Determination of PCT on admission is a useful tool for the assessment of disease severity in travelers with imported Plasmodium falciparum malaria

Elda Righi; Maria Merelli; Alessandra Arzese; Paola Della Siega; Claudio Scarparo; Matteo Bassetti

doi:10.1515/ap-2016-0055

Article

Determination of PCT on admission is a useful tool for the assessment of disease severity in travelers with imported Plasmodium falciparum malaria

Elda Righi , Maria Merelli , Alessandra Arzese , Paola Della Siega , Claudio Scarparo and Matteo Bassetti

Published/Copyright: March 30, 2016

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From the journal Acta Parasitologica Volume 61 Issue 2

Abstract

Procalcitonin (PCT) and C-reactive protein (CRP) may be useful to predict complicated forms of malaria. A total of 30 consecutive travelers diagnosed with Plasmodium falciparum malaria over a two-year period were included in the study. Patients with complicated Plasmodium falciparum malaria showed higher levels of parasitemia (P = 0.0001), PCT (P = 0.0018), CRP (P = 0.0005), bilirubinemia (P = 0.004), and a lower platelet count (P<0.0001) compared with patients with uncomplicated forms. PCT levels above 5 ng/mL showed the highest value of specificity (0.86) and positive predictive factor (0.67) among other parameters, and equal sensitivity (0.67) was displayed by CRP levels above 150 mg/dl. None of the patients with complicated malaria showed PCT levels within normal limits (<0.5 ng/ml). Both PCT and CRP correlated with parasitemia (P<0.001) and showed areas under ROC curve of 0.83. At multivariate analysis, only PCT was associated with an increased risk of complicated malaria (OR 8.2, IC 95% 1.2–57.2, P = 0.03). The determination of PCT on admission showed better results compared to CRP, platelet count, and bilirubinemia and can be useful in non-endemic areas for the initial clinical assessment of disease severity in travelers with Plasmodium falciparum malaria.

Key words: Complicated P. falciparum malaria; procalcitonin; C-reactive protein; parasitemia; bilirubinemia; platelet count

Elda Righi and Maria Merelli contributed equally to this work and should be consider as first co-authors

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Received: 2015-7-17

Revised: 2015-12-28

Accepted: 2016-1-20

Published Online: 2016-3-30

Published in Print: 2016-6-1

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Articles in the same Issue

https://doi.org/10.1515/ap-2016-0055

Keywords for this article

Complicated P. falciparum malaria; procalcitonin; C-reactive protein; parasitemia; bilirubinemia; platelet count