Serum biomarkers for the diagnosis of malaria, bacterial and viral infections in children living in malaria-endemic areas.

This review assesses current knowledge on the use of serum biomarkers for the diagnosis of malaria, bacterial and viral infections in sick children living in malaria-endemic areas. Reducing pediatric morbidity and mortality remains an essential challenge in these areas, where malaria and bacterial infections are the leading cause of death. In such settings, diagnostic tools that aid to overcome this problem are scarce and diagnosis relies mainly on clinical observations that can lead to incorrect treatment prescriptions. Currently, only malaria RDTs (rapid diagnostic tests) fulfill the criteria for a wide implementation under the operational conditions of resource-limited settings. New, affordable, simple and rapid diagnostic tools for bacterial diagnosis are crucial to guarantee adequate management of antibiotics. Serum biomarkers such as C-reactive protein or procalcitonin, used in developed countries, could form the basis for these tools. Few studies have, however, assessed their validity in malaria-endemic areas and data remain inconclusive. Viral diagnosis is not of highest priority in places where no specific etiological treatment is available and the presence of a virus cannot exclude bacterial/malarial coinfections. Although future studies may elucidate the diagnostic role of certain biomarkers in malaria-endemic areas, understanding the operational and sociological conditions of these settings will remain essential for the successful implementation of current and new diagnostic tools.