title: Procalcitonin as a biomarker for severe Plasmodium falciparum disease: a critical appraisal of a semi-quantitative point-of-care test in a cohort of travellers with imported malaria.
abstract: BACKGROUND
  Imported malaria occurs as a relatively rare event in developed countries. As a consequence, most clinicians have little experience in making clinical assessments of disease severity and decisions regarding the need for parenteral therapy or high-level monitoring. In this study, the diagnostic accuracy of procalcitonin (PCT) for severe Plasmodium falciparum disease was assessed in a cohort of 100 consecutive travellers with various species of imported malaria.
  
  
  RESULTS
  In all patients, PCT was measured on admission with a semi-quantitative 'point-of-care' test. Patients with severe P. falciparum malaria had significantly higher median PCT levels on admission as compared with patients with uncomplicated P. falciparum disease. In addition, PCT levels in patients with non-falciparum malaria were also higher compared with patients with non-severe falciparum malaria but lower compared with severe P. falciparum malaria. At a cut-off point of 10 ng/mL, PCT had a sensitivity of 0,67 and a specificity of 0,94 for severe falciparum disease. However, at lower cut-off points the specificity and positive predictive value were rather poor although the sensitivity and negative predictive value remained high.
  
  
  CONCLUSIONS
  Potential drawbacks in the interpretation of elevated PCT levels on admission may be caused by infections with non-falciparum species and by concomitant bacterial infections.
  
  
  CONCLUSIONS
  Semi-quantitative determination of PCT on admission is of limited use in the initial clinical assessment of disease severity in travellers with imported malaria, especially in settings with limited experience with the treatment of malaria.
authors.affiliation: Department of Internal Medicine, Harbour Hospital and Institute for Tropical Diseases, Haringvliet 2, 3011 TD Rotterdam, The Netherlands. d.a.hesselink@erasmusmc.nl
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Hesselink
authors.forename: Jan-Steven
authors.initials: JS
authors.lastname: Burgerhart
authors.forename: Hanna
authors.initials: H
authors.lastname: Bosmans-Timmerarends
authors.forename: Pieter
authors.initials: P
authors.lastname: Petit
authors.forename: Perry J J
authors.initials: PJ
authors.lastname: van Genderen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity; D014195:Travel; D014330:Tropical Medicine / Q000379:methods*; D055815:Young Adult
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide