Serum Procalcitonin: as a Triage Tool for Severe Plasmodium falciparum Malaria

In non-immune individuals, early diagnosis and treatment with appropriate antimalarials lead to recovery within few days. On the contrary, a late diagnosis and/or delayed therapy may lead to the development of various complications causing death. At present, complicated malaria is no more limited to anaemia, cerebral malaria or renal failure. Though it is conventional to describe various complications of falciparum malaria in isolation, clinical reality, however, are that majority of patients present with combined complications with different grades of severity leading to multiple organ failure [3]. We observed that the mortality due to severe malaria is directly related to number of organs involved and the severity of organ dysfunction [3]. Once multi organ dysfunction develops antimalarials along with organ support is mandatory for treatment of such patients in intensive care setting [3,4]. Therefore there is a necessity to identify such patients who are at high risk of mortality for intensified care and treatment. As there is no tool to assess the severity objectively, we developed Malaria Severity Score (MSS), an objective model to define, assess the severity of organ dysfunction, and to estimate the probability of mortality risk in severe falciparum malaria [5]. Accordingly, for the management we triaged the patients into low (Score ≤ 5), intermediate (Score 6-11), and high risk (Score ≥ 12) [5]. Patients with high risk require intensive treatment; hence we coined “critical” malaria for such patients and other two groups as “non-critical” malaria. But for assessment of organ dysfunction and to calculate the MSS, one needs various investigations and determination of different physiological parameters at the time of admission which is time taking and may not be feasible in low resource settings or even in tertiary care hospital near the bed side at the time of admission. Therefore there is a need to find out a biomarker that can be detected easily and can be used as a tool to distinguish “critical” malaria from “non-critical” severe malaria at the entry for prompt management.