Ghanaian researchers have discovered that malaria can induce vaso-occlusive crises in patients with sickle cell disease, requiring them to receive prompt treatment to prevent further clinical deterioration, according to a study published in PLoS One.

Sickle cell disease is a particularly pressing problem in Ghana, affecting about 5000 newborns per year. From 2013 to 2014, it was reported that 5451 patients with sickle cell disease visited a local sickle cell clinic for medical attention. Of these patients, about half were homozygous for hemoglobin S.

Another disease that is of particular concern in Ghana is malaria. In 2017, official reports indicated that about half of all outpatient visits were related to malaria. The groups most likely to be affected by malaria are children aged less than 15 years, male individuals, people from rural or periurban areas, and individuals with only a primary education or who did not attend school at all. 

The authors of the study noted similarities between the two diseases, writing, “Both malaria and sickle cell disease are blood-associated diseases that affect the hematological cell lines but with varied clinical presentations. Whereas fever, cephalgia, fatigue, malaise, and musculoskeletal pain are commonly seen in uncomplicated malaria, the clinical features of homozygous sickle cell disease varies widely between patients.” 

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To further explore the relationship between the diseases, the research team conducted a prospective cohort study at Ga North Municipal Hospital in Taifa, Ghana. Three groups of participants were recruited: individuals with malaria who were homozygous for hemoglobin A, individuals with both malaria and sickle cell disease, and individuals with sickle cell disease without malaria. 

The study revealed that oxidative stress was a significant biomarker in comorbid malaria and sickle cell disease. An increase in oxidative stress corresponded with symptoms such as a significant increase in body temperature. In addition, the researchers observed that malaria exacerbated oxidative stress in sickle cell disease. 

“It is obvious to note that in malaria-[sickle cell disease], excessive production of free radicals overwhelms the neutralization capacity of antioxidants,” the authors of the study wrote. “This results in enhanced lipid peroxidation which plays an important role in disease pathogenesis and presentation.” 

Hence, the research team recommended that all patients with sickle cell disease experiencing a hemolytic crisis are tested for malaria, which can ensure prompt management to prevent vaso-occlusive crises from developing. 

Reference

Aninagyei E, Tettey CO, Kwansa-Bentum H, et al. Oxidative stress and associated clinical manifestations in malaria and sickle cell (HbSS) comorbidityPLoS One. 2022;17(6):e0269720. doi:10.1371/journal.pone.0269720