title: Intraleucocytic malaria pigment and prognosis in severe malaria.
abstract: The quantity of malaria pigment liberated into the circulation at schizogony reflects the pathogenic sequestered parasite burden in Plasmodium falciparum malaria, and may therefore be a measure of disease severity. Among 300 consecutive adult patients with severe falciparum malaria, the 40 who died had significantly higher proportions of malaria pigment-containing neutrophils on admission (mean = 7.7%, standard deviation (SD) = 5.9%) and pigment-containing monocytes (mean = 8.6%, SD = 5.9%) than did survivors (mean 3.2%, SD = 4.1% and mean 4.8%, SD = 4.6%, respectively) (P < 0.0001). This proved a better indicator of prognosis than the peripheral parasite count. A count of peripheral neutrophils containing visible pigment > or = 5% predicted a fatal outcome with 73% sensitivity and 77% specificity (relative risk 6.2, 95% confidence interval (CI) 3.2-11.8) compared to 60% sensitivity and 57% specificity for parasitaemia > 100,000/microL (relative risk 1.8, 95% CI 1.0-3.3). The peripheral blood count of pigment-containing neutrophils in severe malaria is a rapid, simple, and practical prognostic test.
authors.affiliation: Wellcome Trust Clinical Research Unit, Centre for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Viet Nam.
authors.forename: P H
authors.initials: PH
authors.lastname: Nguyen
authors.forename: N
authors.initials: N
authors.lastname: Day
authors.forename: T D
authors.initials: TD
authors.lastname: Pram
authors.forename: D J
authors.initials: DJ
authors.lastname: Ferguson
authors.forename: N J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000273:Adipose Tissue / Q000648:ultrastructure; D006420:Hemeproteins / Q000032:analysis; D006801:Humans; D007958:Leukocyte Count; D016778:Malaria, Falciparum / Q000097:blood* / Q000401:mortality / Q000473:pathology; D008854:Microscopy, Electron; D009000:Monocytes / Q000737:chemistry; D009504:Neutrophils / Q000737:chemistry*; D015588:Observer Variation; D010860:Pigments, Biological / Q000097:blood*; D011379:Prognosis; D012680:Sensitivity and Specificity
chemical_list: D006420:Hemeproteins; D010860:Pigments, Biological; C020753:hemozoin