Table 2

Studies assessing correlation between CRP levels and malaria

StudyCountryAge groupDisease characteristicsNumber of patientsCRP testCorrelation with malaria infection
Studies in Africa
Mahende et al10Tanzania2–59 monthsFever691Cobas 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 al16Angola≤16 yearsSuspected malaria346QuikRead 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 al18Ghana≤15 yearsFever541CRP 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 al9Cambodia, Laos, Myanmar5–49 yearsAcute undifferentiated fever1372NycoCard 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 al17Cambodia>6 monthsGeneral populationParasitaemia: 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.