A malaria survey of the entire population of a village in Western Burkina Faso (n=1,561) was conducted to assess malaria endemicity. The study population was examined for symptoms characteristic of malaria including fever, anaemia, splenomegaly and parasites present in thick blood films. In the overall study population, the prevalence of Plasmodium spp. infection by microscopic examination of thick blood films was 79.0% (1,233/1,561). In a subcohort with 201 individuals, PCR techniques found a prevalence rate for all Plasmodium spp. of 92.0% (185/201), while microscopy found one of 80.6% (162/201). A combination of both methods gives a rate of 95.5% (192/201). Though univariate logistic analyses of elevated body temperature, anaemia, splenomegaly and age showed them all to be predictors of or risk factors for an infection, only elevated body temperature and age were predictors in multivariate logistic analysis. However, the symptom of splenomegaly did show a highly significant association with infection by multiple species of Plasmodium.
Abstract. The aim of the study was to assess whether infections with Plasmodium falciparum isolates encoding the P. falciparum chloroquine resistance transporter (pfcrt) gene K76T polymorphism, a molecular marker for chloroquine resistance, are associated with multiple infections, age, or clinical signs of malaria in a semi-immune population in a holoendemic area of Burkina Faso. The parameters of interest were investigated in 210 P. falciparum-positive inhabitants. Logistic regression analysis showed that pfcrt K76T-carrying isolates are significantly more likely to cause anemia and splenomegaly. Furthermore, we found that infections with P. falciparum isolates encoding pfcrt K76T are dependent on age rather than multiple infections. Our findings suggest that pfcrt K76T might serve as a valuable marker for assessing the long-term clinical effect of chronic infections with chloroquine-resistant P. falciparum isolates in populations, without the need of drug efficacy trials.
An assessment of differing PCR protocols for the diagnosis of Plasmodium falciparum infection was performed on samples from an area of holoendemic malaria transmission in western Burkina Faso. The PCR protocols had generally high sensitivities (>92%) and specificities (>69%), but the negative predictive values (NPV) were moderate and differed widely among the PCR protocols tested. These PCR protocols that amplified either the P. falciparum pfcrt gene or the small subunit ribosomal DNA were the most reliable diagnostic tools. However, the moderate NPV imply that more than one PCR protocol should be used for diagnosis in holoendemic areas.
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