Abstract
Biomarkers have been used to diagnose and prognosticate the progress and outcome of many chronic diseases such as neoplastic and non communicable diseases. However, only recently did the field of malaria research move in the direction of actively identifying biomarkers that can accurately discriminate the severe forms of malaria. Malaria continues to be a deadly disease, killing close to a million people (mostly children) every year. One life-threatening complication of malaria is cerebral malaria (CM). Studies carried out in Africa have demonstrated that even with the best treatment, as high as 15–30% of CM patients die and about 10–24% of CM survivors suffer short-or long-term neurological impairment. The transition from mild malaria to CM can be sudden and requires immediate intervention. Currently, there is no biological test available to confirm the diagnosis of CM and its complications. It is hoped that development of biomarkers to identify CM patients and potential risk for adverse outcomes would greatly enhance better intervention and clinical management to improve the outcomes. We review here what is currently known regarding biomarkers for CM outcomes.A Pub Med literature search was performed using the following search terms: “malaria,” “cerebral malaria,” “biomarkers,” “mortality” and “neurological sequelae.” This search revealed a paucity of usable biomarkers for CM management. We propose three main areas in which researchers can attempt to identify CM biomarkers: 1) early biomarkers, 2) diagnostic biomarkers and 3) prognostic biomarkers.
Highlights
Biomarkers have been used to diagnose and prognosticate the progress and outcome of many chronic diseases such as neoplastic and non communicable diseases
Other studies revealed that CXCL10 independently predicted severe and fatal cerebral malaria (CM) [30,31,50,51] as elevated levels of CXCL10 expression in the cerebral spinal fluid (CSF) and peripheral blood plasma were observed in CM patients who died compared to CM survivors
If we were to adapt Pepe’s biomarker development stages, the development of the different categories of the CM-management biomarker can be viewed as being at different phases
Summary
A biomarker is a substance or a characteristic that can be objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes or responses to a therapeutic intervention. The use of biomarkers in parasitic infectious diseases is limited. The use of biomarkers in clinical practices requires a thorough validation of their utility. The initial phase involves preclinical exploration during which potential biomarkers are identified. The second phase involves the development of clinical assay (s) capable of measuring the potential biomarkers; these assays are established to detect the disease and validate the biomarkers. The biomarkers should detect the disease early enough before it becomes clinically obvious and during this phase, the biomarkers’ sensitivity and specificity are determined. The fourth phase involves a prospective screening phase which entails the use of the identified biomarkers to screen large populations to determine their utility. The fifth phase involves determination of the biomarker’s impact on disease control and management with a successful biomarker having a tangible impact on the management of the disease
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