Document Detail

Erythropoietin levels are not independently associated with malaria-attributable severe disease in Mozambican children.
MedLine Citation:
PMID:  21912616     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Severe malaria is difficult to differentiate from other forms of malaria or other infections with similar symptoms. Any parameter associated to malaria-attributable severe disease could help to improve severe malaria diagnosis.
METHODOLOGY: This study assessed the relation between erythropoietin (EPO) and malaria-attributable severe disease in an area of Mozambique with moderate malaria transmission. 211 children <5 years, recruited at Manhiça District Hospital or in the surrounding villages, were included in one of the following groups: severe malaria (SM, n = 44), hospital malaria without severity (HM, n = 49), uncomplicated malaria (UM, n = 47), invasive bacterial infection without malaria parasites (IBI, n = 39) and healthy community controls (C, n = 32). Malaria was diagnosed by microscopy and IBI by blood/cerebrospinal fluid culture.
PRINCIPAL FINDINGS: Mean EPO concentration in the control group was 20.95 U/l (SD = 2.96 U/l). Values in this group were lower when compared to each of the clinical groups (p = 0.026 C versus UM, p<0.001 C vs HM, p<0.001 C vs SM and p<0.001 C vs IBI). In the 3 malaria groups, values increased with severity [mean = 40.82 U/l (SD = 4.07 U/l), 125.91 U/l (SD = 4.99U/l) and 320.87 U/l (SD = 5.91U/l) for UM, HM and SM, respectively, p<0.001]. The IBI group [mean = 101.75 U/l (SD = 4.12 U/l)] presented lower values than the SM one (p = 0.002). In spite of the differences, values overlapped between study groups and EPO levels were only associated to hemoglobin. Hemoglobin means of the clinical groups were 93.98 g/dl (SD = 14.77 g/dl) for UM, 75.96 g/dl (SD = 16.48 g/dl) for HM, 64.34 g/dl (SD = 22.99 g/dl) for SM and 75.67 g/dl (SD = 16.58 g/dl) for IBI.
CONCLUSIONS: Although EPO levels increase according to malaria severity and are higher in severe malaria than in bacteremia, the utility of EPO to distinguish malaria-attributable severe disease is limited due to the overlap of values between the study groups and the main role of hemoglobin in the expression of EPO.
Núria Díez-Padrisa; Ruth Aguilar; Sonia Machevo; Luis Morais; Tacilta Nhampossa; Cristina O'Callaghan-Gordo; Delino Nhalungo; Clara Menéndez; Anna Roca; Pedro L Alonso; Quique Bassat
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-08-30
Journal Detail:
Title:  PloS one     Volume:  6     ISSN:  1932-6203     ISO Abbreviation:  PLoS ONE     Publication Date:  2011  
Date Detail:
Created Date:  2011-09-13     Completed Date:  2011-12-23     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  101285081     Medline TA:  PLoS One     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e24090     Citation Subset:  IM    
Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
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MeSH Terms
Bacteremia / diagnosis,  metabolism
Bilirubin / blood
Child, Preschool
Diagnosis, Differential
Erythropoietin / metabolism*
Hemoglobins / metabolism
L-Lactate Dehydrogenase / blood
Malaria / blood,  diagnosis,  metabolism*,  transmission
Reg. No./Substance:
0/Hemoglobins; 11096-26-7/Erythropoietin; 635-65-4/Bilirubin; EC Dehydrogenase

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