Plasmodium Parasitemia Associated with Increased Survival in Ebola Virus-Infected Patients

Kyle Rosenke, Jennifer Adjemian, Vincent J. Munster, Andrea Marzi, Darryl Falzarano, Clayton O. Onyango, Melvin Ochieng, Bonventure Juma, Robert J. Fischer, Joseph B. Prescott, David Safronetz, Victor Omballa, Collins Owuor, Thomas Hoenen, Allison Groseth, Cynthia Martellaro, Neeltje Van Doremalen, Galina Zemtsova, Joshua Self, Trenton BushmakerKristin McNally, Thomas Rowe, Shannon L. Emery, Friederike Feldmann, Brandi N. Williamson, Sonja M. Best, Tolbert G. Nyenswah, Allen Grolla, James E. Strong, Gary Kobinger, Fatorma K. Bolay, Kathryn C. Zoon, Jorgen Stassijns, Ruggero Giuliani, Martin De Smet, Stuart T. Nichol, Barry Fields, Armand Sprecher, Moses Massaquoi, Heinz Feldmann, Emmie De Wit

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Background. The ongoing Ebola outbreak in West Africa has resulted in 28 646 suspected, probable, and confirmed Ebola virus infections. Nevertheless, malaria remains a large public health burden in the region affected by the outbreak. A joint Centers for Disease Control and Prevention/National Institutes of Health diagnostic laboratory was established in Monrovia, Liberia, in August 2014, to provide laboratory diagnostics for Ebola virus. Methods. All blood samples from suspected Ebola virus-infected patients admitted to the Médecins Sans Frontières ELWA3 Ebola treatment unit in Monrovia were tested by quantitative real-time polymerase chain reaction for the presence of Ebola virus and Plasmodium species RNA. Clinical outcome in laboratory-confirmed Ebola virus-infected patients was analyzed as a function of age, sex, Ebola viremia, and Plasmodium species parasitemia. Results. The case fatality rate of 1182 patients with laboratory-confirmed Ebola virus infections was 52%. The probability of surviving decreased with increasing age and decreased with increasing Ebola viral load. Ebola virus-infected patients were 20% more likely to survive when Plasmodium species parasitemia was detected, even after controlling for Ebola viral load and age; those with the highest levels of parasitemia had a survival rate of 83%. This effect was independent of treatment with antimalarials, as this was provided to all patients. Moreover, treatment with antimalarials did not affect survival in the Ebola virus mouse model. Conclusions. Plasmodium species parasitemia is associated with an increase in the probability of surviving Ebola virus infection. More research is needed to understand the molecular mechanism underlying this remarkable phenomenon and translate it into treatment options for Ebola virus infection.

Original languageEnglish (US)
Pages (from-to)1026-1033
Number of pages8
JournalClinical Infectious Diseases
Issue number8
StatePublished - Oct 15 2016
Externally publishedYes


  • Coinfection
  • Ebolavirus
  • Plasmodium
  • Survival

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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