Abstract
Complications of malaria can develop suddenly and unexpectedly. Although various parameters have been associated with severity of malaria, they have not been studied as predictors of these events. Many of the malarial complications are inflammatory in nature, and C-reactive protein (CRP) and elevated erythrocyte sedimentation rate (ESR) could be early markers of these complications and might precede and predict the development of complications. A total of 122 inpatients with uncomplicated newly diagnosed malaria were studied. CRP, ESR, hemoglobin, and platelets were measured before initiating treatment. Patients were monitored closely for the subsequent development of complications based on the World Health Organization's definition of severe malaria. Seven patients (5.7%) had worsening of symptoms compared to the day of admission and had higher pretreatment CRP and increased ESR compared to those patients who did not develop complications. Area under receiver operator characteristic curve was 0.761(p=0.02) for CRP and 0.739 (p = 0.035) for ESR. CRP>124 mg/L and increased ESR (>34.5 mm in the first hour) had a sensitivity of 71.4% and specificity of 79.1%, respectively, for predicting complications of malaria. Other parameters did not reach statistical significance for predicting complications. Elevated CRP and elevated ESR had a negative predictive value of 97.8%. Elevated CRP>124mg/L and increased ESR>34.5 mm in the first hour at the time of diagnosis in patients with uncomplicated malaria identifies patients who might subsequently develop complications of malaria.
Highlights
Complications of malaria can develop suddenly and unexpectedly
Flow cytometry was found to be a good tool to identify multiple-infected red blood cells (RBCs), which could be a marker of severe disease; correlation to clinical endpoints of severe disease has Vemula et al – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in malarial complications
Diabetes was defined based on the American Diabetes Association (ADA) guidelines as persons on treatment or fasting plasma glucose ≥126 mg/dL (7.0 mmol/L), 2-hour postprandial glucose (PG) ≥200 mg/dL (11.1 mmol/L) during oral glucose tolerance test (OGTT) (75g), glycosylated hemoglobin (A1C) ≥6.5% (48 mmol/mol), and random PG ≥200 mg/dL (11.1 mmol/L) [18]
Summary
Complications of malaria can develop suddenly and unexpectedly. various parameters have been associated with severity of malaria, they have not been studied as predictors of these events. Some of the parameters include anemia, spleen enlargement, glucose, lactate, cytokines, and strain multiplicity Most of these parameters have been studied in the setting of mixed populations consisting of uncomplicated and complicated cases [5]. Various parameters, such as C- reactive protein (CRP), have been associated with severity of malaria [6], they have not been studied as predictors of these events. They are not used to predict the development of these complications in a pretreatment setting of stable, uncomplicated patients Inflammatory markers such as tumor necrosis factor, interferon-gamma, and CRP have been shown to be closely associated with disease severity in vivax malaria [6]. Flow cytometry was found to be a good tool to identify multiple-infected red blood cells (RBCs), which could be a marker of severe disease; correlation to clinical endpoints of severe disease has Vemula et al – ESR and CRP in malarial complications
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