Abstract
BackgroundFor rapid initiation of anti-malarial treatment and prevention of complications, early diagnosis and risk stratification is important in patients with Plasmodium falciparum malaria. Routine laboratory values do not correlate well with disease severity. The aim of this study was to determine the diagnostic and prognostic value of several biomarkers related to inflammation; endothelial and cardiac dysfunction; coagulation, and haemolysis in imported P. falciparum malaria.MethodsIn a prospective case-control study, 79 adult travellers with both uncomplicated and complicated P. falciparum malaria were included between 2007 and 2011. Forty-one healthy subjects were included as controls. Blood samples were obtained within 24 hours after first consultation to assess routine laboratory values as well as markers related to inflammation (PAPP-A, copeptin, CRP), endothelial activation (MPO, elastase-2, endothelin-1, sICAM-1, sVCAM-1), cardiac function (NT-proBNP, MR-proANP), coagulation (fibrinogen, D-dimers, platelet count), and haemolysis (LDH). Prognostic performance was assessed using the receiver operating characteristic curve (area under the curve = AUROC).ResultsTwelve (15.2%) patients had severe P. falciparum malaria. In the patient group, significant thrombocytopaenia was found, all other markers but PAPP-A were significantly elevated. Diagnostic performance was best for CRP with an AUROC of 1.00, followed by MPO (0.99), D-dimers (0.98), elastase-2 (0.98), and sICAM-1 (0.98). Biomarker levels did not correlate well with disease severity.ConclusionThe combination of travel history, fever prior to blood sampling, and CRP serum levels above or below 10.8 mg/l upon hospital admission, best discriminated between malaria patients and control persons. None of the biomarkers studied predicted the presence or the development of malaria complications, neither at the time of admission, nor during hospitalization.
Highlights
For rapid initiation of anti-malarial treatment and prevention of complications, early diagnosis and risk stratification is important in patients with Plasmodium falciparum malaria
Many malaria patients initially present to physicians who, lack expertise in diagnosing Plasmodium infection, judging the disease severity, and prognosis after the diagnosis has been established by standard microscopy
Study site and participants Between June 2007 and February 2011, patients with imported P. falciparum malaria were screened at the inand outpatient departments of the Section for Tropical Medicine at the University Medical Centre HamburgEppendorf, which is a tertiary hospital in Hamburg, Germany
Summary
For rapid initiation of anti-malarial treatment and prevention of complications, early diagnosis and risk stratification is important in patients with Plasmodium falciparum malaria. Malaria remains the most important parasitic disease with an estimated number of deaths of 1.2 million in 2010, especially amongst children under five [1,2]. Many malaria patients initially present to physicians who, lack expertise in diagnosing Plasmodium infection, judging the disease severity, and prognosis after the diagnosis has been established by standard microscopy. Diagnosis and treatment may be postponed until the patient is referred to a tropical disease specialist. In this setting it would be favourable to have a combination of biomarkers that are sensitive for malaria and correlate with disease severity
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