In¯uence of Hemoglobin E Trait on the Severity of Falciparum Malaria

To determine if hemoglobin E trait in¯uences the course of acute malaria, adults hospitalized for the treatment of symptomatic infection with Plasmodium falciparum were studied retro-spectively. Forty-two patients with hemoglobin E trait were compared with 175 reference subjects who did not have hemoglobin E, b-thalassemia, glucose-6-phosphate dehydrogenase de®ciency, or a-thalassemia. One patient (2.4%) with hemoglobin E trait had a severe com-plication of malaria by World Health Organization criteria (cerebral malaria), while 32 subjects in the reference group (18.3%) had one or more severe complications: cerebral malaria (n 5), hyperparasitemia (), renal failure (), and severe anemia ( ) ( after18 n 5 16 n 5 10 n 5 1 P 5.044 adjustment for ethnic categories). The estimated odds of severe complications in the reference subjects were 6.9 times the odds in patients with hemoglobin E trait (95 % con®dence interval, 1.2±146.4). These results suggest that hemoglobin E trait may ameliorate the course of acute falciparum malaria. The most common single gene disorders known are abnor-malities affecting the synthesis or structure of hemoglobin, the thalassemias and hemoglobinopathies. Geographic overlap in the historical distributions of Plasmodium falciparum, the thal