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dc.contributor.authorBuchwald, A.G.
dc.contributor.authorSixpence, A.
dc.contributor.authorChimenya, M.
dc.date.accessioned2019-03-29T14:47:35Z
dc.date.available2019-03-29T14:47:35Z
dc.date.issued2019
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85058889959&doi=10.1093%2fcid%2fciy427&partnerID=40&md5=ecd21bed87f67a2cb906a69a9c90ea85
dc.identifier.urihttp://hdl.handle.net/10713/8666
dc.description.abstractBackground. Asymptomatic Plasmodium falciparum infections are common in Malawi; however, the implications of these infections for the burden of malaria illness are unknown. Whether asymptomatic infections eventually progress to malaria illness, persist without causing symptoms, or clear spontaneously remains undetermined. We identified asymptomatic infections and evaluated the associations between persistent asymptomatic infections and malaria illness. Methods. Children and adults (N = 120) who presented at a health facility with uncomplicated malaria were followed monthly for 2 years. During follow-up visits, participants with malaria symptoms were tested and, if positive, treated. Samples from all visits were tested for parasites using both microscopy and polymerase chain reaction, and all malaria infections underwent genotyping. Cox frailty models were used to estimate the temporal association between asymptomatic infections and malaria illness episodes. Mixed models were used to estimate the odds of clinical symptoms associated with new versus persistent infections. Results. Participants had a median follow-up time of 720 days. Asymptomatic infections were detected during 23% of visits. Persistent asymptomatic infections were associated with decreased risk of malaria illness in all ages (hazard ratio 0.50, P < .001). When asymptomatic infections preceded malaria illness, newly-acquired infections were detected at 92% of subsequent clinical episodes, independent of presence of persistent infections. Malaria illness among children was more likely due to newly-acquired infections (odds ratio, 1.4; 95% confidence interval, 1.3-1.5) than to persistent infections. Conclusions. Asymptomatic P. falciparum infections are associated with decreased incidence of malaria illness, but do not protect against disease when new infection occurs. Copyright 2018 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.en_US
dc.description.sponsorshipFinancial support. This work was supported by the National Institutes of Health Malawi International Center of Excellence for Malaria Research (grant U19AI089683), the National Institute of Allergy and Infectious Disease (grant K24AI114996-03), and the National Institutes of Aging (grant P30AG028747).en_US
dc.description.urihttps://dx.doi.org/10.1093/cid/ciy427en_US
dc.language.isoen_USen_US
dc.publisherOxford University Pressen_US
dc.relation.ispartofClinical Infectious Diseases
dc.subjectclinical immunityen_US
dc.subjectmalariaen_US
dc.subjectpersistent infectionen_US
dc.subjecttime to diseaseen_US
dc.titleClinical implications of asymptomatic plasmodium falciparum infections in Malawien_US
dc.typeArticleen_US
dc.identifier.doi10.1093/cid/ciy427
dc.identifier.pmid29788054


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