IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 8, Issue 2 (Jul.- Aug. 2013), PP 23-26 www.iosrjournals.org www.iosrjournals.org 23 | Page Evaluation of C-reactive protein as a biochemical marker for assessing disease severity in Malaria Vandana Agrawal 1 , Vaishali Jain 2 , Shubho Biswas 2 1 (Department of Pathology, L.N. Medical College and Research Centre,Bhopal,India) 2 (Department of Biochemistry, L.N. Medical College and Research Centre,Bhopal,India) Abstract: Levels of C-reactive protein , a well characterised serum acute phase protein were measured in a total of 32 patients admitted to JK hospital with the diagnosis of Malaria (18 vivax malaria and 14 falciparum malaria) . Serum C-reactive protein concentrations were measured daily in all the patients over a seven day period .Percentage parasitemia , platelet count , serum bilirubin , alanine aminotransferase and aspartate aminotransferase levels were measured initially on the day of admission . Though Serum C-reactive protein concentration was significantly elevated in all the malaria patients , it was significantly higher (P<0.01) in Plasmodium falciparum(29.4± 10.9 mg/L ) as compared to P. Vivax malaria(14.5± 3.7mg/L ) . The highest concentration was observed on day 2 ( Plasmodium falciparum :65.3± 16.8 mg/L ; Plasmodium vivax: 27.1± 13.0 mg/L )and fell significantly between day 1 and day 7 in parallel with clinical recovery. A significant positive correlation was found between serum CRP and conventional laboratory markers of severity of malaria like percentage parasitemia , serum bilirubin, serum concentrations of alanine aminotransferase and aspartate aminotransferase in Plasmodium falciparum patients but not in Plasmodium Vivax.These results suggest that C-reactive protein can be used as a biomarker for assessing disease severity particularly in Plasmodium falciparum malaria. Key words : Biochemical marker , C-reactive protein , malaria I. Introduction Malaria is a major public health problem in South East Asia [1] . Caused by Plasmodium parasite and transmitted through the bite of an infected female Anopheles mosquito , malaria still remains to be a major health burden particularly to the developing nations[2]. Several methods have been used to assess objectively the severity of Malaria . Clinical assessment of severity depends on bed side observation of variables such as blood pressure , fever and mental alertness. Laboratory markers include % parasitemia , platelet count , serum sodium , serum albumin , serum bilirubin and urea concentrations [3] . But these tests are not always sensitive in estimating disease severity. Recently some acute phase reactants have emerged as biomarkers in malaria infection in addition to chemokines and cytokines . In particular C-reactive protein(CRP) and nitric oxide (NO) have been identified as important inflammatory biomarkers [4,5]. CRP is an acute phase protein that is involved in the activation of complement , acceleration of phagocytosis and detoxification of substances released from the damaged tissue . Measurement of serum CRP is most frequently used for the evaluation of injury in the body tissue or for the detection of inflammatory event somewhere in the body . In malaria CRP secretion is induced by pro – inflammatory cytokines that are secreted by host mononuclear cells and strong correlations have been found between CRP levels and parasitemia [6]. In fact CRP levels have proven to be valuable in assessing the severity of malaria and as a prognostic tool in the follow up response to treatment [3]. As malaria is highly endemic in certain parts of India and since studies involving sequential measurement of CRP in malaria patients are quite few in India, this study was designed to evaluate whether serial measurements of CRP in malaria patients can be used to assess disease severity along with other haematological and biochemical parameters. II. Material And Methods The study was undertaken from May ‘2012 to March ‘2013. The study population consisted of 40 untreated malaria patients attending the Out-patient – department at LN Medical College and JK Hospital , Bhopal with symptoms of fever , rigor , headache and vomiting . Patients who tested positive for malaria by slide microscopy were enrolled in the study . All the patients were admitted to the hospital for treatment. Of the 40 ,initially enrolled patients only 32 patients completed the study . 8 patients were lost to follow up. The Submitted date 20 June 2013 Accepted Date: 25 June 2013