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Malaria Infection and Risk for Endemic Burkitt Lymphoma: A Systematic Review and Meta-Analysis.

ABSTRACT: Background: Malaria infection is reportedly linked to endemic Burkitt lymphoma (eBL) in malaria-endemic areas. This study aimed to pool the overall risk (or odds) of eBL among children with previous or concurrent malaria infection. Methods: We searched PubMed, Web of Science, Scopus, and reference lists of publications for potentially relevant studies on malaria infection and eBL. The quality of the included studies was assessed using the Joanna Briggs Institute for case-control studies. Random-effects meta-analysis was used to summarize whether the odds of eBL can be increased by (1) malaria infection or (2) elevated titer of IgGs to malaria antigen. The level of heterogeneity was evaluated using Cochran's Q statistic and I². The individual study data, pooled odds, and confidence interval (CI) were illustrated using the forest plot. Publication bias was assessed using funnel plots and Egger's test. Results: Ten studies were included, reporting the number of malaria cases in eBL and non-eBL (5 studied malaria infection and the odds of eBL; five studied the burden of IgGs to malarial antigens and the odds of eBL). According to the meta-analysis results, the odds of eBL was not increased by malaria infection (p = 0.562, OR: 0.87, 95% CI: 0.54-1.39, I²: 93.5%, malaria in eBL: 604/1506 cases, malaria in non-eBL: 2117/4549 cases) and the elevated titer of IgGs to malaria antigen (p = 0.051, OR: 1.50, 95% CI: 1.00-2.25, I²: 89%, increased IgG titer in eBL: 1059/1736 cases, increased IgG titer in non-eBL: 847/1722 cases). In meta-regression analysis, sex was not a confounding factor for the effect size of malaria infection and eBL (p = 0.10) and that of increased IgGs and eBL (p = 0.80). Conclusions: Malaria infection and IgG titer elevation did not increase the risk for eBL among children. However, the included studies, which are only few, do not generally agree on this point. Therefore, the risk for eBL in children diagnosed with malaria should be investigated further by longitudinal studies to confirm our evidence-based approach.

SUBMITTER: Kotepui KU

PROVIDER: S-EPMC8198990 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundIn order to attain the objectives set out in the global technical strategy against malaria 2016-2030, it is important to have accurate epidemiological data on malaria in all age categories, including those which are often neglected because of an apparent low burden of disease. The current systematic review with meta-analysis synthesizes the epidemiology of clinical congenital and neonatal malaria in endemic areas.MethodsPubMed, EMBASE, Global Index Medicus, and Web of Science were searched up to 30th October 2019, to identify observational studies reporting on congenital (0-7 days) and neonatal (0-28 days) malaria. No restriction related to language was applied. Study selection, data extraction, and methodological quality assessment were performed independently by two investigators. A random-effects meta-analysis was used to pool prevalence data. Prevalence were adjusted taking into account the variance due to diagnostic method and regional distribution. Subgroup analyses were performed to identify sources of heterogeneity in case of substantial heterogeneity. This review was registered in PROSPERO with number CRD42020150124.ResultsThe bibliographical search identified 1,961 studies, of which 22 were finally retained with a total population of 28,083 neonates. The overall crude prevalence of clinical congenital malaria was 40.4‰ (95%CI 19.6-67.7; 17 studies). The adjusted prevalence considering the variance due to difference in region/country (hierarchical model) was 33.7‰ (95%CI 6.9-77.2). There was no difference between the prevalence of clinical congenital malaria in Africa 39.5‰ (95%CI 17.2-59.5; 15 studies) and outside Africa 56.3‰ (95%CI 0.0-406.1), p = 0.867. The overall crude prevalence of clinical neonatal malaria was 12.0‰ (95%CI 1.4-30.3; 12 studies), and the adjusted one (considering the variance due to diagnostic method and the region/country) was 12.9‰ (95%CI 0.1-39.7). There was no difference between the prevalence of clinical neonatal malaria in Africa 12.1‰ (95%CI 1.3-31.2; 11 studies) and outside Africa 12.5‰ (95%CI 0.0-52.9), p = 0.802.ConclusionThis study suggests a high prevalence of clinical congenital and neonatal malaria. It calls for an intensification of preventive measures against malaria during pregnancy and in the neonatal period, and to consider neonates as a distinct age category in the elaboration of malaria treatment and prevention guidelines.

Project description:BackgroundRecommended vector control tools against malaria, such as long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), mainly target mosquitoes that rest and feed on human hosts indoors. However, in some malaria-endemic areas, such as Southeast Asia and South America, malaria vectors primarily bite outdoors meaning that LLINs and IRS may be less effective. In these situations the use of topical insect repellents may reduce outdoor biting and morbidity from malaria. A systematic review and meta-analysis was conducted to assess the efficacy of topical insect repellents against malaria.MethodsStudies were identified using database searches (MEDLINE, EMBASE, Web of Science and clinical trials registers), as well as reference list searches and contact with researchers. Randomized and non-randomized controlled trials were included that assessed the effect of topical repellents (all active ingredients and concentrations) on Plasmodium falciparum or Plasmodium vivax malaria or infection in malaria-endemic populations. Meta-analysis of clinical data was conducted in order to generate summary risk ratios.ResultsTen trials met the inclusion criteria. Studies varied in terms of repellent active ingredient and formulation, co-interventions, study population, compliance, and follow-up period. Topical repellents showed an 18% protective efficacy against P. falciparum malaria, although this was not significant (95% CI: -8%, 38%). Similarly, the average protective efficacy of topical repellents against P. vivax malaria did not reach significance (protective efficacy: 20%, 95% CI: -37%, 53%). Exclusion of non-randomized trials from the meta-analysis did not alter the findings.ConclusionsAlthough topical repellents can provide individual protection against mosquitoes, the results of this meta-analysis indicate that topical repellents are unlikely to provide effective protection against malaria. However, there was substantial heterogeneity between studies included and the relatively small number of studies meant that this heterogeneity could not be fully explored in the analysis. Further well-designed trials of topical repellents at appropriate doses and alternative modes of repellent delivery, such as spatial repellents and long-lasting insecticide-treated clothing, are required.

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Malaria Infection and Risk for Endemic Burkitt Lymphoma: A Systematic Review and Meta-Analysis.

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