Plasma concentration of parasite DNA as a measure of disease severity in falciparum malaria

Abstract

In malaria-endemic areas, Plasmodium falciparum parasitemia is common in apparently healthy children and severe malaria is commonly misdiagnosed in patients with incidental parasitemia. We assessed whether the plasma Plasmodium falciparum DNA concentration is a useful datum for distinguishing uncomplicated from severe malaria in African children and Asian adults. P. falciparum DNA concentrations were measured by real-time polymerase chain reaction (PCR) in 224 African children (111 with uncomplicated malaria and 113 with severe malaria) and 211 Asian adults (100 with uncomplicated malaria and 111 with severe malaria) presenting with acute falciparum malaria. The diagnostic accuracy of plasma P. falciparum DNA concentrations in identifying severe malaria was 0.834 for children and 0.788 for adults, similar to that of plasma P. falciparum HRP2 levels and substantially superior to that of parasite densities (P < .0001). The diagnostic accuracy of plasma P. falciparum DNA concentrations plus plasma P. falciparum HRP2 concentrations was significantly greater than that of plasma P. falciparum HRP2 concentrations alone (0.904 for children [P = .004] and 0.847 for adults [P = .003]). Quantitative real-time PCR measurement of parasite DNA in plasma is a useful method for diagnosing severe falciparum malaria on fresh or archived plasma samples.

Keywords: Plasmodium falciparum; diagnostic accuracy; malaria; plasma DNA; severe disease.

Figure 1.

Parasitemia (A), plasma Plasmodium falciparum HRP2 concentration (B), and plasma P. falciparum DNA concentration (C) among African children and Asian adults who had uncomplicated malaria, who survived severe malaria, and who died from severe malaria.

Figure 2.

Receiver operating characteristic curves for test discrimination of uncomplicated from severe malaria in African children (A) and Asian adults (B) with Plasmodium falciparum malaria.