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Improving the diagnosis of severe malaria in African children using platelet counts and plasma Pf HRP2 concentrations

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Title: Improving the diagnosis of severe malaria in African children using platelet counts and plasma Pf HRP2 concentrations
Authors: Watson, J
Uyoga, S
Wanjiku, P
Makale, J
Nyutu, G
Mturi, N
George, E
Woodrow, C
Day, N
Bejon, P
Opoka, R
Dondorp, A
John, C
Maitland, K
Williams, T
White, N
Item Type: Journal Article
Abstract: Severe falciparum malaria is difficult to diagnose accurately in children in high transmission settings. Using data from 2,649 patients enrolled in four studies of severe illness in three countries (Bangladesh, Kenya, and Uganda), we fitted Bayesian latent class models using two diagnostic biomarkers: the platelet count and the plasma PfHRP2 concentration. In severely ill patients with clinical features consistent with severe malaria, a combined platelet count ≤ 150,000 per µL and a plasma PfHRP2 concentration ≥ 1,000 ng/mL had an estimated sensitivity of 74% and specificity of 93% in identifying ‘true’ severe falciparum malaria. Compared to misdiagnosed children, patients with true severe malaria had higher parasite densities, lower hematocrits, lower rates of invasive bacterial disease, and a lower prevalence of both HbAS and HbSS. We estimate one third of African children enrolled in clinical studies of severe malaria in high transmission settings had another cause of severe illness.
Issue Date: 20-Jul-2022
Date of Acceptance: 9-Mar-2022
URI: http://hdl.handle.net/10044/1/97194
DOI: 10.1126/scitranslmed.abn5040
ISSN: 1946-6234
Publisher: American Association for the Advancement of Science
Start Page: 1
End Page: 10
Journal / Book Title: Science Translational Medicine
Volume: 14
Issue: 654
Copyright Statement: © 2022 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works
Sponsor/Funder: Wellcome Trust
Wellcome Trust
Wellcome Trust
Wellcome Trust
Medical Research Council (MRC)
Wellcome Trust
Funder's Grant Number: 091758/B/10/Z
203077/Z/16/Z (C161)
202800/Z/16/Z
203077/C/16/Z
G0601027
209265/Z/17/Z
Keywords: Adult
Antigens, Protozoan
Bayes Theorem
Child
Humans
Malaria
Malaria, Falciparum
Plasmodium falciparum
Platelet Count
Protozoan Proteins
Uganda
Humans
Plasmodium falciparum
Malaria
Malaria, Falciparum
Protozoan Proteins
Antigens, Protozoan
Platelet Count
Bayes Theorem
Adult
Child
Uganda
06 Biological Sciences
11 Medical and Health Sciences
Publication Status: Published
Online Publication Date: 2022-07-20
Appears in Collections:Department of Surgery and Cancer
Department of Infectious Diseases
Faculty of Medicine