Journal article
Value of Plasmodium falciparum histidine-rich protein 2 level and malaria retinopathy in distinguishing cerebral malaria from other acute encephalopathies in Kenyan children
- Abstract:
-
Background. The diagnosis of cerebral malaria is problematic in malaria-endemic areas because encephalopathy in patients with parasitemia may have another cause. Abnormal retinal findings are thought to increase the specificity of the diagnosis, and the level of histidine-rich protein 2 (HRP2) may reflect the parasite biomass.
Methods. We examined the retina and measured plasma HRP2 levels in children with acute nontraumatic encephalopathy in Kenya. Logistic regression, with HRP2 level as an independent variable and World Health Organization–defined cerebral malaria and/or retinopathy as the outcome, was used to calculate malaria-attributable fractions (MAFs) and retinopathy-attributable fractions (RAFs).
Results. Of 270 children, 140 (52%) had peripheral parasitemia, 80 (30%) had malaria retinopathy, and 164 (61%) had an HRP2 level of >0 U/mL. During 2006–2011, the incidence of HRP2 positivity among admitted children declined by 49 cases per 100 000 per year (a 78% reduction). An HRP2 level of >0 U/mL had a MAF of 93% for cerebral malaria, with a MAF of 97% observed for HRP2 levels of ≥10 U/mL (the level of the best combined sensitivity and specificity). HRP2 levels of >0 U/mL had a RAF of 77% for features of retinopathy combined, with the highest RAFs for macular whitening (99%), peripheral whitening (98%), and hemorrhages (90%).
Conclusion. HRP2 has a high attributable fraction for features of malarial retinopathy, supporting its use in the diagnosis of cerebral malaria. HRP2 thresholds improve the specificity of the definition.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
-
-
(Preview, Version of record, pdf, 451.7KB, Terms of use)
-
- Publisher copy:
- 10.1093/infdis/jit500
Authors
- Funder identifier:
- https://ror.org/029chgv08
- Grant:
- 083744
- 099782
- 079082
- Publisher:
- Oxford University Press
- Journal:
- Journal of Infectious Diseases More from this journal
- Volume:
- 209
- Issue:
- 4
- Pages:
- 600-609
- Publication date:
- 2013-09-16
- Acceptance date:
- 2013-08-28
- DOI:
- EISSN:
-
1537-6613
- ISSN:
-
0022-1899
- Language:
-
English
- Keywords:
- Pubs id:
-
pubs:429343
- UUID:
-
uuid:faafea03-02b2-488e-a915-8e11efad4eb6
- Local pid:
-
pubs:429343
- Source identifiers:
-
429343
- Deposit date:
-
2013-11-16
- ARK identifier:
Terms of use
- Copyright holder:
- Kariuki et al.
- Copyright date:
- 2013
- Rights statement:
- © The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
If you are the owner of this record, you can report an update to it here: Report update to this record