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Circulating immune complexes and G6PD deficiency predict readmissions for blackwater fever and severe anemia in children with severe malaria in Eastern Uganda.
Namazzi, Ruth; Mellencamp, Kagan A; Opoka, Robert O; Datta, Dibyadyuti; Lima-Cooper, Giselle; Liepmann, Claire; Sherman, Julian; Rodriguez, Ana; Kazinga, Caroline; Ware, Russell E; Goings, Michael G; Lacerda, Marcus; Abreu, Marco; Schwantes-An, Tae-Hwi; John, Chandy C; Conroy, Andrea L.
Afiliação
  • Namazzi R; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda.
  • Mellencamp KA; Global Health Uganda, Kampala, Uganda.
  • Opoka RO; Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
  • Datta D; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda.
  • Lima-Cooper G; Global Health Uganda, Kampala, Uganda.
  • Liepmann C; Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
  • Sherman J; Center for Global Health, Indiana University, Indianapolis, IN, 46202, USA.
  • Rodriguez A; Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
  • Kazinga C; Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
  • Ware RE; New York University School of Medicine, 430E 29th St. New York, NY 10016.
  • Goings MG; New York University School of Medicine, 430E 29th St. New York, NY 10016.
  • Lacerda M; Global Health Uganda, Kampala, Uganda.
  • Abreu M; Division of Hematology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
  • Schwantes-An TH; Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
  • John CC; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado and Instituto de Pesquisa Leônidas e Maria Deane, Fiocruz, 69077-000 Manaus, AM, Brazil.
  • Conroy AL; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
J Infect Dis ; 2024 Aug 29.
Article em En | MEDLINE | ID: mdl-39208451
ABSTRACT

BACKGROUND:

Recently, there has been an unexplained increase in the incidence of blackwater fever (BWF) in Eastern Uganda. In this study, we evaluate the association between immune complexes, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and the occurrence and recurrence of BWF in children with severe malaria (SM).

METHODS:

Between 2014 and 2017, children aged six months to <4 years hospitalized with SM and community children (CC) were recruited at two hospitals in Central and Eastern Uganda. We measured serum circulating immune complexes (cIC) and their relationship to SM complications and post-discharge outcomes and evaluated effect mediation through G6PD deficiency.

RESULTS:

557 children with SM and 101 CC were enrolled. The mean age of children was 2.1 years. Children with SM had higher cIC levels than CC, p<0.001. After controlling for age, sex, and site, cIC were associated with severe anemia, jaundice, and BWF (adjusted odds ratio, 95% confidence interval 7.33 (3.45, 15.58), p<0.0001; 4.31 (1.68, 11.08), p=0.002; and 5.21 (2.06, 13.18), p<0.0001), respectively. cIC predicted readmissions for SM, severe anemia, and BWF (adjusted incidence rate ratios (95% confidence interval) 2.11 (1.33, 3.34), p=0.001; 8.62 (2.80, 26.59), p<0.0001; and 7.66 (2.62, 22.45), p<0.0001), respectively. The relationship was most evident in males where the frequency of the G6PD African allele (A-) was 16.8%. G6PD deficiency was associated with increases in cIC in males (p=0.01) and mediation analysis suggested G6PD deficiency contributes to recurrent severe anemia and BWF via increased cIC.

CONCLUSIONS:

Immune complexes are associated with hemolytic complications and predict recurrences in SM survivors.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: J Infect Dis Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Uganda

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: J Infect Dis Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Uganda