Abstract
The quantity of malaria pigment liberated into the circulation at schizogony reflects the pathogenic sequestered parasite burden in Plasmodium falciparum malaria, and may therefore be a measure of disease severity. Among 300 consecutive adult patients with severe falciparum malaria, the 40 who died had significantly higher proportions of malaria pigment-containing neutrophils on admission (mean = 7·7%, standard deviation ( sd) = 5·9%) and pigment-containing monocytes (mean = 8·6%, SD = 5·9%) than did survivors (mean 3·2%, sd = 4·1% and mean 4·8%, sd = 4·6%, respectively) ( P < 0·0001): This proved a better indicator of prognosis than the peripheral parasite count. A count of peripheral neutrophils containing visible pigment ⩾5% predicted a fatal outcome with 73% sensitivity and 77% specificity (relative risk 6·2, 95% confidence interval (CI) 3·2–11·8) compared to 60% sensitivity and 57% specificity for parasitaemia >100 000/μL (relative risk 1·8, 95% CI 1·0–3·3). The peripheral blood count of pigment-containing neutrophils in severe malaria is a rapid, simple, and practical prognostic test.
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