Malaria Infection in Patients with Sickle Cell Disease in Nigeria: Association with Markers of Hyposplenism

Abstract

Background Malaria is considered an important cause of morbidity and mortality among people living with sickle cell disease (SCD). This has partly been attributed to the loss of splenic function that occurs early in the disease process. We aimed to study the prevalence of malaria infection among Nigerian SCD patients and explore the association with spleen size and function. Method This was a hospital-based, cross-sectional study performed at the University of Maiduguri Teaching Hospital in North-Eastern Nigeria from October 2020 to November 2021. Giemsa-stained blood smears for malaria parasites, Howell-Jolly body (HJB) red cells enumeration for spleen function evaluation and ultrasonography for spleen size assessment, were performed in acutely-ill SCD patients. Results of malaria parasitaemia and parasite density were compared with those of steady-state SCD patients and non-SCD controls. Results A total of 394 participants consisting of 119 acutely-ill SCD patients, 167 steady-state SCD controls and 108 non-SCD controls were studied. The prevalence of P. falciparum parasitaemia was 51.3% in acutely-ill SCD patients, 31.7% in steady-state SCD controls and 13.0% in the non-SCD controls. In the SCD group, the mean parasite density was significantly higher among the acutely- ill SCD patients than the steady-state SCD controls (29,747 vs 18,563 parasites/ul; P = 0.001). Although parasitaemia prevalence was lower among the non-SCD controls, parasite density was significantly higher compared to both SCD groups (P = 0.0001). Among the acutely-ill SCD patients, the prevalence of clinical malaria and severe malaria anaemia were highest among children less than 5 years of age. Prevalence of parasitaemia (P = 0.540) and parasite density (P = 0.975) among acutely-ill SCD patients with visualized spleens on ultrasonography were not statistically different compared to those with absent spleens. Similarly, the frequency of HJB red cells among patients with parasitaemia was not significantly different compared to patients without parasitaemia (P = 0.183). Conclusion Our study highlights the frequency and role of malaria infection in acutely-ill SCD patients, especially in those younger than five years. Although we have found no evidence of an increased risk of malaria parasitaemia or parasite density with markers of hyposplenism, the role played by an underlying immunity to malaria among SCD patients is not clear. Further studies are required to elucidate the role of hyposplenism and malaria in SCD patients in malaria-endemic regions.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the University of Maiduguri Teaching Hospital (UMTH/REC/20/606) and Liverpool School of Tropical Medicine Research (REC reference number: 20-010) Ethics Review Committee.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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