{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:09:48Z","timestamp":1791850188075,"version":"4.3.4"},"reference-count":49,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T00:00:00Z","timestamp":1724889600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01NS055349"],"award-info":[{"award-number":["R01NS055349"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43 TW010928"],"award-info":[{"award-number":["D43 TW010928"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institutes of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["R21AI151349"],"award-info":[{"award-number":["R21AI151349"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Ralph W. and Grace M. Showalter"},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Disease","doi-asserted-by":"crossref","award":["T32DK120524"],"award-info":[{"award-number":["T32DK120524"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Recently, there has been an unexplained increase in the incidence of blackwater fever (BWF) in Eastern Uganda. In this study, we evaluated the association between immune complexes, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and the occurrence and recurrence of BWF in children with severe malaria (SM).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Between 2014 and 2017, children aged 6 months to &amp;lt;4 years hospitalized with SM and community children (CC) were recruited at 2 hospitals in Central and Eastern Uganda. We measured serum circulating immune complexes (cIC) and their relationship to SM complications and postdischarge outcomes, and evaluated effect mediation through G6PD deficiency.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 557 children with SM and 101 CC were enrolled. The mean age was 2.1 years. Children with SM had higher cIC levels than CC (P &amp;lt; .001). After controlling for age, sex, and site, cIC were associated with severe anemia, jaundice, and BWF: adjusted odds ratio (aOR), 7.33 (95% confidence interval [CI], 3.45\u201315.58), P &amp;lt; .0001; aOR, 4.31 (95% CI, 1.68\u201311.08), P = .002; and aOR, 5.21 (95% CI, 2.06\u201313.18), P &amp;lt; .0001, respectively. cIC predicted readmissions for SM, severe anemia, and BWF: adjusted incidence rate ratios (aIRR), 2.11 (95% CI, 1.33\u20133.34), P = .001; aIRR, 8.62 (95% CI, 2.80\u201326.59), P &amp;lt; .0001; and aIRR, 7.66 (95% CI, 2.62\u201322.45), P &amp;lt; .0001, respectively. The relationship was most evident in boys where the frequency of the G6PD African allele (A\u2212) was 16.8%. G6PD deficiency was associated with increases in cIC in boys (P = .01) and mediation analysis suggested G6PD deficiency contributes to recurrent severe anemia and BWF via increased cIC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Immune complexes are associated with hemolytic complications and predict recurrences in SM survivors.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiae431","type":"journal-article","created":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T22:11:36Z","timestamp":1724969496000},"source":"Crossref","is-referenced-by-count":4,"title":["Circulating Immune Complexes and Glucose-6-Phosphate Dehydrogenase Deficiency Predict Recurrent Blackwater Fever in Ugandan Children With Severe Malaria"],"prefix":"10.1093","author":[{"given":"Ruth","family":"Namazzi","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Child Health, 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