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J Infect Dis ; 206(3): 309-18, 2012 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-22634877

RESUMO

BACKGROUND: Brain histology and ophthalmoscopy suggest that approximately 25% of children with World Health Organization-defined cerebral malaria (CM) have a nonmalarial cause of death. Misclassification complicates clinical care, confounds studies of association, and may obfuscate successes in malaria control. Retinopathy predicts intracerebral parasite sequestration with >90% sensitivity and specificity, but detecting retinopathy requires well-trained personnel and expensive equipment. METHODS: We investigated the utility of plasma concentrations of parasite histidine-rich protein 2 (pHRP2), a Plasmodium-specific protein, as a predictor of intracerebral parasite sequestration at autopsy and of malaria retinopathy on clinical examination in patients with clinically defined CM. RESULTS: In 64 autopsy cases, 47 of whom had histological evidence of sequestration, the sensitivity and specificity of a plasma pHRP2 level of >1700 ng/mL were 98% and 94%, respectively, and the area under the receiver operating characteristic (AUROC) curve was 0.98. In a separate, prospectively studied group of 101 children with clinically defined CM, of whom 71 had retinopathy, the same pHRP2 cutoff predicted retinopathy-positivity with a sensitivity of 90% and specificity of 87% (AUROC, 0.90). CONCLUSIONS: Elevated plasma pHRP2 concentrations can identify Malawian children with histologically confirmed or retinopathy-positive CM and is a more field-friendly approach to confirming the diagnosis than post mortem sampling or ophthalmoscopy.


Assuntos
Antígenos de Protozoários/sangue , Malária Cerebral/sangue , Malária Cerebral/complicações , Proteínas de Protozoários/sangue , Doenças Retinianas/complicações , Autopsia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Malária Cerebral/diagnóstico , Malária Cerebral/epidemiologia , Malaui/epidemiologia , Masculino , Doenças Retinianas/sangue , Doenças Retinianas/diagnóstico , Doenças Retinianas/epidemiologia , Sensibilidade e Especificidade
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