PLoS By Category | Recent PLoS Articles

Hematology - Infectious Diseases - Pediatrics and Child Health - Public Health and Epidemiology

Erythropoietin Levels Are Not Independently Associated with Malaria-Attributable Severe Disease in Mozambican Children
Published: Tuesday, August 30, 2011
Author: Núria Díez-Padrisa et al.

by 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


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.


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.


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.