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BACKGROUND:Anemia is a major complication of vivax malaria. Antiphosphatidylserine (PS) antibodies generated during falciparum malaria mediate phagocytosis of uninfected red blood cells that expose PS and have been linked to late malarial anemia. However, their role in anemia from non-falciparum Plasmodium species is not known, nor their role in early anemia from falciparum malaria. METHODS:We measured PS immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in Malaysian patients with vivax, falciparum, knowlesi, and malariae malaria, and in healthy controls, and correlated antibody titres with hemoglobin. PS antibodies were also measured in volunteers experimentally infected with Plasmodium vivax and Plasmodium falciparum. RESULTS:PS IgM and IgG antibodies were elevated in patients with vivax, falciparum, knowlesi, and malariae malaria (P < .0001 for all comparisons with controls) and were highest in vivax malaria. In vivax and falciparum malaria, PS IgM and IgG on admission correlated inversely with admission and nadir hemoglobin, controlling for parasitemia and fever duration. PS IgM and IgG were also increased in volunteers infected with blood-stage P. vivax and P. falciparum, and were higher in P. vivax infection. CONCLUSIONS:PS antibodies are higher in vivax than falciparum malaria, correlate inversely with hemoglobin, and may contribute to the early loss of uninfected red blood cells found in malarial anemia from both species.

Original publication

DOI

10.1093/infdis/jiz334

Type

Journal

The Journal of infectious diseases

Publication Date

09/2019

Volume

220

Pages

1435 - 1443

Addresses

Global and Tropical Health Division, Menzies School of Health Research, and Charles Darwin University, Darwin, Northern Territory, Australia.

Keywords

Humans, Malaria, Falciparum, Malaria, Vivax, Anemia, Hemoglobins, Immunoglobulin G, Immunoglobulin M, Antibodies, Antiphospholipid, Adolescent, Adult, Malaysia, Female, Male, Young Adult