Cited by 386Malaria Research and ControlHemoglobinopathies and Related DisordersBird parasitology and diseases

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“Asymptomatic” Malaria: A Chronic and Debilitating Infection That Should Be Treated

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Chen, Ingrid, Clarke, Siân E., Gosling, Roly, Hamainza, Busiku, Killeen, Gerry, Magill, Alan, O’Meara, Wendy, Price, Ric N., Riley, Eleanor M.·2016·PLOS Medicine

DOI 10.1371/journal.pmed.1001942PMC PMC4718522

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Abstract

Points• Are afebrile malaria infections truly asymptomatic, benign, or even beneficial to the individual?The evidence suggests the contrary.• So-called "asymptomatic" malaria infections are associated with recurrent episodes of symptomatic parasitemia, chronic anemia, maternal and neonatal mortality, co-infection with invasive bacterial disease, cognitive impairment, and ongoing transmission of the parasite.• "Asymptomatic" malaria infections have significant health and societal consequences, and we propose that they should be renamed "chronic" malaria infections.• Targeting chronic malaria infections poses major scientific, operational, and ethical challenges.• We call for the malaria community to work with malaria control and elimination programs to target all malaria infections, irrespective of their density or presentation.The operational challenges to detect and treat chronic infections are significant, but accomplishing this is likely to result in substantial gains to both the individual and society.

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Fig 1 Spectrum of malaria infection. The figure shows increasing risks of morbidity, co-morbidity, mortality, and onward transmission as density of parasitemia increases. Note that malaria RDTs or microscopy are unable to detect low-density chronic infections below the threshold indicated and that infections of very low density are undetectable by PCR [64].CC BY · PubMed Central

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Authors: Chen, I., Clarke, S. E., Gosling, R., Hamainza, B., Killeen, G., Magill, A., O’Meara, W., Price, R. N., & Riley, E. M.
Affiliations: University of California, San Francisco (US)
London School of Hygiene & Tropical Medicine (GB)
Ministry of Health (ZM)
Ifakara Health Institute (TZ)
Gates Foundation (US)
Duke University (US)
Charles Darwin University (AU)
Corresponding author: Gosling, Roly
ORCID: Chen, Ingrid
Clarke, Siân E.
Gosling, Roly
Hamainza, Busiku
O’Meara, Wendy
Price, Ric N.
Riley, Eleanor M.
Venue: PLOS Medicine
Publisher: Public Library of Science (PLoS)
Published: 2016-01-19
Volume: 13
Issue: 1
Pages: e1001942
ISSN: 1549-1277 (ISSN-L)
1549-1676
DOI: 10.1371/journal.pmed.1001942
PMC: PMC4718522
OpenAlex: W2266475816
Cited by: 386
References: 66
Citations by year: 2026: 20 · 2025: 31 · 2024: 41 · 2023: 41 · 2022: 36 · 2021: 59 · 2020: 39 · 2019: 39 · 2018: 34 · 2017: 32 · 2016: 14
FWCI: 5.86
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: PLoS Medicine (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Bill and Melinda Gates Foundation (A115501, A122394)
Wellcome Trust (FP7/2007–2013, 084933, 091625)
European Commission (242095)
Department for International Development
Duke Global Health Institute, Duke University
Medical Research Council (G1000808)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
Health Sciences › Medicine › Genetics (clinical) › Hemoglobinopathies and Related Disorders
Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
Keywords: asymptomatic malaria, chronic malaria infection, chronic anemia, maternal and neonatal mortality, cognitive impairment, malaria transmission, malaria elimination, parasite density
MeSH terms: Anemia, Chronic Disease, Cognition Disorders, Humans, Malaria, Treatment Outcome, Asymptomatic Diseases

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“Asymptomatic” Malaria: A Chronic and Debilitating Infection That Should Be Treated

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