title: Plasma Plasmodium falciparum histidine-rich protein-2 concentrations do not reflect severity of malaria in Papua new guinean children.
abstract: BACKGROUND
  In areas of unstable malaria transmission, plasma Plasmodium falciparum histidine-rich protein 2 (PfHRP-2) concentrations parallel total parasite biomass and thus infection severity. However, where transmission is more intense, plasma PfHRP-2 might not reliably predict complications and mortality.
  
  
  METHODS
  As part of a prospective case-control study of severe pediatric illness in Madang, Papua New Guinea, we recruited 220 children aged 6 months to 10 years with severe falciparum malaria, 48 with uncomplicated malaria, and 139 healthy controls. Groups were matched by age, sex, and province of parental birth. Plasma PfHRP-2 levels were quantified by validated immunoassay.
  
  
  RESULTS
  Detectable plasma PfHRP-2 concentrations were present in 21 healthy controls (15.1%). Although plasma PfHRP-2 levels were higher in the children with clinical malaria (P < .001), there was no difference between those with uncomplicated and severe infections (median, 584 and 456 ng/mL, respectively [interquartile range, 77-1114 and 113-1113 ng/mL, respectively]; P = .43). Log parasitemia, hemoglobin, log plasma bilirubin, and plasma creatinine levels were independently associated with plasma PfHRP-2 levels in multiple regression analysis (P ≤ .014), but coma, blood lactate level, and plasma bicarbonate level were not. The 1 severely ill child who died had a plasma PfHRP-2 concentration of 483 ng/mL, close to the group median.
  
  
  CONCLUSIONS
  The clinical and prognostic utility of plasma PfHRP-2 concentrations depends on the epidemiologic circumstances. In areas of intense malaria transmission, plasma PfHRP-2 reflects recent as well as present infections.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Western Australia.
authors.forename: Laurens
authors.initials: L
authors.lastname: Manning
authors.forename: Moses
authors.initials: M
authors.lastname: Laman
authors.forename: Danielle
authors.initials: D
authors.lastname: Stanisic
authors.forename: Anna
authors.initials: A
authors.lastname: Rosanas-Urgell
authors.forename: Cathy
authors.initials: C
authors.lastname: Bona
authors.forename: David
authors.initials: D
authors.lastname: Teine
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.forename: Ivo
authors.initials: I
authors.lastname: Mueller
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D000818:Animals; D000953:Antigens, Protozoan / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000401:mortality* / Q000469:parasitology / Q000473:pathology*; D008297:Male; D010219:Papua New Guinea; D010949:Plasma / Q000737:chemistry*; D011379:Prognosis; D011446:Prospective Studies; D015800:Protozoan Proteins / Q000097:blood*; D012720:Severity of Illness Index
chemical_list: D000953:Antigens, Protozoan; D015415:Biomarkers; C514457:HRP-2 antigen, Plasmodium falciparum; D015800:Protozoan Proteins