@article{121c2a574ea244f6b671190093141e36,
title = "Improving the diagnosis of severe malaria in African children using platelet counts and plasma PfHRP2 concentrations",
abstract = "Severe malaria caused by Plasmodium falciparum is difficult to diagnose accurately in children in high-transmission settings. Using data from 2649 pediatric and adult patients enrolled in four studies of severe illness in three countries (Bangladesh, Kenya, and Uganda), we fitted Bayesian latent class models using two diagnostic markers: the platelet count and the plasma concentration of P. falciparum histidine-rich protein 2 (PfHRP2). In severely ill patients with clinical features consistent with severe malaria, the combination of a platelet count of ≤150,000/υl and a plasma PfHRP2 concentration of ≥1000 ng/ml had an estimated sensitivity of 74% and specificity of 93% in identifying severe falciparum malaria. Compared with misdiagnosed children, pediatric patients with true severe malaria had higher parasite densities, lower hematocrits, lower rates of invasive bacterial disease, and a lower prevalence of both sickle cell trait and sickle cell anemia. We estimate that one-third of the children enrolled into clinical studies of severe malaria in high-transmission settings in Africa had another cause of their severe illness.",
author = "Watson, {James A.} and Sophie Uyoga and Perpetual Wanjiku and Johnstone Makale and Nyutu, {Gideon M.} and Neema Mturi and George, {Elizabeth C.} and Woodrow, {Charles J.} and Day, {Nicholas P. J.} and Philip Bejon and Opoka, {Robert O.} and Dondorp, {Arjen M.} and John, {Chandy C.} and Kathryn Maitland and Williams, {Thomas N.} and White, {Nicholas J.}",
note = "Funding Information: This research was funded by Wellcome. A CC BY or equivalent license is applied to the author-accepted manuscript arising from this submission, in accordance with the grant{\textquoteright}s open access conditions. This work was done as part of SMAART (Severe Malaria Africa—A consortium for Research and Trials) funded by a Wellcome Collaborative Award in Science grant (209265/Z/17/Z) held in part by K.M., N.P.J.D., and A.M.D. J.A.W. is a Sir Henry Dale Fellow jointly funded by the Wellcome Trust and the Royal Society (223253/Z/21/Z). T.N.W. and N.J.W. are senior and principal research fellows, respectively, funded by the Wellcome Trust (202800/Z/16/Z and 093956/Z/10/C, respectively). S.U. is funded by a Wellcome Intermediate Fellowship (221998/Z/20/Z). E.C.G. acknowledges funding from a core grant to the Medical Research Council (MRC) CTU at UCL from the MRC (MC_UU_12023/26). C.C.J. and R.O.O. acknowledge grant R01 NS055349 from the National Institute for Neurological Disorders and Stroke. The FEAST trial was supported by a grant (G0801439) from the MRC, UK provided through the (MRC) DFID concordat. K.M. and E.C.G. were supported by this grant. This paper is published with permission from the Director of the Kenya Medical Research Institute (KEMRI). Publisher Copyright: {\textcopyright} 2022 The Authors, some rights reserved.",
year = "2022",
month = jul,
day = "20",
doi = "https://doi.org/10.1126/scitranslmed.abn5040",
language = "English",
volume = "14",
pages = "eabn5040",
journal = "Science Translational Medicine",
issn = "1946-6234",
publisher = "American Association for the Advancement of Science",
number = "654",
}