, Trypanosoma, and Entameoba. Microorganisms 2024; 12:827. [PMID: 38674770 PMCID: PMC11051968 DOI: 10.3390/microorganisms12040827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/04/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Neutrophils are the most abundant polymorphonuclear granular leukocytes in human blood and are an essential part of the innate immune system. Neutrophils are efficient cells that eliminate pathogenic bacteria and fungi, but their role in dealing with protozoan parasitic infections remains controversial. At sites of protozoan parasite infections, a large number of infiltrating neutrophils is observed, suggesting that neutrophils are important cells for controlling the infection. Yet, in most cases, there is also a strong inflammatory response that can provoke tissue damage. Diseases like malaria, trichomoniasis, leishmaniasis, Chagas disease, and amoebiasis affect millions of people globally. In this review, we summarize these protozoan diseases and describe the novel view on how neutrophils are involved in protection from these parasites. Also, we present recent evidence that neutrophils play a double role in these infections participating both in control of the parasite and in the pathogenesis of the disease.
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Affiliation(s)
- Eileen Uribe-Querol
- Laboratorio de Biología del Desarrollo, División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Carlos Rosales
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
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Soriano-Pérez MJ, Castillo-Fernández N, Lozano-Serrano AB, Luzón-García MP, Vázquez-Villegas J, Cabeza-Barrera MI, Borrego-Jiménez J, Giménez-López MJ, Salas-Coronas J. Estimation of parasitaemia in imported falciparum malaria using the results of a combined rapid diagnostic test. No big help from haematological parameters. Malar J 2023; 22:351. [PMID: 37974257 PMCID: PMC10655380 DOI: 10.1186/s12936-023-04781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Microscopy continues to be the mainstay for the evaluation of parasitaemia in malaria but requires laboratory support and microbiological experience. Other fast and simple methods are necessary. METHODS A retrospective observational study of imported malaria treated from July-2007 to December-2020 was carried out to evaluate the association between the degree of parasitaemia and both rapid diagnostic tests (RDT) reactivity patterns and haematological parameters. Plasmodium falciparum monoinfections diagnosed by peripheral blood smear and/or polymerase chain reaction (PCR),which also had a positive RDT result in the same blood sample, were included in the study. RESULTS A total of 273 patients were included. Most of them were male (n = 256; 93.8%) and visiting friends and relatives (VFR) travellers (n = 252; 92.3%). Patients with plasmodial lactate dehydrogenase (pLDH) or aldolase and histidine-rich protein 2 (HRP-2) co-reactivity (Pan/Pf pattern) had a parasitaemia range between 0 and 37% while those with just HRP-2 reactivity (P. falciparum pattern) had ranges between 0 and 1%. Not a single case of P. falciparum pattern was found for parasitaemia ranges greater than 1%, showing a negative predictive value of 100% for high parasitaemia. All the correlations between haematological parameters and parasitaemia resulted to be weak, with a maximum rho coefficient of -0.35 for lymphocytes and platelets, and of 0.40 for neutrophils-to-lymphocytes count ratio. Multivariate predictive models were constructed reflecting a poor predictive capacity. CONCLUSIONS The reactivity pattern of RDT allows a rapid semi-quantitative assessment of P. falciparum parasitaemia in travellers with imported malaria, discriminating patients with lower parasite loads. Haematological parameters were not able to estimate parasitaemia with sufficient precision.
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Affiliation(s)
- Manuel Jesús Soriano-Pérez
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - Nerea Castillo-Fernández
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain.
| | - Ana Belén Lozano-Serrano
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - María Pilar Luzón-García
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - José Vázquez-Villegas
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - María Isabel Cabeza-Barrera
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - Jaime Borrego-Jiménez
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | | | - Joaquín Salas-Coronas
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
- Department of Nursing, Physiotherapy and Medicine. Faculty of Health Sciences, University of Almeria, Almeria, Spain
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Tripathy R, Das BK, Panda AK. Procalcitonin is elevated in severe malaria and is a promising biomarker of severe malaria and multi-organ dysfunction: A cross-sectional study and meta-analysis. Int Immunopharmacol 2023; 124:110923. [PMID: 37716164 DOI: 10.1016/j.intimp.2023.110923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Elevated procalcitonin (PCT) has been reported in bacterial infection and is positively associated with the severity of the disease. Patients with severe Plasmodium falciparum malaria also display higher procalcitonin levels compared to those with non-severe disease, indicating a possible role for bacterial infection in severe disease, however this observation remained variable in different study population. Furthermore, the significance of PCT in different clinical categories of severe malaria has not been evaluated so far. METHODS A total of 74 P. falciparum-infected subjects were enrolled in the study comprising of 55 cases complicated malaria [cerebral malaria- 14; non-cerebral severe malaria- 21; multi-organ dysfunction- 20] and 19 uncomplicated cases. Serum levels of PCT were quantified by fluorescence immunoassay. For meta-analysis, the literature search was performed in different databases, and all relevant articles were screened, and eligible reports were identified based on predefined inclusion and exclusion criteria. The meta-analysis was performed by comprehensive meta-analysis software V3 and MedCalc 20.218. RESULTS Patients with severe P. falciparum malaria had significantly higher PCT levels compared to uncomplicated cases (p = 0.01). Analysis of PCT in different categories of patients with severe malaria revealed significantly elevated PCT in multi-organ dysfunctions compared to those with uncomplicated malaria (p = 0.004) and cerebral malaria (p = 0.05). Interestingly the receiver operating characteristics curve analysis showed procalcitonin as a promising biomarker for differentiating severe malaria (AUC: 0.697, p = 0.01) and multi-organ dysfunction (AUC: 0.704, p = 0.007) from uncomplicated malaria and other clinical categories of falciparum malaria, respectively. Furthermore, meta-analysis also revealed an elevated procalcitonin in severe malaria and it could be an important biomarker in the management of severe disease. CONCLUSIONS PCT is elevated in P. falciparum-infected patients and could be a good biomarker for diagnosis of severe malaria and multi-organ dysfunction. It can help in the management of severe disease with additional treatment options.
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Affiliation(s)
- Rina Tripathy
- Department of Biochemistry, Sardar Vallabhbhai Patel Post Graduate Institute of Pediatrics, Cuttack, Odisha 753002, India.
| | - Bidyut K Das
- Department of Clinical Immunology and Rheumatology, SCB Medical College, Cuttack, Odisha 753007, India.
| | - Aditya K Panda
- Department of Biotechnology, Berhampur University, Bhanja Bihar, Berhampur, Odisha 760007, India; Centre of Excellence on "Bioprospecting of Ethnopharmaceuticals of Southern Odisha" (CoE-BESO), Berhampur University, Bhanja Bihar, Berhampur, Odisha 760007, India.
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Freire-Antunes L, Ornellas-Garcia U, Rangel-Ferreira MV, Ribeiro-Almeida ML, de Sousa CHG, Carvalho LJDM, Daniel-Ribeiro CT, Ribeiro-Gomes FL. Increased Neutrophil Percentage and Neutrophil-T Cell Ratio Precedes Clinical Onset of Experimental Cerebral Malaria. Int J Mol Sci 2023; 24:11332. [PMID: 37511092 PMCID: PMC10379066 DOI: 10.3390/ijms241411332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Newly emerging data suggest that several neutrophil defense mechanisms may play a role in both aggravating and protecting against malaria. These exciting findings suggest that the balance of these cells in the host body may have an impact on the pathogenesis of malaria. To fully understand the role of neutrophils in severe forms of malaria, such as cerebral malaria (CM), it is critical to gain a comprehensive understanding of their behavior and functions. This study investigated the dynamics of neutrophil and T cell responses in C57BL/6 and BALB/c mice infected with Plasmodium berghei ANKA, murine models of experimental cerebral malaria (ECM) and non-cerebral experimental malaria, respectively. The results demonstrated an increase in neutrophil percentage and neutrophil-T cell ratios in the spleen and blood before the development of clinical signs of ECM, which is a phenomenon not observed in the non-susceptible model of cerebral malaria. Furthermore, despite the development of distinct forms of malaria in the two strains of infected animals, parasitemia levels showed equivalent increases throughout the infection period evaluated. These findings suggest that the neutrophil percentage and neutrophil-T cell ratios may be valuable predictive tools for assessing the dynamics and composition of immune responses involved in the determinism of ECM development, thus contributing to the advancing of our understanding of its pathogenesis.
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Affiliation(s)
- Lucas Freire-Antunes
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz & Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) of Fundação Oswaldo Cruz (Fiocruz) and of Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Rio de Janeiro 21041-250, Brazil
| | - Uyla Ornellas-Garcia
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz & Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) of Fundação Oswaldo Cruz (Fiocruz) and of Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Rio de Janeiro 21041-250, Brazil
| | - Marcos Vinicius Rangel-Ferreira
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz & Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) of Fundação Oswaldo Cruz (Fiocruz) and of Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Rio de Janeiro 21041-250, Brazil
| | - Mônica Lucas Ribeiro-Almeida
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz & Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) of Fundação Oswaldo Cruz (Fiocruz) and of Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Rio de Janeiro 21041-250, Brazil
| | - Carina Heusner Gonçalves de Sousa
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz & Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) of Fundação Oswaldo Cruz (Fiocruz) and of Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Rio de Janeiro 21041-250, Brazil
| | - Leonardo José de Moura Carvalho
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz & Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) of Fundação Oswaldo Cruz (Fiocruz) and of Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Rio de Janeiro 21041-250, Brazil
| | - Cláudio Tadeu Daniel-Ribeiro
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz & Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) of Fundação Oswaldo Cruz (Fiocruz) and of Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Rio de Janeiro 21041-250, Brazil
| | - Flávia Lima Ribeiro-Gomes
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz & Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) of Fundação Oswaldo Cruz (Fiocruz) and of Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Rio de Janeiro 21041-250, Brazil
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Oyong DA, Duffy FJ, Neal ML, Du Y, Carnes J, Schwedhelm KV, Hertoghs N, Jun SH, Miller H, Aitchison JD, De Rosa SC, Newell EW, McElrath MJ, McDermott SM, Stuart KD. Distinct immune responses associated with vaccination status and protection outcomes after malaria challenge. PLoS Pathog 2023; 19:e1011051. [PMID: 37195999 PMCID: PMC10228810 DOI: 10.1371/journal.ppat.1011051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/30/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
Understanding immune mechanisms that mediate malaria protection is critical for improving vaccine development. Vaccination with radiation-attenuated Plasmodium falciparum sporozoites (PfRAS) induces high level of sterilizing immunity against malaria and serves as a valuable tool for the study of protective mechanisms. To identify vaccine-induced and protection-associated responses during malarial infection, we performed transcriptome profiling of whole blood and in-depth cellular profiling of PBMCs from volunteers who received either PfRAS or noninfectious mosquito bites, followed by controlled human malaria infection (CHMI) challenge. In-depth single-cell profiling of cell subsets that respond to CHMI in mock-vaccinated individuals showed a predominantly inflammatory transcriptome response. Whole blood transcriptome analysis revealed that gene sets associated with type I and II interferon and NK cell responses were increased in prior to CHMI while T and B cell signatures were decreased as early as one day following CHMI in protected vaccinees. In contrast, non-protected vaccinees and mock-vaccinated individuals exhibited shared transcriptome changes after CHMI characterized by decreased innate cell signatures and inflammatory responses. Additionally, immunophenotyping data showed different induction profiles of vδ2+ γδ T cells, CD56+ CD8+ T effector memory (Tem) cells, and non-classical monocytes between protected vaccinees and individuals developing blood-stage parasitemia, following treatment and resolution of infection. Our data provide key insights in understanding immune mechanistic pathways of PfRAS-induced protection and infective CHMI. We demonstrate that vaccine-induced immune response is heterogenous between protected and non-protected vaccinees and that inducted-malaria protection by PfRAS is associated with early and rapid changes in interferon, NK cell and adaptive immune responses. Trial Registration: ClinicalTrials.gov NCT01994525.
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Affiliation(s)
- Damian A. Oyong
- Center for Global Infectious Disease Research (CGIDR), Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Fergal J. Duffy
- Center for Global Infectious Disease Research (CGIDR), Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Maxwell L. Neal
- Center for Global Infectious Disease Research (CGIDR), Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Ying Du
- Center for Global Infectious Disease Research (CGIDR), Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Jason Carnes
- Center for Global Infectious Disease Research (CGIDR), Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Katharine V. Schwedhelm
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Nina Hertoghs
- Center for Global Infectious Disease Research (CGIDR), Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Seong-Hwan Jun
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Helen Miller
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - John D. Aitchison
- Center for Global Infectious Disease Research (CGIDR), Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Stephen C. De Rosa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Evan W. Newell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - M Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Suzanne M. McDermott
- Center for Global Infectious Disease Research (CGIDR), Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Kenneth D. Stuart
- Center for Global Infectious Disease Research (CGIDR), Seattle Children’s Research Institute, Seattle, Washington, United States of America
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Saleh AG, Shehab AY, Abdul-Ghani R, Allam AF, Osman MM, Ibrahim HS, El-Taweel HA, Moneer EA, Hagras NAE, Farag HF. Key cytokines and hematological parameters in patients with uncomplicated falciparum malaria in Hodeidah, Yemen. Cytokine 2023; 164:156156. [PMID: 36857851 DOI: 10.1016/j.cyto.2023.156156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/14/2023] [Accepted: 02/11/2023] [Indexed: 02/28/2023]
Abstract
Immunity to malaria has a major role in controlling disease and pathogenesis with cytokine production being involved in almost every phase of the immune response. The present study aimed to assess hematological variables and to measure plasma levels of TNFα, IFNγ and IL10, their ratios, and their relation to parasitemia among patients with uncomplicated falciparum malaria in Hodeidah, Yemen. Forty patients with uncomplicated P. falciparum monoinfection and 40 healthy age and sex-matched controls were enrolled in the study. Parasitological diagnosis was confirmed, and parasite density was estimated. Plasma cytokine levels, hematologic parameters, and the presence of gametocytes were determined. Results revealed higher TNFα, IFNγ and IL10 in patients than in controls. A relatively higher IL10 production was demonstrated by the significantly lower TNFα/IL10 and IFNγ/IL10 ratios in patients than in controls. TNFα and IL10 correlated positively with parasite density. Lower Hb levels, RBC, lymphocyte and platelet counts, and higher neutrophil and reticulocyte counts were observed in patients compared to controls. Reticulocyte count was higher and IFNγ level was lower in the presence of gametocytes. Conclusively, uncomplicated falciparum malaria is associated with the ability to regulate the production of pro-inflammatory and anti-inflammatory cytokines. This mediates parasite clearance while simultaneously avoiding severe pathology.
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Affiliation(s)
- Ali Gamali Saleh
- Faculty of Medicine and Health Sciences, Hodeidah University, Yemen
| | - Amel Youssef Shehab
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen and Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Amal Farahat Allam
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt
| | - Mervat Mostafa Osman
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt
| | - Heba Said Ibrahim
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt
| | - Hend Ali El-Taweel
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt.
| | - Esraa Abdelhamid Moneer
- Department of Medical Laboratory, Faculty of Applied Health Sciences Technology, Pharos University, Alexandria, Egypt
| | - Nancy Abd-Elkader Hagras
- Department of Medical Laboratory, Faculty of Applied Health Sciences Technology, Pharos University, Alexandria, Egypt
| | - Hoda Fahmy Farag
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt
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Zhang YH, Su XZ, Li J, Shi JJ, Xie LH. Multicohort transcriptome analysis of whole blood identifies robust human response signatures in Plasmodium falciparum infections. Malar J 2022; 21:333. [PMID: 36380373 PMCID: PMC9664782 DOI: 10.1186/s12936-022-04374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background To understand how Plasmodium falciparum malaria is controlled, it is essential to elucidate the transcriptomic responses of the human host in naturally-exposed populations. Various individual studies of the human transcriptomic responses to naturally transmitted P. falciparum infections have been reported with varying results. Multicohort gene expression analysis by aggregating data from diverse populations into a single analysis will increase the reproducibility and reliability of the results. Methods In this study, discovery cohorts GSE1124-GPL96, GSE34404, GSE117613, and validation cohort GSE35858 were obtained from the Gene Expression Omnibus. A meta-analysis using data from the multicohort studies was performed to identify the differentially expressed genes (DEGs) between malaria-infected and noninfected individuals using the MetaIntegrator R package. Subsequently, the protein–protein interaction (PPI) networks of the DEGs were constructed using Cytoscape software. Significant modules were selected, and the hub genes were identified using the CytoHubba and MCODE plug-ins. Multicohort WGCNA was conducted to find a correlation between modules and malaria infection. Furthermore, the immune cell profile of the peripheral blood in different groups was identified using ssGSEA. Results These analyses reveal that neutrophil activation, neutrophil-mediated immunity, and neutrophil degranulation are involved in the human response to natural malaria infection. However, neutrophil cell enrichment and activation were not significantly different between mild malaria and severe malaria groups. Malaria infection also downregulates host genes in ribosome synthesis and protein translation and upregulates host cell division-related genes. Furthermore, immune cell profiling analysis shows that activated dendritic cells and type 2 T helper cells are upregulated, while activated B cells, immature B cells, and monocytes are downregulated in the malaria-infected patients relative to the noninfected individuals. Significantly higher enrichment of activated dendritic cell-related genes and significantly lower enrichment of monocyte-related genes are also observed in the peripheral blood of the severe malaria group than in the mild malaria group. Conclusion These results reveal important molecular signatures of host responses to malaria infections, providing some bases for developing malaria control strategies and protective vaccines. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04374-5.
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Affiliation(s)
- Yan-hui Zhang
- grid.419897.a0000 0004 0369 313XKey Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
| | - Xin-zhuan Su
- grid.94365.3d0000 0001 2297 5165Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD USA
| | - Jian Li
- grid.12955.3a0000 0001 2264 7233State Key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signaling Network, School of Life Sciences, Xiamen University, Xiamen, Fujian China
| | - Jia-jian Shi
- grid.419897.a0000 0004 0369 313XKey Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
| | - Li-hua Xie
- grid.419897.a0000 0004 0369 313XKey Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
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10
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Sharma D, Priest H, Wilcox A. Pseudoreticulocytosis by the ADVIA 2120 Hematology Analyzer and Other Hematologic Changes in a Cynomolgus Macaque ( Macaca fascicularis) With Malaria. Toxicol Pathol 2022; 50:684-692. [DOI: 10.1177/01926233221083217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Important hematologic changes can be observed in nonhuman primates with malaria, including inaccurate reticulocyte counts by the ADVIA 2120 hematology analyzer. A 5-year-old male purpose-bred cynomolgus macaque ( Macaca fascicularis) imported from a commercial source in Cambodia was enrolled in a nonclinical toxicity study investigating the effects of an immunomodulatory pharmaceutical agent. On study day 22, an increase in large unstained cells (LUCs), due to increased monocytes (2.20 × 103/µl, reference interval: 0.17-0.76 × 103/µl), was reported by the analyzer during a scheduled hematologic evaluation, which prompted blood smear review and revealed that the macaque had a high burden of Plasmodium spp.. The macaque did not have clinical signs for the infection at this time point. Progressively higher parasite burdens and persistently increased monocytes (markedly increased by study day 56, 10.38 × 103/µl) were observed at subsequent hematologic evaluations. New Methylene Blue stain manual reticulocyte counts were performed on study day 43 and at later time points, and showed that the analyzer reported erroneous higher reticulocyte counts (study day 43: +6.7%, +266.2 × 109/L; study day 50: +18.9%, +409.8 × 109/L) compared with the manual reticulocyte counts (pseudoreticulocytosis). The magnitude of regenerative response was considered inadequate for the severity of anemia at these time points. Atypical reticulocyte scatter plot distributions from the analyzer were also observed at time points with high parasite burdens, and combined with increased LUCs, may suggest high burden parasitemia. Verification of automated reticulocyte counts is important in cases with high malarial parasite burdens and the recognition of pseudoreticulocytosis is prudent in assessing appropriateness of the regenerative response. Increases in monocytes correlated with higher parasite burdens and marked increases may be an indicator of advanced disease.
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Affiliation(s)
- Diya Sharma
- Charles River Laboratories, Reno, Nevada, USA
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11
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Brook B, Schaltz-Buchholzer F, Ben-Othman R, Kollmann T, Amenyogbe N. A place for neutrophils in the beneficial pathogen-agnostic effects of the BCG vaccine. Vaccine 2022; 40:1534-1539. [PMID: 33863572 DOI: 10.1016/j.vaccine.2021.03.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/25/2021] [Accepted: 03/26/2021] [Indexed: 12/20/2022]
Abstract
The BCG vaccine has long been recognized for reducing the risk to suffer from infectious diseases unrelated to its target disease, tuberculosis. Evidence from human trials demonstrate substantial reductions in all-cause mortality, especially in the first week of life. Observational studies have identified an association between BCG vaccination and reduced risk of respiratory infectious disease and clinical malaria later in childhood. The mechanistic basis for these pathogen-agnostic benefits, also known as beneficial non-specific effects (NSE) of BCG have been attributed to trained immunity, or epigenetic reprogramming of hematopoietic cells that give rise to innate immune cells responding more efficiently to a broad range of pathogens. Furthermore, within trained immunity, the focus so far has been on enhanced monocyte function. However, polymorphonuclear cells, namely neutrophils, are not only major constituents of the hematopoietic compartment but functionally as well as numerically represent a prominent component of the immune system. The beneficial NSEs of the BCG vaccine on newborn sepsis was recently demonstrated to be driven by a BCG-mediated numeric increase of neutrophils (emergency granulopoiesis (EG)). And experimental evidence in animal models suggest that BCG can modulate neutrophil function as well. Together, these findings suggest that neutrophils are crucial to at least the immediate beneficial NSE of the BCG vaccine. Efforts to uncover the full gamut of mechanisms underpinning the broad beneficial effects of BCG should therefore include neutrophils at the forefront.
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Affiliation(s)
- Byron Brook
- Precision Vaccines Program, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Frederick Schaltz-Buchholzer
- Institute of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Rym Ben-Othman
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Tobias Kollmann
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Nelly Amenyogbe
- Telethon Kids Institute, Perth, Western Australia, Australia.
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12
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Kamau E, Yates A, Maisiba R, Singoei V, Opot B, Adeny R, Arima CO, Otieno V, Sumbi CS, Okoth RO, Abdi F, Mwalo M, Ochola J, Otieno J, Ake J, Imbach M, Turley HA, Juma D, Akala HM, Owuoth J, Andagalu B, Crowell TA, Nwoga C, Cowden J, Polyak CS. Epidemiological and clinical implications of asymptomatic malaria and schistosomiasis co-infections in a rural community in western Kenya. BMC Infect Dis 2021; 21:937. [PMID: 34503469 PMCID: PMC8431856 DOI: 10.1186/s12879-021-06626-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria and schistosomiasis present considerable disease burden in tropical and sub-tropical areas and severity is worsened by co-infections in areas where both diseases are endemic. Although pathogenesis of these infections separately is well studied, there is limited information on the pathogenic disease mechanisms and clinical disease outcomes in co-infections. In this study, we investigated the prevalence of malaria and schistosomiasis co-infections, and the hematologic and blood chemistry abnormalities in asymptomatic adults in a rural fishing community in western Kenya. METHODS This sub-study used samples and data collected at enrollment from a prospective observational cohort study (RV393) conducted in Kisumu County, Kenya. The presence of malaria parasites was determined using microscopy and real-time-PCR, and schistosomiasis infection by urine antigen analysis (CCA). Hematological analysis and blood chemistries were performed using standard methods. Statistical analyses were performed to compare demographic and infection data distribution, and hematologic and blood chemistry parameters based on different groups of infection categories. Clinically relevant hematologic conditions were analyzed using general linear and multivariable Poisson regression models. RESULTS From February 2017 to May 2018, we enrolled 671 participants. The prevalence of asymptomatic Plasmodium falciparum was 28.2% (157/556) and schistosomiasis 41.2% (229/562), with 18.0% (100/556) of participants co-infected. When we analyzed hematological parameters using Wilcoxon rank sum test to evaluate median (IQR) distribution based on malarial parasites and/or schistosomiasis infection status, there were significant differences in platelet counts (p = 0.0002), percent neutrophils, monocytes, eosinophils, and basophils (p < 0.0001 each). Amongst clinically relevant hematological abnormalities, eosinophilia was the most prevalent at 20.6% (116/562), whereas thrombocytopenia was the least prevalent at 4.3% (24/562). In univariate model, Chi-Square test performed for independence between participant distribution in different malaria parasitemia/schistosomiasis infection categories within each clinical hematological condition revealed significant differences for thrombocytopenia and eosinophilia (p = 0.006 and p < 0.0001, respectively), which was confirmed in multivariable models. Analysis of the pairwise mean differences of liver enzyme (ALT) and kidney function (Creatinine Clearance) indicated the presence of significant differences in ALT across the infection groups (parasite + /CCA + vs all other groups p < .003), but no differences in mean Creatinine Clearance across the infection groups. CONCLUSIONS Our study demonstrates the high burden of asymptomatic malaria parasitemia and schistosomiasis infection in this rural population in Western Kenya. Asymptomatic infection with malaria or schistosomiasis was associated with laboratory abnormalities including neutropenia, leukopenia and thrombocytopenia. These abnormalities could be erroneously attributed to other diseases processes during evaluation of diseases processes. Therefore, evaluating for co-infections is key when assessing individuals with laboratory abnormalities. Additionally, asymptomatic infection needs to be considered in control and elimination programs given high prevalence documented here.
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Affiliation(s)
- Edwin Kamau
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA
| | - Risper Maisiba
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Valentine Singoei
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - Benjamin Opot
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Rose Adeny
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Cornel O Arima
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Victor Otieno
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Catherine S Sumbi
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Raphael O Okoth
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Farid Abdi
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Maurine Mwalo
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Jew Ochola
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - June Otieno
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Julie Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA
| | - Hannah A Turley
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA
| | - Dennis Juma
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Hoseah M Akala
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - John Owuoth
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,HJF Medical Research International, Kisumu, Kenya
| | - Ben Andagalu
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA
| | - Jessica Cowden
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD, 20817, USA.
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13
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Wang H, Li S, Cui Z, Qin T, Shi H, Ma J, Li L, Yu G, Jiang T, Li C. Analysis of spleen histopathology, splenocyte composition and haematological parameters in four strains of mice infected with Plasmodium berghei K173. Malar J 2021; 20:249. [PMID: 34090420 PMCID: PMC8180108 DOI: 10.1186/s12936-021-03786-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a fatal disease that presents clinically as a continuum of symptoms and severity, which are determined by complex host-parasite interactions. Clearance of infection is believed to be accomplished by the spleen and mononuclear phagocytic system (MPS), independent of artemisinin treatment. The spleen filters infected red blood cells (RBCs) from circulation through immune-mediated recognition of the infected RBCs followed by phagocytosis. This study evaluated the tolerance of four different strains of mice to Plasmodium berghei strain K173 (P. berghei K173), and the differences in the role of the spleen in controlling P. berghei K173 infection. METHODS Using different strains of mice (C57BL/6, BALB/C, ICR, and KM mice) infected with P. berghei K173, the mechanisms leading to splenomegaly, histopathology, splenocyte activation and proliferation, and their relationship to the control of parasitaemia and host mortality were examined and evaluated. RESULTS Survival time of mice infected with P. berghei K173 varied, although the infection was uniformly lethal. Mice of the C57BL/6 strain were the most resistant, while mice of the strain ICR were the most susceptible. BALB/c and KM mice were intermediate. In the course of P. berghei K173 infection, all infected mice experienced significant splenomegaly. Parasites were observed in the red pulp at 3 days post infection (dpi) in all animals. All spleens retained late trophozoite stages as well as a fraction of earlier ring-stage parasites. The percentages of macrophages in infected C57BL/6 and KM mice were higher than uninfected mice on 8 dpi. Spleens of infected ICR and KM mice exhibited structural disorganization and remodelling. Furthermore, parasitaemia was significantly higher in KM versus C57BL/6 mice at 8 dpi. The percentages of macrophages in ICR infected mice were lower than uninfected mice, and the parasitaemia was higher than other strains. CONCLUSIONS The results presented here demonstrate the rate of splenic mechanical filtration and that splenic macrophages are the predominant roles in controlling an individual's total parasite burden. This can influence the pathogenesis of malaria. Finally, different genetic backgrounds of mice have different splenic mechanisms for controlling malaria infection.
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Affiliation(s)
- Huajing Wang
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
- Artemisinin Research Center, China Academy of Traditional Chinese Medical Sciences, Beijing, China
| | - Shuo Li
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
- Artemisinin Research Center, China Academy of Traditional Chinese Medical Sciences, Beijing, China
| | - Zhao Cui
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
| | - Tingting Qin
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
- Artemisinin Research Center, China Academy of Traditional Chinese Medical Sciences, Beijing, China
| | - Hang Shi
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
| | - Ji Ma
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
- Artemisinin Research Center, China Academy of Traditional Chinese Medical Sciences, Beijing, China
| | - Lanfang Li
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
| | - Guihua Yu
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
| | - Tingliang Jiang
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China
- Artemisinin Research Center, China Academy of Traditional Chinese Medical Sciences, Beijing, China
| | - Canghai Li
- Tang Center for Herbal Medicine Research, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medical Sciences, No. 16 Dongzhimen Nanxiaojie, Dongcheng District, Beijing, 100700, China.
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14
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Imported Malaria in Countries where Malaria Is Not Endemic: a Comparison of Semi-immune and Nonimmune Travelers. Clin Microbiol Rev 2020; 33:33/2/e00104-19. [PMID: 32161068 DOI: 10.1128/cmr.00104-19] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The continuous increase in long-distance travel and recent large migratory movements have changed the epidemiological characteristics of imported malaria in countries where malaria is not endemic (here termed non-malaria-endemic countries). While malaria was primarily imported to nonendemic countries by returning travelers, the proportion of immigrants from malaria-endemic regions and travelers visiting friends and relatives (VFRs) in malaria-endemic countries has continued to increase. VFRs and immigrants from malaria-endemic countries now make up the majority of malaria patients in many nonendemic countries. Importantly, this group is characterized by various degrees of semi-immunity to malaria, resulting from repeated exposure to infection and a gradual decline of protection as a result of prolonged residence in non-malaria-endemic regions. Most studies indicate an effect of naturally acquired immunity in VFRs, leading to differences in the parasitological features, clinical manifestation, and odds for severe malaria and clinical complications between immune VFRs and nonimmune returning travelers. There are no valid data indicating evidence for differing algorithms for chemoprophylaxis or antimalarial treatment in semi-immune versus nonimmune malaria patients. So far, no robust biomarkers exist that properly reflect anti-parasite or clinical immunity. Until they are found, researchers should rigorously stratify their study results using surrogate markers, such as duration of time spent outside a malaria-endemic country.
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15
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Rubio E, Alejo-Cancho I, Aylagas C, Camprubí D, Ferré R, Albarracín MR, Gonzalo V, Barrachina J, Álvarez-Martínez MJ, Valls ME, Mas J, Vila J, Losada I, Martínez MJ, Casals-Pascual C. Diagnostic Value of Platelet and Leukocyte Counts in the Differential Diagnosis of Fever in the Returning Traveler. Am J Trop Med Hyg 2019; 100:470-475. [PMID: 30526735 DOI: 10.4269/ajtmh.18-0736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Malaria, arbovirus infection and travelers' diarrhea are among the most common etiologies of fever after a stay in the tropics. Because the initial symptoms of these diseases often overlap, the differential diagnostic remains a challenge. The aim of this study was to establish the effectiveness of platelet and leukocyte counts in the differential diagnosis of fever in the returning traveler. Between 2013 and 2016, patients with a clinical suspicion of malaria, who had thick blood smears performed were retrospectively included. The microbiological etiology of each episode was established based on molecular detection in the case of arbovirus infection, the detection of pathogens in stool samples for diarrhea and other gastrointestinal symptoms and the thick and thin blood smear results for malaria. A total of 1,218 episodes were included. Malaria, arbovirus infection, and diarrhea and other gastrointestinal symptoms caused 102 (8.4%), 68 (5.6%), and 72 (5.9%) episodes, respectively. The median platelet counts in malaria episodes were 89 × 109/L and thrombocytopenia (< 150,000 × 109 platelets/L) yielded a 98% negative predictive value to predict malaria. The median leukocyte counts in arbovirus infection episodes were 3.19 × 109/L and leucopenia (< 4 × 109 leukocytes/L) yielded a 97.9% negative predictive value to predict arbovirus infections. Platelet and leukocyte counts were not significantly altered in episodes caused by diarrhea and other gastrointestinal symptoms. Initial platelet and leukocyte counts might be useful for the clinical differential diagnosis of fever in the returning traveler. Although these results are insufficient to establish a diagnosis, they should be considered in the initial clinical assessment.
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Affiliation(s)
- Elisa Rubio
- Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | | | - Cristian Aylagas
- Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | - Daniel Camprubí
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain.,Department of Tropical Medicine and International Health, Hospital Clinic, Barcelona, Spain
| | - Roser Ferré
- Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | | | - Verónica Gonzalo
- Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | - Josep Barrachina
- Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | - Míriam José Álvarez-Martínez
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain.,Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | | | - Jordi Mas
- Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | - Jordi Vila
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain.,Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | - Irene Losada
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain.,Department of Tropical Medicine and International Health, Hospital Clinic, Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain.,Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
| | - Climent Casals-Pascual
- ISGlobal Barcelona Institute for Global Health, Barcelona, Spain.,Department of Clinical Microbiology, Hospital Clinic, Barcelona, Spain
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16
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Monocyte-to-Lymphocyte Ratio Is Associated With Tuberculosis Disease and Declines With Anti-TB Treatment in HIV-Infected Children. J Acquir Immune Defic Syndr 2019; 80:174-181. [PMID: 30399036 DOI: 10.1097/qai.0000000000001893] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The blood monocyte-to-lymphocyte ratio (MLR) is associated with active tuberculosis (TB) in adults but has not been evaluated as a TB diagnostic biomarker in HIV-infected children in whom respiratory sampling is difficult. SETTING In a cohort of HIV-infected hospitalized Kenyan children initiating antiretroviral therapy, absolute monocyte and lymphocyte counts were determined at enrollment and 4, 12, and 24 weeks thereafter. METHODS Children were classified as confirmed, unconfirmed, or unlikely pulmonary TB. Receiver operating characteristic curves of MLR cutoff values were generated to distinguish children with confirmed TB from those with unconfirmed and unlikely TB. General estimating equations were used to estimate change in the MLR over time by TB status. RESULTS Of 160 children with median age 23 months, 13 (8.1%) had confirmed TB and 67 (41.9%) had unconfirmed TB. The median MLR among children with confirmed TB {0.407 [interquartile range (IQR) 0.378-0.675]} was higher than the MLR in children with unconfirmed [0.207 (IQR 0.148-0.348), P < 0.01] or unlikely [0.212 (IQR 0.138-0.391), P = 0.01] TB. The MLR above 0.378 identified children with confirmed TB with 77% sensitivity, 78% specificity, 24% positive predictive value, and 97% negative predictive value. After TB treatment, the median MLR declined in children with confirmed TB and levels were similar to children with unlikely TB after 12 weeks. CONCLUSIONS The blood MLR distinguished HIV-infected children with confirmed TB from those with unlikely TB and declined with TB treatment. The MLR may be a useful diagnostic tool for TB in settings where respiratory-based microbiologic confirmation is inaccessible.
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17
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Russell CD, Parajuli A, Gale HJ, Bulteel NS, Schuetz P, de Jager CPC, Loonen AJM, Merekoulias GI, Baillie JK. The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and meta-analysis. J Infect 2019; 78:339-348. [PMID: 30802469 PMCID: PMC7173077 DOI: 10.1016/j.jinf.2019.02.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the utility of the neutrophil:lymphocyte (NLR), lymphocyte:monocyte (LMR) and platelet:lymphocyte ratios (PLR) as infection biomarkers. METHODS PubMed/MEDLINE, Embase and Cochrane databases were searched to identify eligible articles. Studies of diagnosis, severity or outcome were included. PROSPERO systematic review registration CRD42017075032. RESULTS Forty studies were included, reporting on bacterial and viral infections, malaria, and critical illness due to sepsis. Ten studies reported an association of higher NLR with bacteraemia, supported by meta-analysis of patient-level data (five studies, n = 3320; AUC 0.72, p<0.0001) identifying a cut-off of >12.65. Two studies reported an association with lower LMR and diagnosis of influenza virus infection in patients with respiratory tract infection. Meta-analysis of patient-level data (n = 85; AUC 0.66, p = 0.01) identified a cut-off of ≤2.06. The directionality of associations between NLR and outcomes in heterogeneous cohorts of critically ill adults with sepsis varied. Potential clinical utility was also demonstrated in pneumonia (NLR), pertussis (NLR), urinary tract infection (NLR), diabetic foot infections (NLR) and Crimean Congo Haemorrhagic Fever (PLR). Longitudinal measurement of LMR during respiratory virus infection reflected symptoms and NLR during sepsis and bacteraemia predicted mortality. CONCLUSIONS Peripheral blood leucocyte ratios are useful infection biomarkers, with the most evidence related to diagnosis of bacteraemia and influenza virus infection. In critical illness due to sepsis, a signal towards an association with NLR and outcomes exists, and NLR should be evaluated in future stratification models. Longitudinal measurement of ratios during infection could be informative. Overall, these biomarkers warrant further recognition and study in infectious diseases.
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Affiliation(s)
- Clark D Russell
- University of Edinburgh Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh BioQuarter, 47 Little France Crescent, EH16 4TJ Edinburgh, UK; Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK.
| | - Arun Parajuli
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Naomi S Bulteel
- Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | | | - Cornelis P C de Jager
- Department of Emergency Medicine and Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Anne J M Loonen
- Laboratory for Molecular Diagnostics, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Georgios I Merekoulias
- Department of Public Health, Medical School of University of Patras, Olympion General Clinic, Patras, Greece
| | - J Kenneth Baillie
- Division of Genetics and Genomics, The Roslin Institute, University of Edinburgh, Edinburgh, UK; Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK
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18
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Abstract
Neutrophils are abundant in the circulation and are one of the immune system's first lines of defense against infection. There has been substantial work carried out investigating the role of neutrophils in malaria and it is clear that during infection neutrophils are activated and are capable of clearing malaria parasites by a number of mechanisms. This review focuses on neutrophil responses to human malarias, summarizing evidence which helps us understand where neutrophils are, what they are doing, how they interact with parasites as well as their potential role in vaccine mediated immunity. We also outline future research priorities for these, the most abundant of leukocytes.
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Affiliation(s)
- Elizabeth H Aitken
- Department of Medicine at Royal Melbourne Hospital, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Agersew Alemu
- Department of Medicine at Royal Melbourne Hospital, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen J Rogerson
- Department of Medicine at Royal Melbourne Hospital, Peter Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
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19
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Thiam A, Baaklini S, Mbengue B, Nisar S, Diarra M, Marquet S, Fall MM, Sanka M, Thiam F, Diallo RN, Torres M, Dieye A, Rihet P. NCR3 polymorphism, haematological parameters, and severe malaria in Senegalese patients. PeerJ 2018; 6:e6048. [PMID: 30533319 PMCID: PMC6282937 DOI: 10.7717/peerj.6048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022] Open
Abstract
Background Host factors, including host genetic variation, have been shown to influence the outcome of Plasmodium falciparum infection. Genome-wide linkage studies have mapped mild malaria resistance genes on chromosome 6p21, whereas NCR3-412 polymorphism (rs2736191) lying within this region was found to be associated with mild malaria. Methods Blood samples were taken from 188 Plasmodium falciparum malaria patients (76 mild malaria patients, 85 cerebral malaria patients, and 27 severe non-cerebral malaria patients). NCR3-412 (rs2736191) was analysed by sequencing, and haematological parameters were measured. Finally, their association with clinical phenotypes was assessed. Results We evidenced an association of thrombocytopenia with both cerebral malaria and severe non-cerebral malaria, and of an association of high leukocyte count with cerebral malaria. Additionally, we found no association of NCR3-412 with either cerebral malaria, severe non-cerebral malaria, or severe malaria after grouping cerebral malaria and severe non-cerebral malaria patients. Conclusions Our results suggest that NCR3 genetic variation has no effect, or only a small effect on the occurrence of severe malaria, although it has been strongly associated with mild malaria. We discuss the biological meaning of these results. Besides, we confirmed the association of thrombocytopenia and high leukocyte count with severe malaria phenotypes.
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Affiliation(s)
- Alassane Thiam
- Unité d'Immunogénétique, Institut Pasteur de Dakar, Dakar, Senegal
| | | | - Babacar Mbengue
- Service d'Immunologie, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Samia Nisar
- Aix Marseille Univ, INSERM, TAGC, Marseille, France
| | - Maryam Diarra
- G4 Biostatistique, Institut Pasteur de Dakar, Dakar, Sénégal
| | | | | | - Michel Sanka
- Aix Marseille Univ, INSERM, TAGC, Marseille, France
| | - Fatou Thiam
- Unité d'Immunogénétique, Institut Pasteur de Dakar, Dakar, Senegal
| | | | | | - Alioune Dieye
- Unité d'Immunogénétique, Institut Pasteur de Dakar, Dakar, Senegal.,Service d'Immunologie, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Pascal Rihet
- Aix Marseille Univ, INSERM, TAGC, Marseille, France
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20
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Ortega-Pajares A, Rogerson SJ. The Rough Guide to Monocytes in Malaria Infection. Front Immunol 2018; 9:2888. [PMID: 30581439 PMCID: PMC6292935 DOI: 10.3389/fimmu.2018.02888] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/26/2018] [Indexed: 12/14/2022] Open
Abstract
While half of the world's population is at risk of malaria, the most vulnerable are still children under five, pregnant women and returning travelers. Anopheles mosquitoes transmit malaria parasites to the human host; but how Plasmodium interact with the innate immune system remains largely unexplored. The most recent advances prove that monocytes are a key component to control parasite burden and to protect host from disease. Monocytes' protective roles include phagocytosis, cytokine production and antigen presentation. However, monocytes can be involved in pathogenesis and drive inflammation and sequestration of infected red blood cells in organs such as the brain, placenta or lungs by secreting cytokines that upregulate expression of endothelial adhesion receptors. Plasmodium DNA, hemozoin or extracellular vesicles can impair the function of monocytes. With time, reinfections with Plasmodium change the relative proportion of monocyte subsets and their physical properties. These changes relate to clinical outcomes and might constitute informative biomarkers of immunity. More importantly, at the molecular level, transcriptional, metabolic or epigenetic changes can “prime” monocytes to alter their responses in future encounters with Plasmodium. This mechanism, known as trained immunity, challenges the traditional view of monocytes as a component of the immune system that lacks memory. Overall, this rough guide serves as an update reviewing the advances made during the past 5 years on understanding the role of monocytes in innate immunity to malaria.
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Affiliation(s)
- Amaya Ortega-Pajares
- Department of Medicine at Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen J Rogerson
- Department of Medicine at Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
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21
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Antwi-Baffour S, Kyeremeh R, Buabeng D, Adjei JK, Aryeh C, Kpentey G, Seidu MA. Correlation of malaria parasitaemia with peripheral blood monocyte to lymphocyte ratio as indicator of susceptibility to severe malaria in Ghanaian children. Malar J 2018; 17:419. [PMID: 30419923 PMCID: PMC6233557 DOI: 10.1186/s12936-018-2569-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Even though malaria is generally on the decline due extensive control and elimination efforts, it still remains a public health problem for over 40% of the world’s population. During the course of malaria infection, parasites and red blood cells come under oxidative stress and there is host immune response in an attempt to protect the red blood cells. The frequency of monocytes and lymphocytes in peripheral blood might, therefore, be expected to reflect the state of an individual’s immune response to the infection. Circulating monocytes and lymphocytes could therefore serve as an index in relation to malaria parasitaemia. The purpose of this study was to determine whether the relative count of monocytes to lymphocytes in peripheral blood (M:L ratio) can predict parasitaemia and, therefore, the severity of malaria infection. Methods Two millilitre of venous blood sample were taken from participants by venisection into anticoagulant tubes. Thick and thin blood films were made and stained with Giemsa and examined for malaria parasites. Whole blood specimen were analysed for full blood count using ABX Pentra 60 C+ automated haematological analyzer. Data was entered into Microsoft Word and analysed using Statistical Package for Social Sciences (SPSS, Version 20.0) and Graphpad prism. Spearman’s correlation was used to determine correlation between occurrences of clinical malaria and the monocytes and lymphocytes ratio. Statistical significance was taken as p ≤ 0.05 with 95% confidence interval. Results The study comprised of 1629 (m = 896; f = 733) children up to 5 years presenting with clinical malaria as cases and 445 (m = 257; f = 188) apparently healthy children as controls. The results indicated that there was a significant positive correlation between the monocytes to lymphocytes ratio and the presence of parasites (p = 0.04) and the level of parasitaemia within the age group of 0–3 years (p = 0.02) and 4–5 years (p = 0.03). Conclusions The monocyte to lymphocyte ratio obtained correlated positively with the presence of malaria as well as the level of parasitaemia. The outcome of this work implies that monocyte to lymphocyte ratio can be used to predict the level of parasitaemia and together with other factors, the development of severe malaria.
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Affiliation(s)
- Samuel Antwi-Baffour
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P. O. Box KB 143, Korle-Bu, Accra, Ghana.
| | - Ransford Kyeremeh
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P. O. Box KB 143, Korle-Bu, Accra, Ghana.,Central Laboratories, Korle-bu Teaching Hospital, Korle-bu, Accra, Ghana
| | - Dorcas Buabeng
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P. O. Box KB 143, Korle-Bu, Accra, Ghana.,Department of Haematology, Wa Regional Hospital, Wa, Ghana
| | - Jonathan Kofi Adjei
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P. O. Box KB 143, Korle-Bu, Accra, Ghana.,Department of Haematology, Sunyani Regional Hospital, Sunyani, Ghana
| | - Claudia Aryeh
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P. O. Box KB 143, Korle-Bu, Accra, Ghana
| | - George Kpentey
- Central Laboratories, Korle-bu Teaching Hospital, Korle-bu, Accra, Ghana
| | - Mahmood Abdulai Seidu
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P. O. Box KB 143, Korle-Bu, Accra, Ghana.,Department of Haematology, Wa Regional Hospital, Wa, Ghana
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22
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Lee HJ, Georgiadou A, Walther M, Nwakanma D, Stewart LB, Levin M, Otto TD, Conway DJ, Coin LJ, Cunnington AJ. Integrated pathogen load and dual transcriptome analysis of systemic host-pathogen interactions in severe malaria. Sci Transl Med 2018; 10:eaar3619. [PMID: 29950443 PMCID: PMC6326353 DOI: 10.1126/scitranslmed.aar3619] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/31/2018] [Accepted: 06/08/2018] [Indexed: 12/13/2022]
Abstract
The pathogenesis of infectious diseases depends on the interaction of host and pathogen. In Plasmodium falciparum malaria, host and parasite processes can be assessed by dual RNA sequencing of blood from infected patients. We performed dual transcriptome analyses on samples from 46 malaria-infected Gambian children to reveal mechanisms driving the systemic pathophysiology of severe malaria. Integrating these transcriptomic data with estimates of parasite load and detailed clinical information allowed consideration of potentially confounding effects due to differing leukocyte proportions in blood, parasite developmental stage, and whole-body pathogen load. We report hundreds of human and parasite genes differentially expressed between severe and uncomplicated malaria, with distinct profiles associated with coma, hyperlactatemia, and thrombocytopenia. High expression of neutrophil granule-related genes was consistently associated with all severe malaria phenotypes. We observed severity-associated variation in the expression of parasite genes, which determine cytoadhesion to vascular endothelium, rigidity of infected erythrocytes, and parasite growth rate. Up to 99% of human differential gene expression in severe malaria was driven by differences in parasite load, whereas parasite gene expression showed little association with parasite load. Coexpression analyses revealed interactions between human and P. falciparum, with prominent co-regulation of translation genes in severe malaria between host and parasite. Multivariate analyses suggested that increased expression of granulopoiesis and interferon-γ-related genes, together with inadequate suppression of type 1 interferon signaling, best explained severity of infection. These findings provide a framework for understanding the contributions of host and parasite to the pathogenesis of severe malaria and identifying new treatments.
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Affiliation(s)
- Hyun Jae Lee
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland 4072, Australia
| | | | - Michael Walther
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Fajara, The Gambia
| | - Davis Nwakanma
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Fajara, The Gambia
| | - Lindsay B Stewart
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Michael Levin
- Section of Paediatrics, Imperial College, London W2 1PG, UK
| | - Thomas D Otto
- Wellcome Trust Sanger Centre, Hinxton, Cambridge CB10 1SA, UK
| | - David J Conway
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Lachlan J Coin
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland 4072, Australia
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23
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Lee HJ, Georgiadou A, Otto TD, Levin M, Coin LJ, Conway DJ, Cunnington AJ. Transcriptomic Studies of Malaria: a Paradigm for Investigation of Systemic Host-Pathogen Interactions. Microbiol Mol Biol Rev 2018; 82:e00071-17. [PMID: 29695497 PMCID: PMC5968457 DOI: 10.1128/mmbr.00071-17] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Transcriptomics, the analysis of genome-wide RNA expression, is a common approach to investigate host and pathogen processes in infectious diseases. Technical and bioinformatic advances have permitted increasingly thorough analyses of the association of RNA expression with fundamental biology, immunity, pathogenesis, diagnosis, and prognosis. Transcriptomic approaches can now be used to realize a previously unattainable goal, the simultaneous study of RNA expression in host and pathogen, in order to better understand their interactions. This exciting prospect is not without challenges, especially as focus moves from interactions in vitro under tightly controlled conditions to tissue- and systems-level interactions in animal models and natural and experimental infections in humans. Here we review the contribution of transcriptomic studies to the understanding of malaria, a parasitic disease which has exerted a major influence on human evolution and continues to cause a huge global burden of disease. We consider malaria a paradigm for the transcriptomic assessment of systemic host-pathogen interactions in humans, because much of the direct host-pathogen interaction occurs within the blood, a readily sampled compartment of the body. We illustrate lessons learned from transcriptomic studies of malaria and how these lessons may guide studies of host-pathogen interactions in other infectious diseases. We propose that the potential of transcriptomic studies to improve the understanding of malaria as a disease remains partly untapped because of limitations in study design rather than as a consequence of technological constraints. Further advances will require the integration of transcriptomic data with analytical approaches from other scientific disciplines, including epidemiology and mathematical modeling.
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Affiliation(s)
- Hyun Jae Lee
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | | | - Thomas D Otto
- Centre of Immunobiology, University of Glasgow, Glasgow, United Kingdom
| | - Michael Levin
- Section of Paediatrics, Imperial College, London, United Kingdom
| | - Lachlan J Coin
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - David J Conway
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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24
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van Wolfswinkel ME, Langenberg MCC, Wammes LJ, Sauerwein RW, Koelewijn R, Hermsen CC, van Hellemond JJ, van Genderen PJ. Changes in total and differential leukocyte counts during the clinically silent liver phase in a controlled human malaria infection in malaria-naïve Dutch volunteers. Malar J 2017; 16:457. [PMID: 29126422 PMCID: PMC5681833 DOI: 10.1186/s12936-017-2108-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/04/2017] [Indexed: 11/25/2022] Open
Abstract
Background Both in endemic countries and in imported malaria, changes in total and differential leukocyte count during Plasmodium falciparum infection have been described. To study the exact dynamics of differential leukocyte counts and their ratios, they were monitored in a group of healthy non-immune volunteers in two separate Controlled Human Malaria Infection (CHMI) studies. Methods In two CHMI trials, CHMI-a and CHMI-b, 15 and 24 healthy malaria-naïve volunteers, respectively, were exposed to bites of infected mosquitoes, using the P. falciparum research strain NF54 and the novel clones NF135.C10 and NF166.C8. After mosquito bite exposure, twice-daily blood draws were taken to detect parasitaemia and to monitor the total and differential leukocyte counts. All subjects received a course of atovaquone–proguanil when meeting the treatment criteria. Results A total of 39 volunteers participated in the two trials. Thirty-five participants, all 15 participants in CHMI-a and 20 of the 24 volunteers in CHMI-b, developed parasitaemia. During liver stage development of the parasite, the median total leukocyte count increased from 5.5 to 6.1 × 109 leukocytes/L (p = 0.005), the median lymphocyte count from 1.9 to 2.2 (p = 0.001) and the monocyte count from 0.50 to 0.54 (p = 0.038). During the subsequent blood stage infection, significant changes in total and differential leukocyte counts lead to a leukocytopenia (nadir median 3.3 × 109 leukocytes/L, p = 0.0001), lymphocytopenia (nadir median 0.7 × 109 lymphocytes/L, p = 0.0001) and a borderline neutropenia (nadir median 1.5 × 109 neutrophils/L, p = 0.0001). The neutrophil to lymphocyte count ratio (NLCR) reached a maximum of 4.0. Significant correlations were found between parasite load and absolute lymphocyte count (p < 0.001, correlation coefficient − 0.46) and between parasite load and NLCR (p < 0.001, correlation coefficient 0.50). All parameters normalized after parasite clearance. Conclusions During the clinically silent liver phase of malaria, an increase of peripheral total leukocyte count and differential lymphocytes and monocytes occurs. This finding has not been described previously. This increase is followed by the appearance of parasites in the peripheral blood after 2–3 days, accompanied by a marked decrease in total leukocyte count, lymphocyte count and the neutrophil count and a rise of the NLCR. Electronic supplementary material The online version of this article (10.1186/s12936-017-2108-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marlies E van Wolfswinkel
- Institute for Tropical Diseases, Harbour Hospital, Rotterdam, The Netherlands. .,Department of Medical Microbiology and Infectious Diseases, Erasmus MC and Harbour Hospital, Rotterdam, The Netherlands.
| | - Marijke C C Langenberg
- Institute for Tropical Diseases, Harbour Hospital, Rotterdam, The Netherlands.,Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda J Wammes
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC and Harbour Hospital, Rotterdam, The Netherlands
| | - Robert W Sauerwein
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob Koelewijn
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC and Harbour Hospital, Rotterdam, The Netherlands
| | - Cornelus C Hermsen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jaap J van Hellemond
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC and Harbour Hospital, Rotterdam, The Netherlands
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25
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Davies ML, Dambaeva SV, Katukurundage D, Repak M, Gilman‐Sachs A, Kwak‐Kim J, Beaman KD. Predicting
NK
cell subsets using gene expression levels in peripheral blood and endometrial biopsy specimens. Am J Reprod Immunol 2017; 78. [DOI: 10.1111/aji.12730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/22/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Michael L. Davies
- Clinical Immunology LaboratoryRosalind Franklin University of Medicine and Science North Chicago IL USA
- Department of Microbiology and ImmunologyRosalind Franklin University of Medicine and Science North Chicago IL USA
| | - Svetlana V. Dambaeva
- Clinical Immunology LaboratoryRosalind Franklin University of Medicine and Science North Chicago IL USA
- Department of Microbiology and ImmunologyRosalind Franklin University of Medicine and Science North Chicago IL USA
| | - Dimantha Katukurundage
- Clinical Immunology LaboratoryRosalind Franklin University of Medicine and Science North Chicago IL USA
| | - Miroslava Repak
- Department of Microbiology and ImmunologyRosalind Franklin University of Medicine and Science North Chicago IL USA
| | - Alice Gilman‐Sachs
- Clinical Immunology LaboratoryRosalind Franklin University of Medicine and Science North Chicago IL USA
- Department of Microbiology and ImmunologyRosalind Franklin University of Medicine and Science North Chicago IL USA
| | - Joanne Kwak‐Kim
- Department of Microbiology and ImmunologyRosalind Franklin University of Medicine and Science North Chicago IL USA
- Department of Obstetrics and GynecologyRosalind Franklin University Health System Vernon Hills IL USA
| | - Kenneth D. Beaman
- Clinical Immunology LaboratoryRosalind Franklin University of Medicine and Science North Chicago IL USA
- Department of Microbiology and ImmunologyRosalind Franklin University of Medicine and Science North Chicago IL USA
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26
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Herbinger KH, Hanus I, Schunk M, Beissner M, von Sonnenburg F, Löscher T, Bretzel G, Hoelscher M, Nothdurft HD, Huber KL. Elevated Values of C-Reactive Protein Induced by Imported Infectious Diseases: A Controlled Cross-Sectional Study of 11,079 Diseased German Travelers Returning from the Tropics and Subtropics. Am J Trop Med Hyg 2016; 95:938-944. [PMID: 27527624 DOI: 10.4269/ajtmh.16-0387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 06/21/2016] [Indexed: 01/17/2023] Open
Abstract
The present controlled cross-sectional study aimed to assess elevated values of C-reactive protein (CRP), a positive acute-phase protein, induced by imported infectious diseases (IDs) seen in patients consulting the University of Munich (1999-2015) after being in the tropics/subtropics. The analysis investigated data sets from 11,079 diseased German travelers (cases) returning from Latin America (1,986), Africa (3,387), and Asia (5,706), and from 714 healthy Germans who had not recently traveled (controls). The proportions of elevated values of CRP (> 0.5 mg/dL) were significantly larger among cases (44.3%) than among controls (20.7%). Among cases, this proportion was largest among males (49.2%) in comparison to females (39.9%), among travelers with short travel duration of 1-14 days (49.6%) in comparison to travelers with a travel duration of > 180 days (30.8%), and with travel destination in Africa (47.0%) in comparison to Asia (44.2%) and Latin America (39.9%), among all-inclusive travelers (47.4%) in comparison to business travelers (46.7%) and backpackers (44.1%), and among patients presenting with fever (70.9%) and arthralgia (54.3%). The study identified various imported IDs with significantly larger proportions of elevated values of CRP including viral (cytomegalovirus infection [94.7%], influenza [88.9%], infectious mononucleosis [71.8%]), bacterial (typhoid fever [100%], paratyphoid fever [92.9%], shigellosis [76.8%], rickettsiosis [74.2%], Salmonella enteritis [71.3%], Campylobacter infection [68.7%]), and protozoan (vivax malaria [100%], ovale malaria [100%], falciparum malaria [95.4%], noninvasive Entamoeba infection [65.9%]) IDs. This study demonstrates that elevated values of CRP can be a useful laboratory finding for travelers returning from the tropics/subtropics, as these findings are typically caused mainly by certain imported bacterial IDs, but also by viral and protozoan IDs.
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Affiliation(s)
- Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany.
| | - Ingrid Hanus
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Marcus Beissner
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Frank von Sonnenburg
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Thomas Löscher
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Gisela Bretzel
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany. German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Hans Dieter Nothdurft
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
| | - Kristina Lydia Huber
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany
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27
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Herbinger KH, Hanus I, Beissner M, Berens-Riha N, Kroidl I, von Sonnenburg F, Löscher T, Hoelscher M, Nothdurft HD, Schunk M. Lymphocytosis and Lymphopenia Induced by Imported Infectious Diseases: A Controlled Cross-Sectional Study of 17,229 Diseased German Travelers Returning from the Tropics and Subtropics. Am J Trop Med Hyg 2016; 94:1385-91. [PMID: 27068397 DOI: 10.4269/ajtmh.15-0920] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/06/2016] [Indexed: 11/07/2022] Open
Abstract
The present controlled cross-sectional study aimed to assess relative and absolute lymphocytosis and lymphopenia induced by imported infectious diseases (IDs) seen among patients consulting the Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (1999-2014) after being in the tropics and subtropics. The analysis investigated data sets from 17,229 diseased German travelers returning from Latin America (3,238), Africa (5,467), and Asia (8,524), and from 1,774 healthy controls who had not recently traveled. Among the cases, the proportion of those with relative lymphopenia (10.5%) and absolute lymphopenia (8.0%) was significantly higher than among controls (3.2% and 3.6%, respectively), whereas relative lymphocytosis was significantly lower among cases (6.1%) than among controls (8.0%). The study identified IDs with significantly larger proportions of relative lymphocytosis (cytomegalovirus [CMV] infection [56%], infectious mononucleosis [51%], and dengue fever [11%]); absolute lymphocytosis (infectious mononucleosis [70%] and CMV infection [63%]); relative lymphopenia (streptococcal pharyngitis [56%], malaria [34%], Campylobacter infection [19%], salmonellosis [18%], and shigellosis [17%]); and of absolute lymphopenia (human immunodeficiency virus infection [53%], malaria [45%], dengue fever [40%], salmonellosis [16%], and Campylobacter infection [11%]). This study demonstrates that relative and absolute lymphocytosis and lymphopenia are useful laboratory findings for travelers returning from the tropics and subtropics, as they are typically caused by imported viral, bacterial, and protozoan IDs.
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Affiliation(s)
- Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Ingrid Hanus
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Marcus Beissner
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Nicole Berens-Riha
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Frank von Sonnenburg
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Thomas Löscher
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Hans Dieter Nothdurft
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine (DITM), Medical Center of the University of Munich, Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
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Liu H, Feng G, Zeng W, Li X, Bai Y, Deng S, Ruan Y, Morris J, Li S, Yang Z, Cui L. A more appropriate white blood cell count for estimating malaria parasite density in Plasmodium vivax patients in northeastern Myanmar. Acta Trop 2016; 156:152-6. [PMID: 26802490 DOI: 10.1016/j.actatropica.2016.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
The conventional method of estimating parasite densities employ an assumption of 8000 white blood cells (WBCs)/μl. However, due to leucopenia in malaria patients, this number appears to overestimate parasite densities. In this study, we assessed the accuracy of parasite density estimated using this assumed WBC count in eastern Myanmar, where Plasmodium vivax has become increasingly prevalent. From 256 patients with uncomplicated P. vivax malaria, we estimated parasite density and counted WBCs by using an automated blood cell counter. It was found that WBC counts were not significantly different between patients of different gender, axillary temperature, and body mass index levels, whereas they were significantly different between age groups of patients and the time points of measurement. The median parasite densities calculated with the actual WBC counts (1903/μl) and the assumed WBC count of 8000/μl (2570/μl) were significantly different. We demonstrated that using the assumed WBC count of 8000 cells/μl to estimate parasite densities of P. vivax malaria patients in this area would lead to an overestimation. For P. vivax patients aged five years and older, an assumed WBC count of 5500/μl best estimated parasite densities. This study provides more realistic assumed WBC counts for estimating parasite densities in P. vivax patients from low-endemicity areas of Southeast Asia.
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Gijsberts CM, Ellenbroek GH, Ten Berg MJ, Huisman A, van Solinge WW, Asselbergs FW, den Ruijter HM, Pasterkamp G, de Kleijn DP, Hoefer IE. Routinely analyzed leukocyte characteristics improve prediction of mortality after coronary angiography. Eur J Prev Cardiol 2015; 23:1211-20. [PMID: 26643521 DOI: 10.1177/2047487315621832] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 11/20/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Inflammation and leukocyte infiltration are hallmarks of atherosclerosis. Clinically routine hematology analyzers mostly perform an entire differential blood count by default, irrespective of the requested parameter. We hypothesize that these normally unreported leukocyte characteristics associate with coronary artery disease (CAD) severity and can improve prediction of mortality in coronary angiography patients. METHODS We studied coronary angiography patients suspected of CAD (n = 1015) from the Utrecht Coronary Biobank cohort. Leukocyte characteristics were routinely assessed in blood drawn directly prior to angiography using an automated hematology analyzer and extracted from the Utrecht patient oriented database (UPOD) database. Patients were followed up for a median duration of 805 days, during which 65 patients died. We evaluated the association of leukocyte characteristics with synergy between PCI with taxus and cardiac surgery (SYNTAX) score as a measure of CAD severity, all-cause and cardiovascular mortality and major adverse cardiovascular events (MACEs). In order to determine the improvement of risk prediction, we calculated continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI). RESULTS Monocyte percentage showed strong independent predictive value for all-cause mortality (hazard ratio (HR) 1.44 (1.19-1.74), p < 0.001), and the monocyte-to-lymphocyte ratio performed best for cardiovascular mortality (HR 1.42 (1.11-1.81), p = 0.005). The cNRIs and IDIs of leukocyte characteristics for all-cause mortality confirmed the improvement in mortality risk prediction. No significantly predictive leukocyte characteristics were found for MACEs. CONCLUSION Readily available yet unreported leukocyte characteristics from routine hematology analyzers significantly improved prediction of mortality in coronary angiography patients on top of clinical characteristics.
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Affiliation(s)
- Crystel M Gijsberts
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands ICIN-Netherlands Heart Institute, the Netherlands
| | | | - Maarten J Ten Berg
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Albert Huisman
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Hester M den Ruijter
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerard Pasterkamp
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dominique Pv de Kleijn
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands ICIN-Netherlands Heart Institute, the Netherlands Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
| | - Imo E Hoefer
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
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The Utility of Blood and Bone Marrow Films and Trephine Biopsy Sections in the Diagnosis of Parasitic Infections. Mediterr J Hematol Infect Dis 2015; 7:e2015039. [PMID: 26075046 PMCID: PMC4450651 DOI: 10.4084/mjhid.2015.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 04/29/2015] [Indexed: 12/18/2022] Open
Abstract
The laboratory haematologist has a role in the diagnosis of parasitic infections. Peripheral blood examination is critical in the diagnosis of malaria, babesiosis, filariasis and trypanosomiasis. Bone marrow examination is important in the diagnosis of leishmaniasis and occasionally leads to the diagnosis of other parasitic infections. The detection of eosinophilia or iron deficiency anaemia can alert the laboratory haematologist or physician to the possibility of parasitic infection. In addition to morphological skills, an adequate clinical history is important for speedy and accurate diagnosis, particularly in non-endemic areas.
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