Abstract
Objective: Patients of severe falciparum malaria may present with multi organ failure requiring critical care management. Procalcitonin (PCT) can be used as a triage tool to discriminate such patients. Methods: We determined serum PCT semi-quantitatively by immunochromatographic test in 41 patients of severe and in 19 cases of uncomplicated falciparum malaria. The diagnosis of malaria was made with detection of the parasite from peripheral blood smear. All patients were subjected to detail clinical, biochemical, and haematological work up. The diagnosis of severe malaria was done according to WHO criteria and the severity of organ dysfunction was assessed with Malaria Severity Score (MSS) in all patients by taking different physiological parameters into consideration. The risk stratification of severe malaria was determined with MSS and it is compared with PCT level. Results: Out of 41 patients of severe falciparum malaria 39 (95.1%) patients had multiple complications and 2 (4.9%) had single complication. The mean MSS was 8.39 ± 4.35. According to MSS, patients were categorized in to low, intermediate, and high risk group in 4 (9.7%), 9 (21.9%), and 28 (68.3%) patients respectively. Estimation of PCT showed that 13 (31.7%) patients of severe malaria had PCT value within 2-10 ng/ml (moderately raised) and 28 (68.3%) patients had ≥ 10.0 ng/ml (highly raised). High risk patients according to MSS were categorized as critical malaria. PCT could able to diagnose such cases with excellent sensitivity and specificity. Conclusion: S. PCT ≥ 10.0 could able to define critical malaria and can be conveniently used as a triage tool for management of severe falciparum malaria. Instead of MSS, PCT enhanced triage will save time and decrease the overall costs while achieving similar result.
Highlights
Still in the second decade of 21st century, malaria remains as a common parasitic disease of the globe with high mortality and morbidity affecting about 216 million and causing death in 655 thousand people [1]
Out of 4 species of Plasmodia that cause human malaria, P. falciparum is notorious for its high case-fatality rate and almost all deaths are attributed to this species [2]
We observed that the mortality due to severe malaria is directly related to number of organs involved and the severity of organ dysfunction [3]
Summary
Still in the second decade of 21st century, malaria remains as a common parasitic disease of the globe with high mortality and morbidity affecting about 216 million and causing death in 655 thousand people [1]. Though it is conventional to describe various complications of falciparum malaria in isolation, clinical reality, are that majority of patients present with combined complications with different grades of severity leading to multiple organ failure [3]. Once multi organ dysfunction develops antimalarials along with organ support is mandatory for treatment of such patients in intensive care setting [3,4]. As there is no tool to assess the severity objectively, we developed Malaria Severity Score (MSS), an objective model to define, assess the severity of organ dysfunction, and to estimate the probability of mortality risk in severe falciparum malaria [5]. Patients with high risk require intensive treatment; we coined “critical” malaria for such patients and other two groups as “non-critical” malaria. There is a need to find out a biomarker that can be detected and can be used as a tool to distinguish “critical” malaria from “non-critical” severe malaria at the entry for prompt management
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