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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Value of plasmodium falciparum histidine-rich protein 2 level and malaria retinopathy in distinguishing cerebral malaria from other acute encephalopathies in Kenyan children
Journal of Infectious Diseases, Volume 209, No. 4, Year 2014
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Description
Background. The diagnosis of cerebral malaria is problematic in malaria-endemic areas because encephalopathy in patients with parasitemia may have another cause. Abnormal retinal findings are thought to increase the specificity of the diagnosis, and the level of histidine-rich protein 2 (HRP2) may reflect the parasite biomass.Methods. We examined the retina and measured plasma HRP2 levels in children with acute nontraumatic encephalopathy in Kenya. Logistic regression, with HRP2 level as an independent variable and World Health Organization-defined cerebral malaria and/or retinopathy as the outcome, was used to calculate malaria-attributable fractions (MAFs) and retinopathy- attributable fractions (RAFs).Results. Of 270 children, 140 (52%) had peripheral parasitemia, 80 (30%) had malaria retinopathy, and 164 (61%) had an HRP2 level of >0 U/mL. During 2006-2011, the incidence of HRP2 positivity among admitted children declined by 49 cases per 100 000 per year (a 78% reduction). An HRP2 level of >0 U/mL had a MAF of 93% for cerebral malaria, with a MAF of 97% observed for HRP2 levels of ≥10 U/mL (the level of the best combined sensitivity and specificity). HRP2 levels of >0 U/mL had a RAF of 77% for features of retinopathy combined, with the highest RAFs for macular whitening (99%), peripheral whitening (98%), and hemorrhages (90%).Conclusion. HRP2 has a high attributable fraction for features of malarial retinopathy, supporting its use in the diagnosis of cerebral malaria. HRP2 thresholds improve the specificity of the definition. © 2013 The Author.
Authors & Co-Authors
Kariuki, Symon M.
Kenya, Kilifi
Kenya Research Institute
United Kingdom, Oxford
University of Oxford
Gitau, Evelyn N.
Kenya, Kilifi
Kenya Research Institute
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Gwer, Samson A.
Kenya, Kilifi
Kenya Research Institute
United States, Nairobi
Kenyatta University
Kenya, Nairobi
Afya Research Africa
Karanja, Henry K.
Kenya, Kilifi
Kenya Research Institute
Chengo, Eddie M.
Kenya, Kilifi
Kenya Research Institute
Kazungu, Michael
Kenya, Kilifi
Kenya Research Institute
Urban, Britta Christina
Kenya, Kilifi
Kenya Research Institute
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Newton, Charles R.J.C.
Kenya, Kilifi
Kenya Research Institute
United Kingdom, Oxford
University of Oxford
United Kingdom, London
Ucl Great Ormond Street Institute of Child Health
Statistics
Citations: 26
Authors: 8
Affiliations: 6
Identifiers
Doi:
10.1093/infdis/jit500
ISSN:
00221899
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Kenya