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Serum procalcitonin levels in severe Plasmodium falciparum malaria
U Hollenstein1, S Looareesuwan, A Aichelburg
1Department of Internal Medicine I, University of Vienna, Austria.
Abstract:
Levels of procalcitonin (ProCT) have been found to be elevated in individuals with severe bacterial infections such as sepsis and peritonitis, and this correlates well with the severity of the disease. Recently, increased levels have been described in melioidosis and Plasmodium falciparum malaria. In this study ProCT levels were measured in 27 Thai patients with complicated malaria before and during/after treatment with artesunate and mefloquine. Initial parasite counts averaged 290,680/microl (range = 533-1,147,040). On admission, ProCT levels were elevated in all but one patient (median = 40 ng/ml, range = 0.04-662, normal values < 0.5 ng/ml). With treatment, levels decreased to 1.3 ng/ml (range = 0.01-6.5). Nitrite/nitrate levels in patients were higher than in controls throughout the study. The ProCT levels correlated with initial parasite density (P < 0.05), which is a marker of disease severity, and with nitrite/nitrate levels (P < 0.05). Based on the changes of ProCT levels over the course of the disease a possible role in the acute-phase reaction seems likely.
Insights
Procalcitonin (ProCT) levels were elevated in Thai patients with complicated malaria, correlating with parasite density and disease severity. Treatment with artesunate and mefloquine significantly reduced ProCT levels, suggesting its role in the acute-phase reaction.
Area of Science:
- Infectious Diseases
- Clinical Chemistry
- Immunology
Background:
- Procalcitonin (ProCT) is a biomarker for severe bacterial infections.
- Elevated ProCT levels have been observed in melioidosis and Plasmodium falciparum malaria.
- The role of ProCT in malaria pathogenesis requires further investigation.
Purpose of the Study:
- To investigate Procalcitonin (ProCT) levels in Thai patients with complicated malaria.
- To assess the correlation between ProCT levels, parasite density, and disease severity.
- To evaluate the impact of antimalarial treatment on ProCT levels.
Main Methods:
- Measurement of Procalcitonin (ProCT) levels in 27 Thai malaria patients before and after treatment.
- Assessment of initial parasite counts and nitrite/nitrate levels.
- Correlation analysis between ProCT levels, parasite density, and nitrite/nitrate levels.
Main Results:
- Procalcitonin (ProCT) levels were elevated in nearly all malaria patients upon admission (median = 40 ng/ml).
- ProCT levels significantly decreased after treatment with artesunate and mefloquine (median = 1.3 ng/ml).
- Elevated ProCT levels correlated with initial parasite density and nitrite/nitrate levels.
Conclusions:
- Procalcitonin (ProCT) may serve as a valuable biomarker for complicated malaria severity in Thailand.
- ProCT levels decrease with effective antimalarial treatment.
- Procalcitonin likely plays a role in the acute-phase reaction during malaria infection.