From the Guidelines
Laboratory signs of malaria include decreased platelet count (thrombocytopenia), reduced red blood cell count (anemia), and elevated white blood cell count in some cases, as seen in a recent study 1 where a patient presented with mild anaemia, thrombocytopaenia, and increased bilirubin.
Key Laboratory Findings
- Decreased platelet count (thrombocytopenia) with a count as low as 27.000/mL in severe cases 1
- Reduced red blood cell count (anemia) with hemoglobin levels as low as 10.9 g/dL 1
- Elevated white blood cell count in some cases, such as mild leukocytosis (11.000/mL) 1
- Elevated liver enzymes (ALT, AST) and bilirubin levels, indicating liver involvement, with total bilirubin levels as high as 14.4 mg/dL 1
- Decreased hemoglobin levels and hematocrit
Diagnostic Tests
- Microscopic examination of blood smears, which can identify Plasmodium parasites within red blood cells, is the gold standard method for diagnosis 1
- Rapid diagnostic tests (RDTs) detect specific malaria antigens in the blood and can be performed in as little as 15-30 minutes 1
- PCR testing provides the highest sensitivity for detecting low-level parasitemia and can be performed in as little as 1-2 hours 1
Importance of Early Detection
Early detection through these laboratory findings is crucial for prompt treatment and preventing complications, as seen in a recent study where a patient with severe malaria was treated with intravenous artesunate after being diagnosed with a high parasitaemia value (17%) 1.
Laboratory Abnormalities
Malaria causes these laboratory abnormalities because the parasite invades and destroys red blood cells, triggers immune responses that affect platelets, and releases toxins that impact liver function, highlighting the importance of prompt diagnosis and treatment to prevent morbidity and mortality.
From the Research
Laboratory Signs of Malaria
- Laboratory abnormalities such as kidney impairment, acidosis, anemia, or high parasitemia can occur in severe malaria 2
- Severe malaria is defined as vital organ involvement including shock, pulmonary edema, significant bleeding, seizures, impaired consciousness, and laboratory abnormalities 2
- In 2017 in the US, severe malaria occurred in approximately 14% of patients, and an estimated 0.3% of those receiving a diagnosis of malaria in the US died 2
Diagnosis and Treatment
- Malaria is diagnosed in approximately 2000 people in the US each year who have returned from visiting regions with endemic malaria 2
- The first-line therapy for P falciparum malaria in the US is combination therapy that includes artemisinin 2
- Artemether-lumefantrine plus amodiaquine is an alternative to artemether-lumefantrine alone as first-line treatment for multidrug-resistant P falciparum malaria 3
- A novel co-formulated triple combination antimalarial therapy, artemether-lumefantrine-amodiaquine, has been developed and evaluated through population pharmacokinetic modeling and simulation 4
Efficacy and Safety
- The efficacy of artemether-lumefantrine plus amodiaquine was similar to that of artemether-lumefantrine alone, with 42-day PCR-corrected treatment efficacy noted in 97% of patients with artemether-lumefantrine plus amodiaquine versus 95% of patients with artemether-lumefantrine alone 3
- Artemether-lumefantrine plus amodiaquine was generally well tolerated, but the number of mild adverse events, mainly gastrointestinal, was greater in this group compared with artemether-lumefantrine alone 3
- Repeated administration of artemisinin-based combination therapies, including artemether-lumefantrine, artesunate plus amodiaquine, and artesunate plus sulfadoxine-pyrimethamine, was found to be safe and efficacious in a malaria hyperendemic area of Mali 5