C-Reactive Protein as an Inflammatory Biomarker for the Assessment of Malaria Parasitemia in a Tertiary Health Care Facility in Rivers State, Nigeria

Abstract

Aim: To use C-Reactive Protein (CRP) in assessing` malaria and malaria parasitemia among out-patients in the University of Port Harcourt Teaching Hospital (UPTH). Study Design: Cross-sectional descriptive study. Place and Duration of Study: This study was carried out at the Out Patients Department (OPD) of the University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. It was conducted between November 2017 and April 2018. Methodology: This study was done on 400 subjects between the ages of 11 and 60 years which consisted of 254 falciparum malaria infected patients and 164 non-infected patients. Quantitative analysis of Serum CRP was done using the High Sensitivity C-Reactive Protein (HsCRP) enzyme immunoassay test kit (Biocheck©) while malaria diagnosis was done using microscopy Giemsa thick and thin film prepared on separate slides, slides were observed under the ×10 and ×100 objectives of the light microscope. Slides viewed under a high power field with parasite density less than three (<3), between 3 and 10 (3-10), from eleven to nineteen (11-19) and greater or equal to 20 (≥20) were classified as scanty, one plus (+), two pluses (++) and three pluses (+++) respectively. Data analysis was done using statistical packages for social science (SPSS) version 21. Results: The results showed a significant (p<0.001) overall mean high serum CRP concentration (25.63±14.40 mg/l) in the malaria infected patients compared to 3.74±1.02 mg/l in the non-infected group, with a direct increment of the CRP level from the scanty to the three pluses with 9.50±0.37 mg/l, 13.51±1.6 mg/l, 44.19±2.62 mg/l and 53.84±1.75 mg/l recorded for scanty, one plus, two pluses and three pluses respectively. CRP correlated positively and significantly with malaria parasitemia (r = 0.89; p < 0.001). Conclusion: The abnormally elevated level of CRP in the infected patients showed that CRP is a positive biomarker for Plasmodium falciparum malaria and can be used as an indicator of the disease coupled with other febrile symptoms.