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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Defining falciparum-malaria-attributable severe febrile illness in moderate-to-high transmission settings on the basis of plasma PfHRP2 concentration
Journal of Infectious Diseases, Volume 207, No. 2, Year 2013
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Description
Background. In malaria-endemic settings, asymptomatic parasitemia complicates the diagnosis of malaria. Histidine-rich protein 2 (HRP2) is produced by Plasmodium falciparum, and its plasma concentration reflects the total body parasite burden. We aimed to define the malaria-attributable fraction of severe febrile illness, using the distributions of plasma P. falciparum HRP2 (PfHRP2) concentrations from parasitemic children with different clinical presentations.Methods. Plasma samples were collected from and peripheral blood slides prepared for 1435 children aged 6-60 months in communities and a nearby hospital in northeastern Tanzania. The study population included children with severe or uncomplicated malaria, asymptomatic carriers, and healthy control subjects who had negative results of rapid diagnostic tests. The distributions of plasma PfHRP2 concentrations among the different groups were used to model severe malaria-attributable disease.Results. The plasma PfHRP2 concentration showed a close correlation with the severity of infection. PfHRP2 concentrations of >1000 ng/mL denoted a malaria-attributable fraction of severe disease of 99% (95% credible interval [CI], 96%-100%), with a sensitivity of 74% (95% CI, 72%-77%), whereas a concentration of <200 ng/mL denoted severe febrile illness of an alternative diagnosis in >10% (95% CI, 3%-27%) of patients. Bacteremia was more common among patients in the lowest and highest PfHRP2 concentration quintiles.Conclusions. The plasma PfHRP2 concentration defines malaria-attributable disease and distinguishes severe malaria from coincidental parasitemia in African children in a moderate-to-high transmission setting. © The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Hendriksen, Ilse C.E.
Unknown Affiliation
White, Lisa J.
Unknown Affiliation
Veenemans, Jacobien
Unknown Affiliation
Mtove, George A.
Unknown Affiliation
Woodrow, Charles Jonathan
Unknown Affiliation
Amos, Ben
Unknown Affiliation
Saiwaew, Somporn
Unknown Affiliation
Gesase, Samwel
Unknown Affiliation
Nadjm, Behzad
Unknown Affiliation
Silamut, Kamolrat
Unknown Affiliation
Joseph, Sarah
Unknown Affiliation
Chotivanich, Kesinee T.
Unknown Affiliation
Day, Nichloas P.J.
Unknown Affiliation
Von-Seidlein, Lorenz
Unknown Affiliation
Verhoef, Hans
Unknown Affiliation
Reyburn, Hugh G.
Unknown Affiliation
White, Nicholas J.
Unknown Affiliation
Dondorp, A. M.
Unknown Affiliation
Statistics
Citations: 81
Authors: 18
Affiliations: 11
Identifiers
Doi:
10.1093/infdis/jis675
ISSN:
00221899
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Locations
Tanzania