title: 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.
authors.affiliation: Department of Molecular Tropical Medicine and Genetics.
authors.forename: Mallika
authors.initials: M
authors.lastname: Imwong
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine, Churchill Hospital, University of Oxford.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Woodrow
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine, Churchill Hospital, University of Oxford.
authors.forename: Ilse C E
authors.initials: IC
authors.lastname: Hendriksen
authors.affiliation: Cell Biology and Immunology Group, Wageningen University Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands.
authors.forename: Jacobien
authors.initials: J
authors.lastname: Veenemans
authors.affiliation: MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, United Kingdom Cell Biology and Immunology Group, Wageningen University MRC Keneba, the Gambia.
authors.forename: Hans
authors.initials: H
authors.lastname: Verhoef
authors.affiliation: Dev Care Foundation, Dhaka, Bangladesh.
authors.forename: M Abul
authors.initials: MA
authors.lastname: Faiz
authors.affiliation: Department of Medicine, Ispat Hospital, Rourkela, India.
authors.forename: Sanjib
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: Department of Medicine, Ispat Hospital, Rourkela, India.
authors.forename: Saroj
authors.initials: S
authors.lastname: Mishra
authors.affiliation: Amani Centre, National Institute for Medical Research, Muheza.
authors.forename: George
authors.initials: G
authors.lastname: Mtove
authors.affiliation: Korogwe Research Laboratory, National Institute for Medical Research, Tanga, Tanzania.
authors.forename: Samwel
authors.initials: S
authors.lastname: Gesase
authors.affiliation: Hospital Central da Beira.
authors.forename: Amir
authors.initials: A
authors.lastname: Seni
authors.affiliation: Hospital Central da Beira Faculty of Health Sciences, Catholic University of Mozambique, Beira, Mozambique.
authors.forename: Kajal D
authors.initials: KD
authors.lastname: Chhaganlal
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine, Churchill Hospital, University of Oxford.
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine, Churchill Hospital, University of Oxford.
authors.forename: Arjen M
authors.initials: AM
authors.lastname: Dondorp
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine, Churchill Hospital, University of Oxford.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000328:Adult; D000818:Animals; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008137:Longitudinal Studies; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D018512:Parasitemia; D010963:Plasmodium falciparum / Q000235:genetics / Q000302:isolation & purification*; D012372:ROC Curve; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods; D012720:Severity of Illness Index; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D016054:DNA, Protozoan
keywords: Plasmodium falciparum; diagnostic accuracy; malaria; plasma DNA; severe disease