Haematological parameters, haemozoin-containing leukocytes in Sudanese children with severe Plasmodium falciparum malaria

Abstract

Introduction: Haemozoin –containing leucocytes (HCL) can be used to predict severe malaria.
 Methodology: A case –control study was conducted in Singa, Sudan, to investigate the haematological values and HCL in children with severe Plasmodium falciparum malaria. The cases were children with severe P. falciparum malaria (67). The two groups of controls were patients with uncomplicated P. falciparum malaria (63) and healthy children (50).
 Results: The mean (±SD) age was 5.5 (±3.8) years. In comparison with children with uncomplicated P. falciparum malaria, children with severe P. falciparum malaria had significantly lower haemoglobin and platelet counts, and significantly higher lymphocyte counts, red cell distribution width (RDW), and platelet distribution width (PDW). The rate of haemozoin –containing monocytes (percentage of children positive for this parameter in each group) was 91.0%, 84.6% and 50.0%, P<0.001 in children with severe P. falciparum, uncomplicated P. falciparum malaria and negative controls, respectively. Receiver Operating Characteristic (ROC) curves for blood parameters and HCL were plotted and the areas under the curve (AUC) were calculated for the prediction of severe P. falciparum malaria infection. The ROC curve analysis, showed a fair predictability of malaria for haemoglobin (AUC = 0.74, sensitivity = 76.0% and specificity = 60.3%, cut-off = 9.7g/dl), lymphocytes (AUC = 0.71, sensitivity = 71.3% and specificity = 62.2%, cut-off = 1.95×103/mm3), PDW (AUC = 0.69, sensitivity = 80.1% and specificity = 66.3%, cut-off = 15.34 %) and haemozoin in the monocytes (AUC = 0.68, sensitivity = 68.2% and specificity = 65.2%, cut-off =5.5 %).
 Conclusion: RDW, PDW and HCL could be used to predict severe malaria in this setting.

Hematological Indices and Abnormalities Among Patients With Uncomplicated Falciparum Malaria in Kosti City of the White Nile State, Sudan: a Comparative Study

“…In the present study, P. falciparum-infected patients showed signi cantly lower median values of Hb, RBC count, MCH, MCHC, neutrophils, lymphocytes and platelets compared to malaria-negative counterparts. In line with the present study, a signi cantly lower median platelet count was found among Sudanese children with falciparum malaria compared to malaria-negative ones [13]. In contrast, a signi cantly higher median WBC count and non-signi cant differences between the median values of Hb and RBC count were observed in infected children [13].…”

“…Hematological abnormalities can contribute to the pathogenesis and complications of the disease [3] and differ according to disease endemicity, nutritional and immune status, co-existence of hemoglobinopathies and demographic factors [6][7][8][9][10][11][12][13][14][15]. Therefore, the pro le of hematological indices can help physicians to predict malaria consequences and to improve malaria case management in different epidemiological situations [12][13][14][15]. Malaria is a leading cause of anemia worldwide and contributes to approximately 25.0% of anemia prevalence in sub-Saharan Africa [16].…”

Reduction in total leukocytes in malaria patients compared to febrile controls: A systematic review and meta-analysis

“…Seven studies were conducted in Asian countries, and six studies were conducted in South America. Eight of the articles from five African countries-Ghana [26], Gabon [7,27], Nigeria [28,29], Cameroon [9,30], and Sudan [31]-reported only P. falciparum infection, while seven of the articles in Brazil [15,32,33], Venezuela [34], Republic of Korea [4], Turkey [35], and Ghana [36] reported only P. vivax infection. P. ovale infection was described only in three studies conducted in France [37], Thailand [6], and South Africa [38].…”

“…All articles were published between 1997 and 2019 (Fig 1). Six studies reported 224 cases of severe malaria in their publications [7,27,30,31,36,38]. Most of the severe complications in the studies were severe anemia (21.9%, 49/224), cerebral malaria (13.8%, 31/224), hyperparasitemia (9.8%, 22/224), repeated convulsions (8%, 18/224), more than one complication (3.6%, 8/224), hypotension (3.1%, 7/224), jaundice (2.7%, 6/224), hypoglycemia (1.8%, 4/224), and prostration (0.4%, 1/224).…”

“…Most of the leukocyte counts in the 29 studies were obtained using hematology analyzers from different manufacturers. Six studies used a Sysmex [15,31,36,38,41,43]. Three studies used a Cell-Dyn [4,5,7].…”