BACKGROUND: Plasmodium falciparum malaria is a common cause of morbidity in African children, but identifying those who are likely to die is problematic. Previous studies suggested that circulating malarial pigment might be a useful predictor of severity, but none were large enough to detect any association with mortality. METHODS: We used thick blood smears performed on admission for 26,296 children hospitalized with P. falciparum at 1 of 6 hospitals in the Severe Malaria in African Children network to assess the prognostic value of pigment-containing granulocytes, monocytes, and parasites. RESULTS: Although at all but one of the study sites the risk of mortality for subjects presenting with >5 pigmented granulocytes per 200 white blood cells was higher than in subjects with no pigmented granulocytes, adjusted odds ratios estimated through logistic regression, which included other established markers of severe malaria, suggested that associations between pigmented cells and mortality were moderate to nonexistent in most sites. The predictive ability of pigmented cells was low, as measured by the change in the area under the receiver operating characteristic curve of logistic regression models. CONCLUSIONS: Although high levels of pigmented cells were associated with a fatal outcome in some study sites, they were not useful predictors of outcome across Africa.
BACKGROUND: Plasmodium falciparum malaria is a common cause of morbidity in African children, but identifying those who are likely to die is problematic. Previous studies suggested that circulating malarial pigment might be a useful predictor of severity, but none were large enough to detect any association with mortality. METHODS: We used thick blood smears performed on admission for 26,296 children hospitalized with P. falciparum at 1 of 6 hospitals in the Severe Malaria in African Children network to assess the prognostic value of pigment-containing granulocytes, monocytes, and parasites. RESULTS: Although at all but one of the study sites the risk of mortality for subjects presenting with >5 pigmented granulocytes per 200 white blood cells was higher than in subjects with no pigmented granulocytes, adjusted odds ratios estimated through logistic regression, which included other established markers of severe malaria, suggested that associations between pigmented cells and mortality were moderate to nonexistent in most sites. The predictive ability of pigmented cells was low, as measured by the change in the area under the receiver operating characteristic curve of logistic regression models. CONCLUSIONS: Although high levels of pigmented cells were associated with a fatal outcome in some study sites, they were not useful predictors of outcome across Africa.
Authors: Climent Casals-Pascual; Oscar Kai; Joyce O P Cheung; Senani Williams; Brett Lowe; Mike Nyanoti; Thomas N Williams; Kathryn Maitland; Malcolm Molyneux; Charles R J C Newton; Norbert Peshu; Suzanne M Watt; David J Roberts Journal: Blood Date: 2006-06-27 Impact factor: 22.113
Authors: C H O Olola; M A Missinou; S Issifou; E Anane-Sarpong; I Abubakar; J N Gandi; M Chagomerana; M Pinder; T Agbenyega; P G Kremsner; C R J C Newton; D Wypij; T E Taylor Journal: Methods Inf Med Date: 2006 Impact factor: 2.176
Authors: A J Luty; D J Perkins; B Lell; R Schmidt-Ott; L G Lehman; D Luckner; B Greve; P Matousek; K Herbich; D Schmid; J B Weinberg; P G Kremsner Journal: Infect Immun Date: 2000-07 Impact factor: 3.441
Authors: Christopher C Keller; Gregory C Davenport; Katherine R Dickman; James B Hittner; Sandra S Kaplan; J Brice Weinberg; Peter G Kremsner; Douglas J Perkins Journal: J Infect Dis Date: 2006-04-07 Impact factor: 5.226
Authors: Martin P Grobusch; Thomas Hänscheid; Benedikt Krämer; Jörg Neukammer; Jürgen May; Joachim Seybold; Jürgen F J Kun; Norbert Suttorp Journal: Cytometry B Clin Cytom Date: 2003-09 Impact factor: 3.058
Authors: Terrie Taylor; Christopher Olola; Clarissa Valim; Tsiri Agbenyega; Peter Kremsner; Sanjeev Krishna; Dominic Kwiatkowski; Charles Newton; Michel Missinou; Margaret Pinder; David Wypij Journal: Trans R Soc Trop Med Hyg Date: 2006-03-23 Impact factor: 2.184
Authors: Rolf Fendel; Christian Brandts; Annika Rudat; Andrea Kreidenweiss; Claudia Steur; Iris Appelmann; Bettina Ruehe; Paul Schröder; Wolfgang E Berdel; Peter G Kremsner; Benjamin Mordmüller Journal: PLoS One Date: 2010-04-06 Impact factor: 3.240
Authors: Alberto Moreno; Monica Cabrera-Mora; Anapatricia Garcia; Jack Orkin; Elizabeth Strobert; John W Barnwell; Mary R Galinski Journal: Infect Immun Date: 2013-03-18 Impact factor: 3.441
Authors: Thomas Hänscheid; Rosangela Frita; Matthias Längin; Peter G Kremsner; Martin P Grobusch Journal: Malar J Date: 2009-11-16 Impact factor: 2.979
Authors: Janet Cox-Singh; Jessie Hiu; Sebastian B Lucas; Paul C Divis; Mohammad Zulkarnaen; Patricia Chandran; Kum T Wong; Patricia Adem; Sherif R Zaki; Balbir Singh; Sanjeev Krishna Journal: Malar J Date: 2010-01-11 Impact factor: 2.979
Authors: Eric Kendjo; Tsiri Agbenyega; Kalifa Bojang; Charles R J C Newton; Marielle Bouyou-Akotet; Florian Pedross; Maryvonne Kombila; Raimund Helbok; Peter Gottfried Kremsner Journal: PLoS One Date: 2013-03-07 Impact factor: 3.240