Clinical trial NCT06769815: Host Immunity, Plasmodium and Pathogens Co-Infections
Official title: Host Immunity, Plasmodium and Pathogens Co-Infections
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Malaria
Bacterial Co-infection
Keywords: malaria
co-infection
immune response
epigenetic mechanisms
children
Togo
Lead sponsor: Institut Pasteur
Sponsor class: INDUSTRY
Collaborators: name: Institut de Recherche pour le Developpement
First posted: 2025-01-10
Enrollment: 2000
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: BASIC_SCIENCE

Brief summary: Few studies have focused on malaria co-infections, mainly caused by Plasmodium falciparum, occurring mainly in children under 5 years of age in sub-Saharan Africa. These studies have focused on malaria-associated bacterial sepsis, with an estimated prevalence of 9.1% and associated mortality of 15.0%. However, no study has documented infectious sites other than the blood compartment, considered viruses and parasites as possible causes of infection in addition to bacteria, and used molecular diagnostic methods based on PCRs, which are more sensitive. Thus, the prevalence of these co-infections and the spectrum of pathogens involved are probably underestimated, as is the impact of these co-infections on mortality. Furthermore, it has been shown that malaria infections can condition the immune cells of naturally exposed individuals, potentially leading to greater susceptibility to all types of infection. But these mechanisms have never been documented in the context of co-infections.

The WHO recommends the use of broad-spectrum antibiotics in cases of severe malaria, in addition to antimalarial drugs, as it can be difficult to differentiate clinically between severe malaria and severe bacterial infection (bacteremia, pneumonia and meningitis). Yet this empirical use of antibiotics could be contributing to an increase in antibiotic resistance. Identifying the determinants of co-infection with malaria and severe bacterial infection would enable this treatment to be better targeted.

These determinants remain undetermined as no study has considered other causes of severe bacterial infection other than bacteremia, used appropriate statistical methodology (univariate analysis only) and explored important determinants, notably the capacity of children's innate immunity to respond to severe bacterial infection.

Detailed description: This is a prospective multicenter longitudinal study.

The study will focus on several populations:

* febrile children: aged between 6 and 60 months consulting ;
* non-febrile children: aged between 6 and 60 months consulting.
* Pregnant women.
* newborns: those born to mothers included in the study with or without pregnancy-associated malaria.

The study will be based on :

* Clinical and microbiological documentation of acute febrile episodes in recruited children
* Documentation of vital status in children 3 months after recruitment
* Ability of host cells to respond to infections.

Eligibility criteria: Inclusion Criteria:

Febrile children:

* aged between 6 and 60 months
* with a febrile episode lasting less than 7 days (axillary temperature \>=37.5° Celsius)
* whose state of health is compatible with a minimum single blood sample volume of 6.25 ml

Non-febrile children:

* aged between 6 and 60 months
* with axillary temperature \<37.5° Celsius
* no clinical signs of infection at the time of inclusion
* no infectious episode or fever for 7 days

Pregnant women :

* giving birth in the project's partner health center
* intending to reside in the study area during the newborn follow-up period
* with a mono-fetal pregnancy
* With an apparently uncomplicated delivery not requiring referral to a higher-level health facility

Newborns at delivery:

* Born at term (determined by Ballard score)
* whose parents or legal guardians reside in the study area during the newborn's follow-up period

Exclusion Criteria:

For all :

- person already participating in another biomedical research project.

For febrile and non-febrile children:

- chronic non-infectious pathology (cancer, malnutrition, etc.)

For pregnant women

* scheduled caesarean section for current pregnancy
* Caesarean section in previous pregnancies
* chronic non-infectious pathology during pregnancy (diabetes, hypertension, pre-eclampsia)

Primary outcomes:
measure: Determine the extent and microbiological spectrum of malaria co-infections in children under 5.
timeFrame: 3 years
Secondary outcomes:
measure: Assess the impact of malaria co-infections on mortality
timeFrame: 2 years
measure: Identify the underlying immunological mechanisms mediating malaria co-infections
timeFrame: 2 years
measure: Identify epigenetic and transcriptomic modifications in infant, maternal and placental blood cells mediating malaria co-infections
timeFrame: 2 years
measure: Identify molecules associated with epigenetic modifications (metabolome, proteome).
timeFrame: 2 years
measure: Identify determinants of malaria co-infections and severe bacterial infections.
timeFrame: 2 years
Other outcomes:
Locations:
Study officials:
affiliation: Institut Pasteur
name: Bich-Tram Huynh, PhD
role: STUDY_DIRECTOR
affiliation: CHU-Campus de Lomé
name: Luc Douti, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Hôpital de district Polyclinique de Zio-Tsévié
name: Serge Ekoué Gbadoe, MD
role: PRINCIPAL_INVESTIGATOR
References: