Accurate Diagnosis of Cerebral Malaria: A Role for Parasite Histidine-Rich Protein 2?

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moderate transmission, plasma concentrations of pHRP2 appear to correspond well to body parasite biomass [5]. Elevated pHRP2 concentrations may, therefore, reflect a high level of sequestered parasites. In the current issue of the journal, Seydel and colleagues provide evidence that high pHRP2 concentrations are an excellent marker for biopsyor retinopathy-confirmed cerebral malaria [6]. The study design has several strengths that boost confidence in the accuracy of its findings, including the use of 3 study groups, which allowed for initial testing, establishment of an optimized pHRP2 cutoff level, and prospective assessment of the sensitivity and specificity of that cutoff level. The first study group consisted of children with WHO-defined cerebral malaria who died. The pHRP2 concentrations in children with autopsy-confirmed parasite sequestration were compared with the pHRP2 concentrations in those without sequestration. The pHRP2 concentrations distinguished almost perfectly between the 2 groups (area under receiver operating characteristic curve, 0.98). The second study group consisted of children from an earlier study who had WHOdefined cerebral malaria and who did (cases) or did not (controls) have malaria retinopathy. The pHRP2 concentrations in this group were used to identify a cutoff