Invasion of Erythroblasts by<i>Pasmodium vivax</i>: A New Mechanism Contributing to Malarial Anemia

Ru, Yongxin; Mao, Bingyu; Zhang, Feng-Kui; Pang, Tianxiang; Zhao, Shi-Xuan; Liu, Jinhua; Wickramasinghe, S. N.

doi:10.3109/01913120903251643

Cited by 38 publications

(38 citation statements)

References 12 publications

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“…Data obtained by transmission electron microscopy revealed two cases of vivax malaria in which parasites were detected in erythroblasts, suggesting that the destruction of these cells by P. vivax could be an underlying mechanism contributing to P. vivaxrelated anemia (87). Moreover, bone marrow aspirate from a Brazilian Amazon patient with chronic P. vivax infection presenting with splenomegaly and thrombocytopenia showed schizonts inside RBCs, without parallel detection of parasites in the peripheral blood (88).…”

Section: Dyserythropoiesis and Immune-mediated Anemiamentioning

confidence: 99%

Potential Immune Mechanisms Associated with Anemia in Plasmodium vivax Malaria: a Puzzling Question

et al. 2014

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The pathogenesis of malaria is complex, generating a broad spectrum of clinical manifestations. One of the major complications and concerns in malaria is anemia, which is responsible for considerable morbidity in the developing world, especially in children and pregnant women. Despite its enormous health importance, the immunological mechanisms involved in malaria-induced anemia remain incompletely understood. Plasmodium vivax, one of the causative agents of human malaria, is known to induce a strong inflammatory response with a robust production of immune effectors, including cytokines and antibodies. Therefore, it is possible that the extent of the immune response not only may facilitate the parasite killing but also may provoke severe illness, including anemia. In this review, we consider potential immune effectors and their possible involvement in generating this clinical outcome during P. vivax infections.

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Section: Dyserythropoiesis and Immune-mediated Anemiamentioning

confidence: 99%

Potential Immune Mechanisms Associated with Anemia in Plasmodium vivax Malaria: a Puzzling Question

et al. 2014

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“…In areas with more severe and widespread P. vivax CR, one could hypothesize that the impact could be more evident. Although higher parasitemia was demonstrated for resistant patients on day 0, the parasite loads became similar on day 3, showing that parasitemia alone should not explain the hemoglobin decrease from day 0 to day 7 in the resistant group, unless initial parasitemia in the bone marrow milieu plays a role in worsening of anemia (31).…”

Section: Discussionmentioning

confidence: 99%

Plasmodium vivax Chloroquine Resistance and Anemia in the Western Brazilian Amazon

Marques

Costa

Filho

et al. 2014

Antimicrob Agents Chemother

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Data on chloroquine (CQ)-resistant Plasmodium vivax in LatinAmerica is limited, even with the current research efforts to sustain an efficient malaria control program in all these countries where P. vivax is endemic and where malaria still is a major public health issue. This study estimated in vivo CQ resistance in patients with uncomplicated P. vivax malaria, with use of CQ and primaquine simultaneously, in the Brazilian Amazon. Of a total of 135 enrolled subjects who accomplished the 28-day follow-up, parasitological failure was observed in 7 (5.2%) patients, in whom plasma CQ and desethylchloroquine (DCQ) concentrations were above 100 ng/dl. Univariate analysis showed that previous exposure to malaria and a higher initial mean parasitemia were associated with resistance but not with age or gender. In the multivariate analysis, only high initial parasitemia remained significant. Hemoglobin levels were similar at the beginning of the follow-up and were not associated with parasitemia. However, at day 3 and day 7, hemoglobin levels were significantly lower in patients presenting CQ resistance. The P. vivax dhfr (pvdhfr), pvmrp1, pvmdr1, and pvdhps gene mutations were not related to resistance in this small sample. P. vivax CQ resistance is already a problem in the Brazilian Amazon, which could be to some extent associated with the simultaneous report of anemia triggered by this parasite, a common complication of the disease in most of the areas of endemicity.

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“…Viable asexual trophozoites of P. vivax in infected reticulocytes (or erythroblasts) have indeed been observed in the bone marrow (95,(166)(167)(168)(169)(170)(171) and spleen (172). In one case, a subpatent parasitemia confirmed by PCR contrasted with a ruptured spleen very heavily laden with P. vivax-infected reticulocytes (175).…”

Section: A Plausible and Testable Hypothesis On Pathogenesismentioning

confidence: 99%

Evidence and Implications of Mortality Associated with Acute Plasmodium vivax Malaria

2013

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SUMMARYVivax malaria threatens patients despite relatively low-grade parasitemias in peripheral blood. The tenet of death as a rare outcome, derived from antiquated and flawed clinical classifications, disregarded key clinical evidence, including (i) high rates of mortality in neurosyphilis patients treated with vivax malaria; (ii) significant mortality from zones of endemicity; and (iii) the physiological threat inherent in repeated, very severe paroxysms in any patient, healthy or otherwise. The very well-documented course of this infection, with the exception of parasitemia, carries all of the attributes of “perniciousness” historically linked to falciparum malaria, including severe disease and fatal outcomes. A systematic analysis of the parasite biomass in severely ill patients that includes blood, marrow, and spleen may ultimately explain this historic misunderstanding. Regardless of how this parasite is pernicious, recent data demonstrate that the infection comes with a significant burden of morbidity and associated mortality. The extraordinary burden of malaria is not heavily weighted upon any single continent by a single species of parasite—it is a complex problem for the entire endemic world, and both species are of fundamental importance. Humanity must rally substantial resources, intellect, and energy to counter this daunting but profound threat.

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Invasion of Erythroblasts byPasmodium vivax: A New Mechanism Contributing to Malarial Anemia

Cited by 38 publications

References 12 publications

Potential Immune Mechanisms Associated with Anemia in Plasmodium vivax Malaria: a Puzzling Question

Potential Immune Mechanisms Associated with Anemia in Plasmodium vivax Malaria: a Puzzling Question

Plasmodium vivax Chloroquine Resistance and Anemia in the Western Brazilian Amazon

Evidence and Implications of Mortality Associated with Acute Plasmodium vivax Malaria

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