Host biomarkers for early identification of severe imported Plasmodium falciparum malaria

• Published in: Travel Medicine and Infectious Disease
• Main Authors: L. Balerdi-Sarasola, C. Parolo, P. Fleitas, A. Cruz, C. Subirà, N. Rodríguez-Valero, A. Almuedo-Riera, L. Letona, M.J. Álvarez-Martínez, M Eugenia Valls, I. Vera, A. Mayor, J. Muñoz, D. Camprubí-Ferrer
• Format: Article in Journal/Newspaper
• Language: English
• Published: Elsevier 2023
• Subjects: Imported malaria; Severe malaria; Biomarkers; Diagnosis; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1016/j.tmaid.2023.102608; https://doaj.org/article/053c7c5b1f8a433299caac59196ac4e2

Background: Severe imported P. falciparum malaria is a source of morbi-mortality in non-endemic regions. WHO criteria don't accurately classify patients at risk of complications. There is a need to evaluate new tools such as biomarkers to better identify patients with severe imported malaria. Methods: A case-control study was conducted in Barcelona, from January 2011–January 2021. Adult patients with microbiologically confirmed P. falciparum malaria were classified according to WHO criteria. Patients with imported non-malarial fevers were included as controls. In each group, angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), soluble triggering receptor expressed on myeloid cells (sTREM-1), C-reactive protein (CRP) and platelets were measured and their concentrations were compared between groups. New groups were made with a modified WHO severity classification and biomarkers’ performance was evaluated using multiple imputation models. Results: 131 participants were included: 52 severe malaria, 30 uncomplicated malaria and 49 non-malarial fever cases. All biomarkers except sTREM-1 showed significant differences between groups. Using the modified WHO severity classification, Ang-2 and CRP presented the best AUROC; 0.79 (95%CI 0.64–0.94) and 0.80(95%CI 0.67–0.93). A model combining CRP and Ang-2 showed the best AUROC, of 0.84(95%CI 0.68–0.99), with the highest sensitivity and specificity: 84.6%(95%CI 58.9–98.1) and 77.4% (95%CI 65.9–87.7), respectively. Conclusions: The combination of Ang-2 and CRP may be a reliable tool for the early identification of severe imported malaria. The use of a rapid prognostic test including the mentioned biomarkers could optimize imported malaria management, with the potential to decrease the rate of complications and hospitalizations in patients with imported malaria.