Table 3 Probabilistic evaluation of patients admitted to large research centres with an initial diagnosis of severe falciparum malaria [108, 109]
From: Severe malaria
Measure | Values in African children with probable misdiagnosed severe falciparum malaria compared with true severe malaria | Comment |
|---|---|---|
Parasite counts | Lower | Thin films should be examined. Thick film counts are harder to evaluate and less reliable |
Haemoglobin | Higher | Â |
White blood cell counts | Higher | Neutrophilia and lymphopenia suggest bacterial infection, although moderate neutrophilia may also occur in very severe malaria |
Platelet counts | Higher | Thrombocytopenia is usual in malaria. Platelet counts over 200,000/µL are unusual in severe malaria |
Plasma PfHRP2 levels | Lower | Usually unavailable as a laboratory measure, but simple adaptation of current RDTs may substitute |
Malaria pigment containing neutrophils | Less | Very easy to assess in the tail of a thin film. > 5% indicates worse prognosis. Usually negative in sepsis (unless concomitant hyperparasitaemia) |
Positive blood cultures | More | Bacteraemia may occur in ‘true’ severe malaria, but misdiagnosis is more likely |
Mortality | Higher | The treated mortality of septicaemia is higher than that of severe malaria |