Evidence for significant influence of host immunity on changes in differential blood count during malaria

Nicole Berens-Riha, Inge Kroidl, Mirjam Schunk, Martin Alberer, Marcus Beissner, Michael Pritsch, Arne Kroidl, Günter Fröschl, Ingrid Hanus, Gisela Bretzel, Frank von Sonnenburg, Hans Dieter Nothdurft, Thomas Löscher, Karl-Heinz Herbinger

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BACKGROUND: Malaria has been shown to change blood counts. Recently, a few studies have investigated the alteration of the peripheral blood monocyte-to-lymphocyte count ratio (MLCR) and the neutrophil-to-lymphocyte count ratio (NLCR) during infection with Plasmodium falciparum. Based on these findings this study investigates the predictive values of blood count alterations during malaria across different sub-populations.

METHODS: Cases and controls admitted to the Department of Infectious Diseases and Tropical Medicine from January 2000 through December 2010 were included in this comparative analysis. Blood count values and other variables at admission controlled for age, gender and immune status were statistically investigated.

RESULTS: The study population comprised 210 malaria patients, infected with P. falciparum (68%), Plasmodium vivax (21%), Plasmodium ovale (7%) and Plasmodium malariae (4%), and 210 controls. A positive correlation of parasite density with NLCR and neutrophil counts, and a negative correlation of parasite density with thrombocyte, leucocyte and lymphocyte counts were found. An interaction with semi-immunity was observed; ratios were significantly different in semi-immune compared to non-immune patients (P <0.001).The MLCR discriminated best between malaria cases and controls (AUC = 0.691; AUC = 0.741 in non-immune travellers), whereas the NLCR better predicted severe malaria, especially in semi-immune patients (AUC = 0.788).

CONCLUSION: Malaria causes typical but non-specific alterations of the differential blood count. The predictive value of the ratios was fair but limited. However, these changes were less pronounced in patients with semi-immunity. The ratios might constitute easily applicable surrogate biomarkers for immunity.

Original languageEnglish
Article number155
JournalMalaria Journal
Number of pages9
Publication statusPublished - 2014


  • Adolescent
  • Adult
  • Aged
  • Biomarkers
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Female
  • Germany/epidemiology
  • Humans
  • Infant
  • Leukocyte Count/methods
  • Malaria/epidemiology
  • Male
  • Middle Aged
  • Parasitemia/epidemiology
  • Plasmodium/physiology
  • Predictive Value of Tests
  • Travel
  • Young Adult


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