Plasma concentration of parasite DNA as a measure of disease severity in falciparum malaria

In endemic areas malaria parasitemia is common in apparently healthy children and severe malaria is commonly misdiagnosed in patients with incidental parasitemia. We assessed the performance of plasma P. falciparum DNA concentration measurement in distinguishing uncomplicated from severe malaria in African children and Asian adults. P. falciparum DNA concentrations were measured by real-time PCR in 224 African children (111 uncomplicated, 113 severe) and 211 Asian adults (100 uncomplicated, 111 severe) presenting with acute falciparum malaria. The diagnostic accuracy of plasma PfDNA concentrations in identifying severe malaria was 0.834 in children and 0.788 in adults, similar to that of plasma PfHRP2, and substantially superior to parasite density (p