Prognostic Value of Procalcitonin Recovery Level for Malaria Recrudescence

Abstract

Background: Malaria is the parasitic disease caused by Plasmodium infection, and is transmitted to humans through the bite of female anopheles. At present, malaria remains the most important cause of disease and death among children and adults. Approximately 214 million people are infected with malaria worldwide. Objectives: This study aimed to analyze the distribution level and compare procalcitonin and C-reactive protein (CRP) in malaria patients before and after treatment, with focus on discussing the prognostic value of procalcitonin recovery level for recrudescence within two weeks of antimalarial treatment. Methods: A retrospective analysis was adopted. We measured the procalcitonin and CRP inflammatory markers of 22 imported malaria patients, who were hospitalized in our hospital from January 2014 to February 2018. The trends of procalcitonin and CRP levels in three malaria patients before and after antimalarial treatment and during recrudescence were applied. Results: The procalcitonin level was significantly elevated before antimalarial treatment in 95% (21/22) of the patients, but sharply declined within two weeks after treatment. The procalcitonin levels of 59% (13/22) and 23% (5/22) of the patients were < 0.5 ng/mL and 0.5-0.8 ng/mL, respectively. The difference in the procalcitonin level before and after treatment was statistically significant (Z = 4.074, P < 0.05), and the difference in the CRP level before treatment (99.63 ± 51.63 mg/L) and after treatment (20.08 ± 13.45 mg/L) was statistically significant (t = 8.167, P < 0.05). Three patients suffered from recrudescence. The procalcitonin levels of two patients were > 1.0 ng/mL and failed to recover to the normal level within two weeks after antimalarial treatment while the procalcitonin level of one patient was 0.89 ng/mL. The dynamic observation showed that the procalcitonin level progressively increased and the procalcitonin level was 0.89 ng/mL when Plasmodium was found in the blood smear. Conclusions: The procalcitonin and CRP serum levels were significantly elevated among malaria patients. The majority of the patients recovered to the normal level within two weeks after effective antimalarial treatment and no longer suffered from recrudescence. However, the procalcitonin recovery level within two weeks after antimalarial treatment remained > 0.8 ng/mL. Hence, heightened alertness should be given to recrudescence.

Procalcitonin as a Candidate Biomarker for Malarial Infection and Severe Malaria: A Meta-Analysis

“…Then 40 potentially relevant studies were examined for full-texts, and 27 full-text articles were excluded for the following reasons: 8 were PCT levels in non-malaria, 6 were reviews, 6 were case reports, 3 had incomplete data/unable to extract, 2 had unavailable full-texts, 1 studied PCT in malaria and bacteremia co-infection, and 1 study used the same group of participants. Thirteen studies [ 16 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ] met the eligibility criteria and were included. Another search in Google Scholar found two studies [ 40 , 41 ], that met the eligibility criteria and were also included.…”

“…Another search in Google Scholar found two studies [ 40 , 41 ], that met the eligibility criteria and were also included. Finally, 15 studies [ 16 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] were included in the systematic review for qualitative and quantitative syntheses ( Figure 1 ).…”

“…Studies conducted in Africa included studies from Ghana [ 28 ], Uganda [ 37 ], Senegal [ 40 ]; and those from Asia included studies from India [ 41 ], China [ 31 ], Thailand [ 36 ], Cambodia/Laos/Thailand [ 38 ], and Indonesia [ 32 ]. Studies with multiple countries included Congo, Angola, Pakistan, and African countries [ 34 ], and studies focusing on imported malaria in Europe included France [ 30 , 35 ], Netherlands [ 16 , 39 ], Italy [ 29 ], and Germany [ 33 ]. Study designs were case-control studies (3/15, 20%) [ 28 , 36 , 37 ], cohort studies (3/15, 20%) [ 16 , 30 , 32 ], prospective observational studies (6/15, 40%) [ 29 , 33 , 35 , 39 , 40 , 41 ], and retrospective studies (3/15, 20%) [ 31 , 34 , 38 ].…”

“…Studies with multiple countries included Congo, Angola, Pakistan, and African countries [ 34 ], and studies focusing on imported malaria in Europe included France [ 30 , 35 ], Netherlands [ 16 , 39 ], Italy [ 29 ], and Germany [ 33 ]. Study designs were case-control studies (3/15, 20%) [ 28 , 36 , 37 ], cohort studies (3/15, 20%) [ 16 , 30 , 32 ], prospective observational studies (6/15, 40%) [ 29 , 33 , 35 , 39 , 40 , 41 ], and retrospective studies (3/15, 20%) [ 31 , 34 , 38 ]. Ten studies (10/15, 66.7%) [ 16 , 28 , 29 , 30 , 33 , 34 , 35 , 37 , 39 , 41 ] evaluated PCT levels in patients with severe malaria and uncomplicated malaria.…”

“…Study designs were case-control studies (3/15, 20%) [ 28 , 36 , 37 ], cohort studies (3/15, 20%) [ 16 , 30 , 32 ], prospective observational studies (6/15, 40%) [ 29 , 33 , 35 , 39 , 40 , 41 ], and retrospective studies (3/15, 20%) [ 31 , 34 , 38 ]. Ten studies (10/15, 66.7%) [ 16 , 28 , 29 , 30 , 33 , 34 , 35 , 37 , 39 , 41 ] evaluated PCT levels in patients with severe malaria and uncomplicated malaria. Three studies [ 31 , 36 , 40 ] and two studies [ 32 , 38 ] evaluated PCT levels in patients with severe malaria only, and uncomplicated malaria only, respectively.…”