Abstract

The influence of the genetic diversity of Plasmodium falciparum infection on the clinical presentation of human malaria was investigated in rural Bolifamba, Cameroon. Parasite DNA was obtained from the blood of 208 children (aged 1-15 years) with malarial infection. The prevalences of anaemia and symptomatic and asymptomatic malaria among these children were 57.7%, 51.4% and 48.6%, respectively. The frequencies of parasites carrying each of the block-2 allelic variants (MAD20, K1 and RO33) of merozoite surface protein 1 (MSP1) were compared among the symptomatic and asymptomatic cases of malaria, the anaemic and non-anaemic subjects, and in various age groupings. Although all three allelic variants were found in Bolifamba, 32.7% of the children investigated were co-infected with parasites carrying the RO33 and K1 variants. There was a significant difference in the prevalence of each MSP1 allelic variant both between age-groups and between the various categories of anaemia considered (P<0.0001 for each), with the highest number of alleles occurring in the children with severe anaemia. The combination of RO33/K1 co-infection and anaemia was detected in most (57.7%) of the children aged 3-<6 years. The RO33/K1 co-infection was also strongly associated with both fever and high levels of parasitaemia (P<0.0001 for each). Although the children of Bolifamba are exposed to all three allelic variants of MSP1, which occur either singly or in varying combinations in the infected children, RO33/K1 co-infections are particularly associated with fever and this association appears independent of age and parasite density. The preliminary data presented here should facilitate the design of future research towards the development and testing of malaria candidate vaccines in the study area.