Serum Biomarkers Distinguishing Malaria from Nonmalaria Fever in Paediatric Patients in Blantyre, Malawi

Abstract

Identifying the aetiology of fever is challenging in paediatric patients, particularly in resource-limited settings like Malawi. Most infectious diseases, including malaria, present with overlapping clinical signs associated with fever. This study aimed to identify specific serum biomarkers that differentiate malaria from non-malarial fever in paediatric patients in Blantyre, Malawi. Ninety archived serum samples obtained from paediatric patients who presented with fever were grouped into non-malarial (n=25), malarial (n=46) and healthy controls (n=19) based on temperature and mRDT results. Serum samples were used to measure the concentration of CRP, ICAM-1, IL -6, IL-1β, IL -10, Ang- 2 and vWF-1 biomarkers using Luminex xMAP® technology. The biomarker and haematology results obtained from participants’ records were analysed using R statistics software. Malaria cases presented with a higher temperature (p=0.0089), low platelet counts (p=0.02) and haemoglobin levels (p=0.01) compared to non-malarial fever. Malarial fever had elevated IL-6 (AUROC=0.66, p= 0.04), IL-10 (AUROC = 0.81, p= ≤0.0001) and CRP (AUROC=0.60, p=0.09) compared to non-malarial fever and controls. Nonmalarial fever had elevated IL-1β (AUROC =0.9, p=0.02), ICAM-1 (AUROC= 0.76, p= <0.05), Ang -2 (AUROC=0.79, p=0.005), vWF-1 (AUROC=0.71, p ≤ 0.001) compared to malaria and controls. IL-10 and IL-1β correctly differentiate malarial fever from non-malarial fever with IL-10 levels increased in malarial fever and IL-1β increased in non-malarial fever. These biomarkers can significantly enhance diagnostic accuracy and treatment outcomes in resourcelimited settings and can be effectively utilized in point-of-care testing.