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Malaria Journal

, 5:64

First Online: 31 July 2006Received: 25 January 2006Accepted: 31 July 2006

Abstract

BackgroundA high prevalence of spherocytes was detected in blood smears of children enrolled in a case control study conducted in the malaria holoendemic Lake Victoria basin. It was speculated that the spherocytes reflect intraerythrocytic removal of malarial parasites with a concurrent removal of RBC membrane through a process analogous to pitting of intraerythrocytic inclusion bodies. Pitting and re-circulation of RBCs devoid of malaria parasites could be a host mechanism for parasite clearance while minimizing the anaemia that would occur were the entire parasitized RBC removed. The prior demonstration of RBCs containing ring-infected erythrocyte surface antigen pf 155 or RESA but no intracellular parasites, support the idea of pitting.

MethodsAn in vitro model was developed to examine the phenomenon of pitting and spherocyte formation in Plasmodium falciparum infected RBCs iRBC co-incubated with human macrophages. In vivo application of this model was evaluated using blood specimens from patients attending Kisumu Ditrict Hospital. RBCs were probed with anti-RESA monoclonal antibody and a DNA stain propidium iodide. Flow cytometry and fluorescent microscopy was used to compare RBCs containing both the antigen and the parasites to those that were only RESA positive.

ResultsCo-incubation of iRBC and tumor necrosis factor-alpha activated macrophages led to pitting 14% ± 1.31% macrophages with engulfed trophozoites as opposed to erythrophagocytosis 5.33% ± 0.95% P < 0.01. Following the interaction, 26.9% ± 8.1% of the RBCs were spherocytes as determined by flow cytometric reduction in eosin-5-maleimide binding which detects RBC membrane band 3. The median of patient RBCs with pitted parasites RESA+, PI- was more than 3 times 95,275-μL that of RESA+, PI+ RBCs 28,365-μL P < 0.01. RBCs with pitted parasites showed other morphological abnormalities, including spherocyte formation.

ConclusionIt is proposed that in malaria holoendemic areas where prevalence of asexual stage parasites approaches 100% in children, RBCs with pitted parasites are re-circulated and pitting may produce spherocytes.

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2875-5-64 contains supplementary material, which is available to authorized users.

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Autor: Samuel B Anyona - Stanley L Schrier - Charity W Gichuki - John N Waitumbi

Fuente: https://link.springer.com/







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