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. 2020 May 27;5(5):e002396. doi: 10.1136/bmjgh-2020-002396

Table 2.

Studies assessing correlation between CRP levels and malaria

Study Country Age group Disease characteristics Number of patients CRP test Correlation with malaria infection
Studies in Africa
Mahende et al10 Tanzania 2–59 months Fever 691 Cobas Indianapolis, Indiana, USA

  • 45 of 56 (80.4%) patients with malaria had elevated CRP levels of >40 mg/L, although they also had low WBC and ANC counts.
Pelkonen et al16 Angola ≤16 years Suspected malaria 346 QuikRead 101
(Orion Diagnostica, Finland)

  • Median CRP was significantly higher in those with malaria vs those without (140 mg/L (IQR 88) vs 69 mg/L (IQR 129), p<0.01).
Sarfo et al18 Ghana ≤15 years Fever 541 CRP Test Kit CRP-K10 (Diagnostik Nord, Germany)

  • 52.2% of those with CRP 10–30 mg/L, and 53.0% of those with CRP >30 mg/L were positive for malaria parasitaemia (ORs 14.2 (95% CI 4.2 to 48.1) and 14.7 (95% CI 4.4 to 48.3) vs those with CRP <10 mg/L).

  • Increased CRP levels were strongly associated with clinical malaria, defined as parasitaemia >5000 parasites/µL (OR 16.5 (95% CI 2.2 to 121), p<0.001).

  • In a multivariate analysis, patients whose CRP level increased by >10 mg/L had more than an eightfold likelihood for positive parasitaemia (adjusted OR 8.7 (95% CI 2.5 to 30.5), p<0.001).
Studies in South-East Asia
Lubell et al9 Cambodia, Laos, Myanmar 5–49 years Acute undifferentiated fever 1372 NycoCard Reader (Abott, USA)

  • CRP levels were significantly higher in malaria infections compared with viral infections (p<0.001).

  • There was no significant difference in CRP levels between bacterial infections and malaria (p=0.15); the AUROC for discriminating between malaria and bacterial infections was 0.54 (95% CI 0.49 to 0.6).
Peto et al17 Cambodia >6 months General population Parasitaemia: n=328
Controls: n=328		 Solid phase sandwich ELISA

  • Plasma CRP concentrations were higher in those with malaria compared with matched controls (p=0.025).

  • 7.6% of malaria-positive cases had CRP of >10 mg/L vs 2.1% of matched controls (p<0.001); 17.3% of malaria-positive cases had CRP of >3 mg/L vs 10.4% of matched controls.

  • There was a significant association between parasite count and CRP, which remained significant after controlling for fever (p<0.001).

ANC, absolute neutrophil count; AUROC, area under the receiver operator characteristic curve; CRP, C reactive protein; WBC, white blood cell count.