C - REACTIVE PROTEIN LEVELS AS A POTENTIAL DIAGNOSTIC MARKER DURING MALARIAL INFECTIONS

Punnath Kishore, Kiran K. Dayanand, Valleesha Chandrashekar, Benudhar Mukhi, Susanta K. Ghosh, Suchetha Kumari, D. Channe Gowda and Rajeshwara N. Achur*

ABSTRACT

C-reactive protein is a plasma protein known to play an important role in the immune response to malaria. In this study, we measured the C - reactive protein levels during uncomplicated and severe malaria patients seeking medical attention at the district Wenlock hospital in Mangaluru. The study population consisted of 627 malaria infected patients; among which 554 had uncomplicated malaria and 73 suffered from severe malaria. We measured various hematological and biochemical parameters including C-reactive protein as well as inflammatory cytokines to correlate the changes during P.falciparum, P.vivax mono and mixed (Pv and Pf) infections. The C-reactive protein levels were found to be significantly high in patients suffering from both uncomplicated and severe malarial infections. (P=<0.0001).Increased C-reactive protein levels showed a positive correlation with increase in percentage parasitemia and a negative correlation with hemoglobin, RBCs, and platelets. While bilirubin showed a positive correlation in patients with P.falciparum and P. vivax, blood urea levels had a positive relationship only in P.vivax infections. Inflammatory cytokines, TNF α and IL-6, showed a positive correlation across various infecting species. The results indicate that C-reactive protein levels showed excellent sensitivity, specificity and odds ratio during malarial infections. In this study, the results i) confirm markedly elevated C-reactive protein levels in patients with severe malaria as compared to uncomplicated malaria, ii) support the idea of its possible significant role in malarial anemia and thrombocytopenia iii) provide the basis for the use of this acute phase protein as a cost effective biomarker.

Keywords: Biomarker, C-reactive protein, Plasmodium vivax and P. falciparum, Mangaluru, Dakshina Kannada, severe malaria.