Serum procalcitonin levels in severe Plasmodium falciparum malaria

Levels of procalcitonin (ProCT) have been found to be elevated in individua ls with severe bacterial infections such as sepsis and peritonitis, and thi s correlates well with the severity of the disease. Recently, increased lev els have been described in melioidosis and Plasmodium falciparum malaria. I n this study ProCT levels were measured in 27 Thai patients with complicate d malaria before and during/after treatment with artesunate and mefloquine. Initial parasite counts averaged 290,680/mu l (range = 533-1,147,040). On admission, ProCT levels were elevated in all but one patient (median = 40 n g/ml, range = 0.04-662, normal values < 0.5 ng/ml). With treatment, levels decreased to 1.3 ng/ml (range = 0.01-6.5). Nitrite/nitrate levels in patien ts were higher than in controls throughout the study. The ProCT levels corr elated with initial parasite density (P < 0.05), which is a marker of disea se severity, and with nitrite/nitrate levels (P < 0.05). Based on the chang es of ProCT levels over the course of the disease a possible role in the ac ute-phase reaction seems likely.