The prognostic and diagnostic value of intraleukocytic malaria pigment in patients with severe falciparum malaria

Ketsanee Srinamon, James A. Watson (), Kamolrat Silamut, Benjamas Intharabut, Nguyen Hoan Phu, Pham Thi Diep, Kirsten E. Lyke, Caterina Fanello, Lorenz Seidlein, Kesinee Chotivanich, Arjen M. Dondorp, Nicholas P. J. Day and Nicholas J. White ()
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Ketsanee Srinamon: Mahidol University
James A. Watson: Oxford University Clinical Research Unit, Hospital for Tropical Diseases
Kamolrat Silamut: Mahidol University
Benjamas Intharabut: Mahidol University
Nguyen Hoan Phu: Oxford University Clinical Research Unit, Hospital for Tropical Diseases
Pham Thi Diep: Oxford University Clinical Research Unit, Hospital for Tropical Diseases
Kirsten E. Lyke: University of Maryland School of Medicine
Caterina Fanello: Mahidol University
Lorenz Seidlein: Mahidol University
Kesinee Chotivanich: Mahidol University
Arjen M. Dondorp: Mahidol University
Nicholas P. J. Day: Mahidol University
Nicholas J. White: Mahidol University

Nature Communications, 2022, vol. 13, issue 1, 1-12

Abstract: Abstract Severe falciparum malaria is a major cause of death in tropical countries, particularly in African children. Rapid and accurate diagnosis and prognostic assessment are critical to clinical management. In 6027 prospectively studied patients diagnosed with severe malaria we assess the prognostic value of peripheral blood film counts of malaria pigment containing polymorphonuclear leukocytes (PMNs) and monocytes. We combine these results with previously published data and show, in an individual patient data meta-analysis (n = 32,035), that the proportion of pigment containing PMNs is predictive of in-hospital mortality. In African children the proportion of pigment containing PMNs helps distinguish severe malaria from other life-threatening febrile illnesses, and it adds to the prognostic assessment from simple bedside examination, and to the conventional malaria parasite count. Microscopy assessment of pigment containing PMNs is simple and rapid, and should be performed in all patients hospitalised with suspected severe malaria.

Date: 2022
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DOI: 10.1038/s41467-022-34678-8

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