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“Asymptomatic” Malaria: A Chronic and Debilitating Infection That Should Be Treated
Open accessAbstract
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].](/paper-figures/efcf09f21ab044329ea91be5010d78e8/asymptomatic-malaria-a-chronic-and-debilitating-infection-that-should-be-treated-figure-1.jpg)
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“submicroscopic cases are not detected or treated, resulting in severe outcomes for the mother and child (anemia and severe malaria) while also perpetuating parasite transmission and disease endemicity [20,23,24,25,26]”
From Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia (2023) · cites this paper as [25]
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Metadata
- 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
- 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
- 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
- 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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