Plasmodium falciparum; Histidine-Rich Protein-2 Plasma Concentrations Are Higher in Retinopathy-Negative Cerebral Malaria Than in Severe Malarial Anemia.

22 Jul 2017
Park GS, Opoka RO, Shabani E, Wypyszynski A, Hanisch B, John CC

BACKGROUND

Malaria retinopathy has been proposed as marker of "true" cerebral malaria (CM), ie, coma due to vs coma due to other causes, with incidental parasitemia. Plasma histidine-rich protein-2 (PfHRP2) concentrations distinguish retinopathy-positive (RP) from retinopathy-negative (RN) CM but have not been compared between RN CM and other forms of severe malaria or asymptomatic parasitemia (AP).

METHODS

We compared plasma PfHRP2 concentrations in 260 children with CM (247 examined for retinopathy), 228 children with severe malarial anemia (SMA), and 30 community children with AP.

RESULTS

HRP2 concentrations were higher in children with RP CM than RN CM ( = .006), with an area under the receiver operating characteristic curve of 0.61 (95% confidence interval, 0.53-0.68). HRP2 concentrations and sequestered parasite biomass were higher in RN CM than SMA (both < .03) or AP (both < .001).

CONCLUSIONS

HRP2 concentrations are higher in children with RN CM than in children with SMA or AP, suggesting that is involved in disease pathogenesis in children with CM. HRP2 concentrations may provide a more feasible and consistent assessment of the contribution of to severe disease than malaria retinopathy.