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Zheng M, Zhang M, Li H, Wu S, Zhao Y, Zhang J, Zhou Y, Jalloh MB, Zhang K, Chen L, Mi Z, Cui Y, Hou L. Rapid, sensitive, and convenient detection of Plasmodium falciparum infection based on CRISPR and its application in detection of asymptomatic infection. Acta Trop 2024; 249:107062. [PMID: 37923286 DOI: 10.1016/j.actatropica.2023.107062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Rapid and convenient detection of the Plasmodium in clinically diagnosed individuals and asymptomatically infected populations is essential for global malaria eradication, especially in malaria-endemic African countries where medical equipment and professionals are relatively deficient. Here, we described a CRISPR-based diagnostic for the detection of Plasmodium falciparum, the deadliest and most prevalent species of malaria parasite in Africa, via lateral flow strip readout without the need of nucleic acid extraction. The assay exhibited 100% sensitivity on clinical samples (5 P falciparum) and significant consistency with qPCR test on asymptomatic infection samples (49 P falciparum and 51 non-P. falciparum, Kappa=0.839). An artemisinin-resistant P. falciparum strain and 4 other laboratory-cultured strains can also be detected through this assay, whereas no cross-reactivity with Plasmodium vivax was observed. A 0.001% parasitaemia (corresponding to ∼60 parasites/μL) below the "low parasite density" test threshold (200 parasites/µL) is detectable. Our study demonstrated that direct malaria detection using whole blood on the spot and the detection of both clinical and asymptomatic infections of P. falciparum are feasible. This method is expected to be employed for clinical testing and large-scale community screening in Africa and possibly other places, contributing to the accurate diagnosis and control of malaria.
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Affiliation(s)
- Minghao Zheng
- School of Medical Devices, Shenyang Pharmaceutical University; Beijing Institute of Biotechnology, Beijing, China
| | | | - Hao Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Shipo Wu
- Beijing Institute of Biotechnology, Beijing, China
| | - Yuee Zhao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | | | - Yunyue Zhou
- Beijing Institute of Biotechnology, Beijing, China; School of Basic Medical Sciences, Zhejiang University
| | - Mohamed Boie Jalloh
- Joint Medical Unit (34 Military Hospital), Republic of Sierra Leone Armed Forces, Wilberforce Barracks, Wilberforce Village, Freetown, Sierra Leone
| | - Kun Zhang
- Department of Cell Biology, National Translational Science Center for Molecular Medicine, Fourth Military Medical University
| | - Lina Chen
- Artemisinin Research Center, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences
| | - Zhiqiang Mi
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
| | - Yong Cui
- School of Medical Devices, Shenyang Pharmaceutical University.
| | - Lihua Hou
- Beijing Institute of Biotechnology, Beijing, China.
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Mshani IH, Siria DJ, Mwanga EP, Sow BB, Sanou R, Opiyo M, Sikulu-Lord MT, Ferguson HM, Diabate A, Wynne K, González-Jiménez M, Baldini F, Babayan SA, Okumu F. Key considerations, target product profiles, and research gaps in the application of infrared spectroscopy and artificial intelligence for malaria surveillance and diagnosis. Malar J 2023; 22:346. [PMID: 37950315 PMCID: PMC10638832 DOI: 10.1186/s12936-023-04780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
Studies on the applications of infrared (IR) spectroscopy and machine learning (ML) in public health have increased greatly in recent years. These technologies show enormous potential for measuring key parameters of malaria, a disease that still causes about 250 million cases and 620,000 deaths, annually. Multiple studies have demonstrated that the combination of IR spectroscopy and machine learning (ML) can yield accurate predictions of epidemiologically relevant parameters of malaria in both laboratory and field surveys. Proven applications now include determining the age, species, and blood-feeding histories of mosquito vectors as well as detecting malaria parasite infections in both humans and mosquitoes. As the World Health Organization encourages malaria-endemic countries to improve their surveillance-response strategies, it is crucial to consider whether IR and ML techniques are likely to meet the relevant feasibility and cost-effectiveness requirements-and how best they can be deployed. This paper reviews current applications of IR spectroscopy and ML approaches for investigating malaria indicators in both field surveys and laboratory settings, and identifies key research gaps relevant to these applications. Additionally, the article suggests initial target product profiles (TPPs) that should be considered when developing or testing these technologies for use in low-income settings.
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Affiliation(s)
- Issa H Mshani
- Ifakara Health Institute, Environmental Health, and Ecological Sciences Department, Morogoro, United Republic of Tanzania.
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK.
| | - Doreen J Siria
- Ifakara Health Institute, Environmental Health, and Ecological Sciences Department, Morogoro, United Republic of Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Emmanuel P Mwanga
- Ifakara Health Institute, Environmental Health, and Ecological Sciences Department, Morogoro, United Republic of Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Bazoumana Bd Sow
- Department of Medical Biology and Public Health, Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Roger Sanou
- Department of Medical Biology and Public Health, Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Mercy Opiyo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Malaria Elimination Initiative (MEI), Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Maggy T Sikulu-Lord
- Faculty of Science, School of the Environment, The University of Queensland, Brisbane, QLD, Australia
| | - Heather M Ferguson
- Ifakara Health Institute, Environmental Health, and Ecological Sciences Department, Morogoro, United Republic of Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Abdoulaye Diabate
- Department of Medical Biology and Public Health, Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Klaas Wynne
- School of Chemistry, The University of Glasgow, Glasgow, G12 8QQ, UK
| | - Mario González-Jiménez
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
- School of Chemistry, The University of Glasgow, Glasgow, G12 8QQ, UK
| | - Francesco Baldini
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Simon A Babayan
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK.
| | - Fredros Okumu
- Ifakara Health Institute, Environmental Health, and Ecological Sciences Department, Morogoro, United Republic of Tanzania.
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK.
- School of Life Sciences and Biotechnology, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania.
- School of Public Health, The University of the Witwatersrand, Park Town, South Africa.
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Tembe D, Malatji MP, Mukaratirwa S. Occurrence, Prevalence, and Distribution of Haemoparasites of Poultry in Sub-Saharan Africa: A Scoping Review. Pathogens 2023; 12:945. [PMID: 37513792 PMCID: PMC10386234 DOI: 10.3390/pathogens12070945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
This review collated existing data on the occurrence, distribution, and prevalence of haemoparasites of poultry in sub-Saharan Africa. A literature search was conducted on three electronic search databases using search terms and Boolean operators (AND, OR). The results recorded 16 haemoparasites, viz., Leucocytozoon spp., L. marchouxi, L. neavei, L. sabrazesi, L. schoutedeni, Haemoproteus columbae, H. pratasi, Haemoproteus spp., Plasmodium spp., P. gallinaceum, P. circumflexum, P. juxtanucleare, Trypanosoma avium, T. gallinarum, T. numidae, and Hepatozoon spp. from a wide range of poultry species distributed across Nigeria, Kenya, South Africa, Tanzania, Uganda, Botswana, Zimbabwe, Ghana, Cameroon, and Zambia. Infections due to Haemoproteus and Leucocytozoon species were the most common and documented in eight of the ten reviewed countries. The presence of mixed infections was observed in quails, pigeons, chickens, ducks, turkeys, and guineafowls, but predominantly in chickens. Co-infections by Plasmodium spp. and Haemoproteus spp. were the most common, which may be attributed to the distribution of these species, coupled with the availability of vectors they are associated with in areas from which they were documented. The information generated in this review is essential for improving existing preventive and control measures of these parasites in sub-Saharan Africa.
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Affiliation(s)
- Danisile Tembe
- School of Life Sciences, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Mokgadi P Malatji
- School of Life Sciences, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Samson Mukaratirwa
- School of Life Sciences, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Durban 4001, South Africa
- One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre P.O. Box 344, Saint Kitts and Nevis
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Ikerionwu C, Ugwuishiwu C, Okpala I, James I, Okoronkwo M, Nnadi C, Orji U, Ebem D, Ike A. Application of machine and deep learning algorithms in optical microscopic detection of Plasmodium: A malaria diagnostic tool for the future. Photodiagnosis Photodyn Ther 2022; 40:103198. [PMID: 36379305 DOI: 10.1016/j.pdpdt.2022.103198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/14/2022]
Abstract
Machine and deep learning techniques are prevalent in the medical discipline due to their high level of accuracy in disease diagnosis. One such disease is malaria caused by Plasmodium falciparum and transmitted by the female anopheles mosquito. According to the World Health Organisation (WHO), millions of people are infected annually, leading to inevitable deaths in the infected population. Statistical records show that early detection of malaria parasites could prevent deaths and machine learning (ML) has proved helpful in the early detection of malarial parasites. Human error is identified to be a major cause of inaccurate diagnostics in the traditional microscopy malaria diagnosis method. Therefore, the method would be more reliable if human expert dependency is restricted or entirely removed, and thus, the motivation of this paper. This study presents a systematic review to understand the prevalent machine learning algorithms applied to a low-cost, portable optical microscope in the automation of blood film interpretation for malaria parasite detection. Peer-reviewed papers were downloaded from selected reputable databases eg. Elsevier, IEEExplore, Pubmed, Scopus, Web of Science, etc. The extant literature suggests that convolutional neural network (CNN) and its variants (deep learning) account for 41.9% of the microscopy malaria diagnosis using machine learning with a prediction accuracy of 99.23%. Thus, the findings suggest that early detection of the malaria parasite has improved through the application of CNN and other ML algorithms on microscopic malaria parasite detection.
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Affiliation(s)
- Charles Ikerionwu
- Machine Learning on Disease Diagnosis Research Group, Nigeria; Department of Software Engineering, Federal University of Technology, Owerri, Imo State, Nigeria
| | - Chikodili Ugwuishiwu
- Machine Learning on Disease Diagnosis Research Group, Nigeria; Department of Computer Science, University of Nigeria, Nsukka, Enugu State, Nigeria.
| | - Izunna Okpala
- Machine Learning on Disease Diagnosis Research Group, Nigeria; Department of Information Technology, University of Cincinnati, USA
| | - Idara James
- Machine Learning on Disease Diagnosis Research Group, Nigeria; Department of Computer Science, Akwa Ibom State University, Nigeria
| | - Matthew Okoronkwo
- Machine Learning on Disease Diagnosis Research Group, Nigeria; Department of Computer Science, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Charles Nnadi
- Machine Learning on Disease Diagnosis Research Group, Nigeria; Deprtment of Pharmaceutical and Medicinal Chemistry, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Ugochukwu Orji
- Machine Learning on Disease Diagnosis Research Group, Nigeria; Department of Computer Science, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Deborah Ebem
- Machine Learning on Disease Diagnosis Research Group, Nigeria; Department of Computer Science, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Anthony Ike
- Machine Learning on Disease Diagnosis Research Group, Nigeria; Department of Microbiology, University of Nigeria, Nsukka, Enugu State, Nigeria
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Automated liquid handling robot for rapid lateral flow assay development. Anal Bioanal Chem 2022; 414:2607-2618. [PMID: 35091761 PMCID: PMC8799445 DOI: 10.1007/s00216-022-03897-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 11/01/2022]
Abstract
AbstractThe lateral flow assay (LFA) is one of the most popular technologies on the point-of-care diagnostics market due to its low cost and ease of use, with applications ranging from pregnancy to environmental toxins to infectious disease. While the use of these tests is relatively straightforward, significant development time and effort are required to create tests that are both sensitive and specific. Workflows to guide the LFA development process exist but moving from target selection to an LFA that is ready for field testing can be labor intensive, resource heavy, and time consuming. To reduce the cost and the duration of the LFA development process, we introduce a novel development platform centered on the flexibility, speed, and throughput of an automated robotic liquid handling system. The system comprises LFA-specific hardware and software that enable large optimization experiments with discrete and continuous variables such as antibody pair selection or reagent concentration. Initial validation of the platform was demonstrated during development of a malaria LFA but was readily expanded to encompass development of SARS-CoV-2 and Mycobacterium tuberculosis LFAs. The validity of the platform, where optimization experiments are run directly on LFAs rather than in solution, was based on a direct comparison between the robotic system and a more traditional ELISA-like method. By minimizing hands-on time, maximizing experiment size, and enabling improved reproducibility, the robotic system improved the quality and quantity of LFA assay development efforts.
Graphical abstract
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Nadeem MF, Khattak AA, Zeeshan N, Awan UA, Yaqoob A. Assessment of Microscopic Detection of Malaria with Nested Polymerase Chain Reaction in War-Torn Federally Administered Tribal Areas of Pakistan. Acta Parasitol 2021; 66:1186-1192. [PMID: 33840058 DOI: 10.1007/s11686-021-00374-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Diagnostic accuracy of malaria is critical for early treatment, control, and elimination of malaria, especially in war-affected malaria-endemic areas. Microscopic detection of Plasmodium species has been the gold standard in remote malaria-endemic regions. However, the diagnostic accuracy is still questioned, especially in discriminating mixed and submicroscopic parasitic levels. This study was designed to evaluate the diagnostic performance of microscopic examination against nested PCR analysis in war-torn malaria-endemic Federally Administered Tribal Areas (FATA) of Pakistan. METHODS Venous blood samples were collected from symptomatic patients for microscopic examination and nested PCR analysis from January 2016-December 2016 from five Agencies (Bajaur, Mohmand, Khyber, Orakzai and Kurram Agency) and four Frontier Regions (Peshawar, Kohat, Bannu, and Dera Ismail Khan Frontier Region) of FATA. Malaria-positive isolates were confirmed by nested PCR (targeting Plasmodium small subunit ribosomal ribonucleic acid (ssrRNA) genes) for speciation. RESULTS Among enrolled participants, 762 were found positive for malaria parasite on microscopic examination of the blood film. Plasmodium vivax was found in 623, Plasmodium falciparum in 132 and 7 were diagnosed with mixed infection (P. vivax and P. falciparum coinfection). Nested PCR detected Plasmodium infection in 679 samples (523 P. vivax, 121 P. falciparum, and 35 mixed infections). Compared with microscopy, the sensitivity of nested PCR was 98.94%, and specificity was 98.27%, while the sensitivity and specificity of slide microscopy 89.34% and 87.99% respectively. CONCLUSION The conventional microscopy method has low sensitivity to detect the mixed infection as compared to nested PCR. High sensitivity and specificity observed in nested PCR make this molecular tool a useful technique for monitoring, controlling, and eliminating malaria-endemic regions.
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The profile of microorganisms that associate with acute tonsillitis in children and their antibiotics sensitivity pattern in Nigeria. Sci Rep 2021; 11:20084. [PMID: 34635755 PMCID: PMC8505406 DOI: 10.1038/s41598-021-99570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/14/2021] [Indexed: 11/08/2022] Open
Abstract
Acute tonsillitis remains one of the common childhood diseases in developing countries. Prompt and appropriate treatment based on the knowledge of the causative microbiota and their antimicrobial susceptibility pattern will improve the treatment outcome and reduce time and resources spent on treatment. This study aims to determine the pattern of microbiota isolates and their susceptibility pattern. The study was a combination of the retrospective and cross-sectional method. The medical records of children treated for tonsillitis were retrieved, as well as those of children who presented with acute tonsillitis for the study. Interviewer-administered questionnaire was used to collect data, as well as document information retrieved from their medical record: presenting symptoms, treatments received. Swab sample was taken for culture and antibiotic susceptibility test. Out of the 72 swab cultures, 29 (40.3%) yielded insignificant growth of gram positive cocci. A total of nine (9) different isolates were obtained from all the significant swab cultures. Streptococcus species (13, 18.6%) and staphylococcus species (11, 15.3%) were the commonest isolates. Imipenem and levofloxacin revealed high level of susceptibility, while Ampicillin and Cefexine recorded high resistance rates. The proportion of the cultures that were positive of significant growth, the proportion of these positive isolates that were Streptococcus spp. and varied sensitivity pattern obtained underpinned the importance to advocate for culture isolates and susceptibility pattern guided treatment. These will not only an efficient approach to management of acute tonsillitis, but also a strong approach towards effective implementation of antibiotic stewardship.
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Mudare N, Matsena-Zingoni Z, Makuwaza A, Mamini E, Munyati SS, Gwanzura L, Midzi N, Mutambu SL, Mason P, Kobayashi T, Mharakurwa S. Detecting Plasmodium falciparum in community surveys: a comparison of Paracheck Pf® Test and ICT Malaria Pf® Cassette Test to polymerase chain reaction in Mutasa District, Zimbabwe. Malar J 2021; 20:14. [PMID: 33407488 PMCID: PMC7789522 DOI: 10.1186/s12936-020-03536-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/07/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Microscopy and rapid diagnostic tests (RDTs) are the main techniques used to diagnose malaria. While microscopy is considered the gold standard, RDTs have established popularity as they allow for rapid diagnosis with minimal technical skills. This study aimed to compare the diagnostic performance of two Plasmodium falciparum histidine-rich protein 2 (PfHRP2)-based RDTs (Paracheck Pf® Test (Paracheck) and Malaria Pf™ ICT (ICT)) to polymerase chain reaction (PCR) in a community survey. METHODS A cross-sectional study was conducted between October 2012 and December 2014 in Mutasa District, Manicaland Province, eastern Zimbabwe. Households were randomly selected using satellite imagery, and 224 households were visited. Residents present in the household on the date of the visit were recruited for the study. Participants of all age groups from the selected households were screened with Paracheck and ICT RDTs in parallel. Dried blood spots (DBS) and thin and thick smears were collected. Parasite DNA extracted from the DBS was subjected to nested PCR targeting the Plasmodium cytochrome b mitochondrial gene. Data analysis was performed using the Cohen's Kappa test to determine the interrater agreement and the sensitivity and specificity of the diagnostic test were reported. RESULTS Results from a total of 702 participants were analysed. Most were females, 397 (57%), and the median age of participants was 21 years with an interquartile range of 9-39 years. Of those who were screened, 8 (1.1%), 35 (5.0%), and 21 (2.9%) were malaria parasite positive by microscopy, RDT and PCR, respectively. Paracheck and ICT RDTs had a 100% agreement. Comparing RDT and PCR results, 34 participants (4.8%) had discordant results. Most of the discordant cases were RDT positive but PCR negative (n = 24). Half of those RDT positive, but PCR negative individuals reported anti-malarials to use in the past month, which is significantly higher than reported anti-malarial drug use in the population (p < 0.001). The participant was febrile on the day of the visit, but relying on PfHRP2-based RDT would miss this case. Among the diagnostic methods evaluated, with reference to PCR, the sensitivity was higher with the RDT (52.4%) while specificity was higher with the microscopy (99.9%). The positive predictive value (PPV) was higher with the microscopy (87.5%), while the negative predictive values were similar for both microscopy and RDTs (98%). Overall, a strong correlated agreement with PCR was observed for the microscopy (97.9%) and the RDTs (95.2%). CONCLUSIONS Paracheck and ICT RDTs showed 100% agreement and can be used interchangeably. As malaria transmission declines and Zimbabwe aims to reach malaria elimination, management of infected individuals with low parasitaemia as well as non-P. falciparum infection can be critical.
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Affiliation(s)
| | | | | | - Edmore Mamini
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Lovemore Gwanzura
- Biomedical Research and Training Institute, Harare, Zimbabwe.,University of Zimbabwe, College of Health Sciences, Institute of Continuing Health Education, Harare, Zimbabwe
| | | | | | - Peter Mason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tamaki Kobayashi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sungano Mharakurwa
- Africa University, Mutare, Zimbabwe. .,Biomedical Research and Training Institute, Harare, Zimbabwe.
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Rei Yan SL, Wakasuqui F, Wrenger C. Point-of-care tests for malaria: speeding up the diagnostics at the bedside and challenges in malaria cases detection. Diagn Microbiol Infect Dis 2020; 98:115122. [PMID: 32711185 DOI: 10.1016/j.diagmicrobio.2020.115122] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022]
Abstract
Malaria remains as one of the major public health problems worldwide. About 228 million cases occurred in 2018 only, with Africa bearing about 93% of the cases. Asymptomatic population carrying the various forms of the parasite Plasmodium in endemic areas plays an important role in the spread of the disease. To tackle this battle, more sensitive and precise detection kits for malaria are crucial to better control the number of new malaria cases. In this review, we not only discuss some of the available approaches to rapidly detect new malaria cases in endemic areas but also shed light on parallel problems that may affect the detection of individuals infected with the parasite, covering kelch 13 mutation, glucose 6-phosphate dehydrogenase deficiency, and hemoglobin disorders. Available approaches for malaria detection covered in this review are focused on point-of-care tests, including portable polymerase chain reaction and aptamers.
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Affiliation(s)
- Sun L Rei Yan
- Department of Parasitology, Institute of Biomedical Sciences at the University of São Paulo, São Paulo, Brazil
| | - Felipe Wakasuqui
- Department of Parasitology, Institute of Biomedical Sciences at the University of São Paulo, São Paulo, Brazil
| | - Carsten Wrenger
- Department of Parasitology, Institute of Biomedical Sciences at the University of São Paulo, São Paulo, Brazil.
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Di Gregorio E, Ferrauto G, Schwarzer E, Gianolio E, Valente E, Ulliers D, Aime S, Skorokhod O. Relaxometric studies of erythrocyte suspensions infected by Plasmodium falciparum: a tool for staging infection and testing anti-malarial drugs. Magn Reson Med 2020; 84:3366-3378. [PMID: 32602953 DOI: 10.1002/mrm.28387] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Malaria is a global health problem with the most malignant form caused by Plasmodium falciparum (P. falciparum). Parasite maturation in red blood cells (RBCs) is accompanied by changes including the formation of paramagnetic hemozoin (HZ) nanocrystals, and increased metabolism and variation in membrane lipid composition. Herein, MR relaxometry (MRR) was applied to investigate water exchange across RBCs' membrane and HZ formation in parasitized RBCs. METHODS Transverse water protons relaxation rate constants (R2 = 1/T2 ) were measured for assessing HZ formation in P. falciparum-parasitized human RBCs. Moreover, water exchange lifetimes across the RBC membrane (τi ) were assessed by measuring longitudinal relaxation rate constants (R1 = 1/T1 ) at 21.5 MHz in the presence of a gadolinium complex dissolved in the suspension medium. RESULTS τi increased after invasion of parasites (ring stage, mean τi / τ i 0 = 1.234 ± 0.022) and decreased during maturation to late trophozoite (mean τi / τ i 0 = 0.960 ± 0.075) and schizont stages (mean τi / τ i 0 = 1.019 ± 0.065). The HZ accumulation in advanced stages was revealed by T2 -shortening. The curves reporting R2 (1/T2 ) vs. magnetic field showed different slopes for non-parasitized RBCs (npRBCs) and parasitized RBCs (pRBCs), namely 0.003 ± 0.001 for npRBCs, 0.009 ± 0.002, 0.028 ± 0.004 and 0.055 ± 0.002 for pRBCs at ring-, early trophozoite-, and late trophozoite stage, respectively. Antimalarial molecules dihydroartemisinin and chloroquine elicited measurable changes in parasitized RBCs, namely dihydroartemisinin modified τi , whereas the interference of chloroquine with HZ formation was detectable by a significant T2 increase. CONCLUSIONS MRR can be considered a useful tool for reporting on P. falciparum blood stages and for screening potential antimalarial molecules.
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Affiliation(s)
- Enza Di Gregorio
- Molecular Imaging Center, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Giuseppe Ferrauto
- Molecular Imaging Center, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | | | - Eliana Gianolio
- Molecular Imaging Center, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Elena Valente
- Department of Oncology, University of Torino, Torino, Italy
| | | | - Silvio Aime
- Molecular Imaging Center, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Oleksii Skorokhod
- Department of Life Sciences and Systems Biology, University of Torino, Torino, Italy
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Bae S, Son K, Lee D, Han S, Choi K, Kim S. Warfarin Pharmacogenetics: Single-nucleotide Polymorphism Detection using CMOS Photosensor-based Real-time PCR. BIOCHIP JOURNAL 2020. [DOI: 10.1007/s13206-020-4209-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Krampa FD, Aniweh Y, Kanyong P, Awandare GA. Recent Advances in the Development of Biosensors for Malaria Diagnosis. SENSORS (BASEL, SWITZERLAND) 2020; 20:E799. [PMID: 32024098 PMCID: PMC7038750 DOI: 10.3390/s20030799] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 02/07/2023]
Abstract
The impact of malaria on global health has continually prompted the need to develop more effective diagnostic strategies that could overcome deficiencies in accurate and early detection. In this review, we examine the various biosensor-based methods for malaria diagnostic biomarkers, namely; Plasmodium falciparum histidine-rich protein 2 (PfHRP-2), parasite lactate dehydrogenase (pLDH), aldolase, glutamate dehydrogenase (GDH), and the biocrystal hemozoin. The models that demonstrate a potential for field application have been discussed, looking at the fabrication and analytical performance characteristics, including (but not exclusively limited to): response time, sensitivity, detection limit, linear range, and storage stability, which are first summarized in a tabular form and then described in detail. The conclusion summarizes the state-of-the-art technologies applied in the field, the current challenges and the emerging prospects for malaria biosensors.
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Affiliation(s)
- Francis D. Krampa
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, P.O. Box LG 25, Legon, Accra, Ghana; (Y.A.); (P.K.); (G.A.A.)
- Department of Biochemistry, Cell & Molecular Biology, University of Ghana, P.O. Box LG 54, Legon, Accra, Ghana
| | - Yaw Aniweh
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, P.O. Box LG 25, Legon, Accra, Ghana; (Y.A.); (P.K.); (G.A.A.)
| | - Prosper Kanyong
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, P.O. Box LG 25, Legon, Accra, Ghana; (Y.A.); (P.K.); (G.A.A.)
- Department of Chemistry, University of Oxford, South Parks Road, Oxford OX1 3QZ, UK
| | - Gordon A. Awandare
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, P.O. Box LG 25, Legon, Accra, Ghana; (Y.A.); (P.K.); (G.A.A.)
- Department of Biochemistry, Cell & Molecular Biology, University of Ghana, P.O. Box LG 54, Legon, Accra, Ghana
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Tuyisenge T, Henry MB, Cartledge PT. Global Health Journal Club: The Use of Rapid Diagnostic Test (RDT) in the Diagnosis of Congenital Malaria. J Trop Pediatr 2019; 65:409-415. [PMID: 30521053 DOI: 10.1093/tropej/fmy066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Theodonata Tuyisenge
- University of Rwanda, Kigali, Rwanda.,Univerisity Teaching Hospital of Butare, Butare, Rwanda
| | - Michael B Henry
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Peter T Cartledge
- Yale University, Rwanda Human Resources for Health (HRH) Program, Kigali, Rwanda.,University Teaching Hospital of Kigali, Kigali, Rwanda
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Hawash Y, Ismail K, Alsharif K, Alsanie W. Malaria Prevalence in a Low Transmission Area, Jazan District of Southwestern Saudi Arabia. THE KOREAN JOURNAL OF PARASITOLOGY 2019; 57:233-242. [PMID: 31284345 PMCID: PMC6616166 DOI: 10.3347/kjp.2019.57.3.233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/24/2019] [Accepted: 05/03/2019] [Indexed: 11/23/2022]
Abstract
Detailed description of malaria in low transmission areas is crucial for elimination. The current study aimed to provide a comprehensive description for malaria transmission in Jazan, a low transmission district, southwestern Saudi Arabia. Patients at a tertiary care hospital were recruited in our study between August 2016 and September 2018. Malaria diagnosis was performed through a species-specific nested polymerase chain reaction (nested PCR), microscopy and Paramax-3TM rapid detection test (RDT). Malaria was detected in 30 patients by the PCR, with point prevalence of 10.9%. Of these malaria infections, 80% was imported, 26.6% was asymptomatic and 23.3% was sub-microscopic. Malaria was reported throughout the year, with February/March and September/October peaks. Infection was significantly more in males than in females (P=0.01). Likewise, infections were detected more in febrile than in non-febrile patients (P=0.01). Adult aged 15-24 years, fever and travel were identified as high-risk factors. Malaria was primarily attributed to Plasmodium falciparum mono-infections, followed by P. vivax mono-infections and lastly to falciparum/vivax mixed infections accounting 76.6%, 16.6%, and 6.6% of PCR-confirmed malaria cases, respectively. The nested PCR was superior to the smear microscopy (sensitivity 76.6%; specificity 100%) and the RDT (sensitivity 83.3%, specificity 94.2%). The overall percent agreement between microscopy and the RDT was 92.7% (kappa=0.63). High proportion of imported malaria including sub-microscopic and sub-patent cases were described. We suggest that incorporation of molecular tool into the conventional malaria diagnosis is beneficial in Jazan district.
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Affiliation(s)
- Yousry Hawash
- Clinical Laboratories Sciences Department, College of Applied Medical Science, Taif University, Taif,
Saudi Arabia
- Parasitology Department, National Liver Institute, Menoufia University, Menoufia,
Egypt
| | - Khadiga Ismail
- Clinical Laboratories Sciences Department, College of Applied Medical Science, Taif University, Taif,
Saudi Arabia
- Parasitology Department, Faculty of Medicine, Ain-Shams University, Cairo,
Egypt
| | - Khalaf Alsharif
- Clinical Laboratories Sciences Department, College of Applied Medical Science, Taif University, Taif,
Saudi Arabia
| | - Walaa Alsanie
- Clinical Laboratories Sciences Department, College of Applied Medical Science, Taif University, Taif,
Saudi Arabia
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Bonyi E, Constance E, Kukoyi Z, Jafar S, Aslan K. Rapid Sensing of Biological and Environmental Analytes Using Microwave-Accelerated Bioassays and a MATLAB Application. ACTA ACUST UNITED AC 2019; 11:111-123. [PMID: 31565490 PMCID: PMC6764453 DOI: 10.5101/nbe.v11i2.p111-123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a method for rapid detection and analysis of biological and environmental analytes by microwave-accelerated bioassays (MABs) and a novel MATLAB-based image processing of colorimetric signals. In this regard, colorimetric bioassays for histidine-rich protein 2 (HRP-2) and microcystin-leucine arginine (MC-LR) toxin were carried out using MABs and without microwave heating (i.e, gold standard bioassays). Our MATLAB-based detection method is based on the direct correlation of color intensity of a solution calculated from images captured with a smartphone with the concentration of the biomolecule of interest using a MATLAB code developed in-house. We demonstrated that our MATLAB-based detection method can yield bioassay sensitivity comparable to the colorimetric gold standard tool, i.e., UV-Visible spectroscopy. In addition, colorimetric bioassay time for the HRP-2 assay (used in malaria diagnosis) and colorimetric MC-LR bioassay (used in MCLR toxin diagnosis) was reduced from up to 2 hours at room temperature without microwave heating to 15 minutes using the MABs technique.
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Affiliation(s)
- Enock Bonyi
- Department of Civil Engineering, Morgan State University, 1700 East Cold Spring Lane, Baltimore, Maryland 21251, USA
| | - Edward Constance
- Department of Civil Engineering, Morgan State University, 1700 East Cold Spring Lane, Baltimore, Maryland 21251, USA
| | - Zeenat Kukoyi
- Department of Civil Engineering, Morgan State University, 1700 East Cold Spring Lane, Baltimore, Maryland 21251, USA
| | - Sanjeeda Jafar
- Department of Biology, Morgan State University, 1700 East Cold Spring Lane, Baltimore, Maryland 21251, USA
| | - Kadir Aslan
- Department of Civil Engineering, Morgan State University, 1700 East Cold Spring Lane, Baltimore, Maryland 21251, USA
- Corresponding author.
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Markwalter C, Kantor AG, Moore CP, Richardson KA, Wright DW. Inorganic Complexes and Metal-Based Nanomaterials for Infectious Disease Diagnostics. Chem Rev 2019; 119:1456-1518. [PMID: 30511833 PMCID: PMC6348445 DOI: 10.1021/acs.chemrev.8b00136] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Indexed: 12/12/2022]
Abstract
Infectious diseases claim millions of lives each year. Robust and accurate diagnostics are essential tools for identifying those who are at risk and in need of treatment in low-resource settings. Inorganic complexes and metal-based nanomaterials continue to drive the development of diagnostic platforms and strategies that enable infectious disease detection in low-resource settings. In this review, we highlight works from the past 20 years in which inorganic chemistry and nanotechnology were implemented in each of the core components that make up a diagnostic test. First, we present how inorganic biomarkers and their properties are leveraged for infectious disease detection. In the following section, we detail metal-based technologies that have been employed for sample preparation and biomarker isolation from sample matrices. We then describe how inorganic- and nanomaterial-based probes have been utilized in point-of-care diagnostics for signal generation. The following section discusses instrumentation for signal readout in resource-limited settings. Next, we highlight the detection of nucleic acids at the point of care as an emerging application of inorganic chemistry. Lastly, we consider the challenges that remain for translation of the aforementioned diagnostic platforms to low-resource settings.
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Affiliation(s)
| | | | | | | | - David W. Wright
- Department of Chemistry, Vanderbilt
University, Nashville, Tennessee 37235, United States
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Simultaneous Quantification of Plasmodium Antigens and Host Factor C-Reactive Protein in Asymptomatic Individuals with Confirmed Malaria by Use of a Novel Multiplex Immunoassay. J Clin Microbiol 2019; 57:JCM.00948-18. [PMID: 30404944 PMCID: PMC6322473 DOI: 10.1128/jcm.00948-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022] Open
Abstract
Malaria rapid diagnostic tests (RDTs) primarily detect Plasmodium falciparum antigen histidine-rich protein 2 (HRP2) and the malaria-conserved antigen lactate dehydrogenase (LDH) for P. vivax and other malaria species. The performance of RDTs and their utility is dependent on circulating antigen concentration distributions in infected individuals in a population in which malaria is endemic and on the limit of detection of the RDT for the antigens. Malaria rapid diagnostic tests (RDTs) primarily detect Plasmodium falciparum antigen histidine-rich protein 2 (HRP2) and the malaria-conserved antigen lactate dehydrogenase (LDH) for P. vivax and other malaria species. The performance of RDTs and their utility is dependent on circulating antigen concentration distributions in infected individuals in a population in which malaria is endemic and on the limit of detection of the RDT for the antigens. A multiplexed immunoassay for the quantification of HRP2, P. vivax LDH, and all-malaria LDH (pan LDH) was developed to accurately measure circulating antigen concentration and antigen distribution in a population with endemic malaria. The assay also measures C-reactive protein (CRP) levels as an indicator of inflammation. Validation was conducted with clinical specimens from 397 asymptomatic donors from Myanmar and Uganda, confirmed by PCR for infection, and from participants in induced blood-stage malaria challenge studies. The assay lower limits of detection for HRP2, pan LDH, P. vivax LDH, and CRP were 0.2 pg/ml, 9.3 pg/ml, 1.5 pg/ml, and 26.6 ng/ml, respectively. At thresholds for HRP2, pan LDH, and P. vivax LDH of 2.3 pg/ml, 47.8 pg/ml, and 75.1 pg/ml, respectively, and a specificity ≥98.5%, the sensitivities for ultrasensitive PCR-confirmed infections were 93.4%, 84.9%, and 48.9%, respectively. Plasmodium LDH (pLDH) concentration, in contrast to that of HRP2, correlated closely with parasite density. CRP levels were moderately higher in P. falciparum infections with confirmed antigenemia versus those in clinical specimens with no antigen. The 4-plex array is a sensitive tool for quantifying diagnostic antigens in malaria infections and supporting the evaluation of new ultrasensitive RDTs.
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McBirney SE, Chen D, Scholtz A, Ameri H, Armani AM. Rapid Diagnostic for Point-of-Care Malaria Screening. ACS Sens 2018; 3:1264-1270. [PMID: 29781606 DOI: 10.1021/acssensors.8b00269] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite significant success in therapeutic development, malaria remains a widespread and deadly infectious disease in the developing world. Given the nearly 100% efficacy of current malaria therapeutics, the primary barrier to eradication is lack of early diagnosis of the infected population. However, there are multiple strains of malaria. Although significant efforts and resources have been invested in developing antibody-based diagnostic methods for Plasmodium falciparum, a rapid and easy to use screening method capable of detecting all malaria strains has not been realized. Yet, until the entire malaria-infected population receives treatment, the disease will continue to impact society. Here, we report the development of a portable, magneto-optic technology for early stage malaria diagnosis based on the detection of the malaria pigment, hemozoin. Using β-hematin, a hemozoin mimic, we demonstrate detection limits of <0.0081 μg/mL in 500 μL of whole rabbit blood with no additional reagents required. This level corresponds to <26 parasites/μL, a full order of magnitude below clinical relevance and comparable to or less than existing technologies.
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Affiliation(s)
| | | | - Alexis Scholtz
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Hossein Ameri
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California 90033, United States
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Thera MA, Kone AK, Tangara B, Diarra E, Niare S, Dembele A, Sissoko MS, Doumbo OK. School-aged children based seasonal malaria chemoprevention using artesunate-amodiaquine in Mali. Parasite Epidemiol Control 2018; 3:96-105. [PMID: 29988270 PMCID: PMC6011810 DOI: 10.1016/j.parepi.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 11/01/2022] Open
Abstract
Introduction Malaria is still a public health problem in Africa. Seasonal Malaria Chemoprevention (SMC) is an efficient control strategy recommended by WHO that targets children under five year old living in areas of seasonal malaria transmission. SMC uses the combination amodiaquine (AQ) - sulfadoxine-pyrimethamine (SP). However SP selects rapidly drug resistant parasites. And malaria burden may increase in older children where SMC is implemented. We initiated a pilot study to assess an alternative approach to SMC in older children in Mali. Methods A randomized open-label clinical trial was conducted to test the efficacy and safety of SMC using artesunate - amodiaquine in school aged children in Mali. Two hundred pupils aged 6-15 years old were enrolled and randomized into two arms of 100 each, to receive either artesunate-amodiaquine (ASAQ) monthly or no intervention. Both arms were followed and clinical malaria were diagnosed and treated with arthemeter-lumefanthrine as recommended by Mali National Malaria Control Program. ASAQ was administered 3 days under study team direct observation and during 4 consecutive months starting in October 2013. Follow up was continued until April 2014. Results Overall, 20 cases of uncomplicated clinical malaria were encountered in the Control arm and three cases in the ASAQ arm, showing a protective efficacy of 85% 95% CI [80.1-89.9] against clinical malaria. Protective efficacy against malaria infection was 69.6% 95% CI [58.6-21.4]. No effect on anemia was observed. ASAQ was well tolerated. Most common solicited adverse events were abdominal pain and headaches of mild intensity in respectively 64% and 44% of children that swallowed ASAQ. Conclusion ASAQ is effective and well tolerated as SMC targeting older children in a peri urban setting in Mali. Its administration at schools is a feasible and accepted strategy to deliver the intervention.
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Affiliation(s)
- Mahamadou A Thera
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Abdoulaye K Kone
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Bourama Tangara
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Elizabeth Diarra
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Sirama Niare
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Abdramane Dembele
- Service of Psychiatry, University and Hospital Center of Point G, Bamako, Mali
| | - Mahamadou S Sissoko
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
| | - Ogobara K Doumbo
- Malaria Research and Training Centre-International Center for Excellence in Research (MRTC-ICER), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, USTTB, Point G, BP 1805 Bamako, Mali
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Yang X, Chen Z, Miao J, Cui L, Guan W. High-throughput and label-free parasitemia quantification and stage differentiation for malaria-infected red blood cells. Biosens Bioelectron 2017; 98:408-414. [PMID: 28711027 PMCID: PMC5558593 DOI: 10.1016/j.bios.2017.07.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/04/2017] [Accepted: 07/08/2017] [Indexed: 12/16/2022]
Abstract
This work reports a high throughput and label-free microfluidic cell deformability sensor for quantitative parasitemia measurement and stage determination for Plasmodium falciparum-infected red blood cells (Pf-iRBCs). The sensor relies on differentiating the RBC deformability (a mechanical biomarker) that is highly correlated with the infection status. The cell deformability is measured by evaluating the transit time when each individual RBC squeezes through a microscale constriction (cross-section ~5µm×5µm). More than 30,000 RBCs can be analyzed for parasitemia quantification in under 1min with a throughput ~500 cells/s. Moreover, the device can also differentiate various malaria stages (ring, trophozoite, and schizont stage) due to their varied deformability. Using Pf-iRBCs at 0.1% parasitemia as a testing sample, the microfluidic deformability sensor achieved an excellent sensitivity (94.29%), specificity (86.67%) and accuracy (92.00%) in a blind test, comparable to the gold standard of the blood smear microscopy. As a supplement technology to the microscopy and flow cytometry, the microfluidic deformability sensor would possibly allow for label-free, rapid and cost-effective parasitemia quantification and stage determination for malaria in remote regions.
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Affiliation(s)
- Xiaonan Yang
- Department of Electrical Engineering, Pennsylvania State University, University Park 16802, USA; School of Information Engineering, Zhengzhou University, Zhengzhou 450000, China
| | - Zhuofa Chen
- Department of Electrical Engineering, Pennsylvania State University, University Park 16802, USA
| | - Jun Miao
- Department of Entomology, Pennsylvania State University, University Park 16802, USA
| | - Liwang Cui
- Department of Entomology, Pennsylvania State University, University Park 16802, USA
| | - Weihua Guan
- Department of Electrical Engineering, Pennsylvania State University, University Park 16802, USA; Department of Biomedical Engineering, Pennsylvania State University, University Park 16802, USA.
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Automatic System for Plasmodium Species Identification from Microscopic Images of Blood-Smear Samples. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2017; 1:231-259. [DOI: 10.1007/s41666-017-0009-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/11/2017] [Accepted: 10/10/2017] [Indexed: 12/19/2022]
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Discovery of Antimalarial Drugs from Streptomycetes Metabolites Using a Metabolomic Approach. J Trop Med 2017; 2017:2189814. [PMID: 29123551 PMCID: PMC5662797 DOI: 10.1155/2017/2189814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/30/2017] [Indexed: 12/05/2022] Open
Abstract
Natural products continue to play an important role as a source of biologically active substances for the development of new drug. Streptomyces, Gram-positive bacteria which are widely distributed in nature, are one of the most popular sources of natural antibiotics. Recently, by using a bioassay-guided fractionation, an antimalarial compound, Gancidin-W, has been discovered from these bacteria. However, this classical method in identifying potentially novel bioactive compounds from the natural products requires considerable effort and is a time-consuming process. Metabolomics is an emerging “omics” technology in systems biology study which integrated in process of discovering drug from natural products. Metabolomics approach in finding novel therapeutics agent for malaria offers dereplication step in screening phase to shorten the process. The highly sensitive instruments, such as Liquid Chromatography-Mass Spectrophotometry (LC-MS), Gas Chromatography-Mass Spectrophotometry (GC-MS), and Nuclear Magnetic Resonance (1H-NMR) spectroscopy, provide a wide range of information in the identification of potentially bioactive compounds. The current paper reviews concepts of metabolomics and its application in drug discovery of malaria treatment as well as assessing the antimalarial activity from natural products. Metabolomics approach in malaria drug discovery is still new and needs to be initiated, especially for drug research in Malaysia.
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Diallo MA, Diongue K, Ndiaye M, Gaye A, Deme A, Badiane AS, Ndiaye D. Evaluation of CareStart™ Malaria HRP2/pLDH (Pf/pan) Combo Test in a malaria low transmission region of Senegal. Malar J 2017; 16:328. [PMID: 28797261 PMCID: PMC5553680 DOI: 10.1186/s12936-017-1980-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study was initiated from the observation that prevalence of malaria obtained with rapid diagnostic test (RDT) (CareStart™Malaria HRP2/pLDH Combo Test) was higher than in microscopy in a malaria low transmission area of Senegal. PCR was then performed to evaluate the performance of the RDT compared to microscopy in clinical settings. Methods The study included 215 patients suspected of malaria in two peri-urban area of Dakar. Finger-pick blood samples were tested using RDT (CareStart™Malaria HRP2/pLDH Combo Test). Venous blood samples were collected for light microscopy and PCR (gold standard). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated as performance characteristics. Results Considering PCR as the gold standard, CareStart™RDT showed high sensitivity (97.3%) and specificity (94.1%) with PPV and NPV of 97.3 and 94.1%, respectively, while microscopy had a sensitivity and specificity of 93.2 and 100%, respectively, and PPV and NPV of 100 and 87.2%, respectively. Conclusions Malaria CareStart™RDT test demonstrated a superior sensitivity compared to microscopy, which is the gold standard for malaria diagnosis. CareStart™RDT could be a useful tool in individuals suspected of malaria even in areas where prevalence is low.
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Affiliation(s)
- Mamadou Alpha Diallo
- Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
| | - Khadim Diongue
- Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal
| | - Mouhamadou Ndiaye
- Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal
| | - Amy Gaye
- Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal
| | - Awa Deme
- Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal
| | - Aida S Badiane
- Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal
| | - Daouda Ndiaye
- Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal
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Han TZ, Han KT, Aye KH, Hlaing T, Thant KZ, Vythilingam I. Comparison of microscopy and PCR for the detection of human Plasmodium species and Plasmodium knowlesi in southern Myanmar. Asian Pac J Trop Biomed 2017. [DOI: 10.1016/j.apjtb.2017.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ifeorah IK, Brown BJ, Sodeinde OO. A COMPARISON OF RAPID DIAGNOSTIC TESTING (BY PLASMODIUM LACTATE DEHYDROGENASE), AND QUANTITATIVE BUFFY COAT TECHNIQUE IN MALARIA DIAGNOSIS IN CHILDREN. Afr J Infect Dis 2017; 11:31-38. [PMID: 28670638 PMCID: PMC5476811 DOI: 10.21010/ajid.v11i2.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) considers early and rapid diagnosis as one of the strategies to control malaria. This study compared the performance of Quantitative Buffy Coat (QBC) test and the Plasmodium lactate dehydrogenase (pLDH) rapid diagnostic test (RDT) with microscopy as the gold standard. MATERIALS AND METHODS The study involved children ages 0-5 years who presented with a history of fever at the University College Hospital, Ibadan, Nigeria. Blood was collected from each patient and used for RDT, QBC and Giemsa-stained blood films for malaria parasites (MP). Results of QBC and RDT were compared with microscopy results for the diagnosis of malaria. RESULTS A total of 370 cases (194 boys and 176 girls) were studied giving a male: female ratio of 1.1:1. Of the 370 cases tested using Giemsa-stained thick blood films for MP, 78 (21 %) were positive. For the QBC test, 78 (21%) of the cases were positive with sensitivity, specificity, positive and negative predictive values of 70.5 %, 92.1%, 70.5 % and 92.1 % respectively. Seventy-six (20%) of the cases were positive by RDT with sensitivity, specificity, positive and negative predictive values of 84.2 %, 95.2 %, 82.1 %, and 95.9 % respectively. There was no significant difference in the sensitivity of QBC compared with the RDT. CONCLUSION Both the QBC and the pfLDH (RDT) performed reasonably well in this study Malaria rapid diagnostic tests are recommended in malaria endemic clinical settings to avoid unnecessary antimalarial treatment. List of Abbreviations: AO: Acridine orange, AIDS: Acquired immunodeficiency syndrome, ACT: Artemisinin-based combination therapy, CM:Cerebral malaria, BCP:Benzothiocarboxypurine, DDT:Dichloro-diphenyl-trichloroethane, DNA:DeoxyriboNucleic Acid, ELAM-1: Endothelial leukocyte adhesion molecule, G6PD: Glucose-6-Phosphate Dehydrogenase, HIV: Human immuno deficiency virus, HRP 2: Histidine Rich Protein 2, ICAM -1: Inter cellular adhesion molecule1, ICER: Incremental cost effectiveness ratio, IL-1: Interleukin -1, IFN-g: Interferon-gamma, IgG: Immunoglobulin G, MP: Malaria parasite, NADP: Oxidised Nicotinamide Adenine Dinucleotide Phosphate, NADPH: Reduced Nicotinamide Adenine Dinucleotide Phosphate, PCV: Packed Cell Volume (haematocrit), P. falciparum: Plasmodium falciparum, PLDH: Plasmodium lactate dehydrogenase, PCR: Polymerase Chain Reaction, PPV: Positive predictive value, QBC: Quantitative Buffy Coat examination, TNF: Tumour necrosis factor, NPV: Negative predictive value, RDT: Rapid diagnostic test, SP: Sulphadoxine -Pyrimethamine, SMA: Severe malarial anaemia, UM: Uncomplicated malaria, USA:United States of America, VCAM-1: Vascular cell adhesion molecule, WBC: White Blood Cell, WHO: World Health Organization.
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Affiliation(s)
| | | | - Olugbemiro O Sodeinde
- Adjunct Professor, Department of Paediatrics, College of Medicine, University of Ibadan, University College Hospital, Ibadan
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Teshome EM, Otieno W, Terwel SR, Osoti V, Demir AY, Andango PEA, Prentice AM, Verhoef H. Comparison of home fortification with two iron formulations among Kenyan children: Rationale and design of a placebo-controlled non-inferiority trial. Contemp Clin Trials Commun 2017; 7:1-10. [PMID: 29696163 PMCID: PMC5898495 DOI: 10.1016/j.conctc.2017.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/11/2017] [Accepted: 04/08/2017] [Indexed: 10/24/2022] Open
Abstract
Introduction Home fortification powders containing iron and other micronutrients have been recommended by World Health Organisation to prevent iron deficiency anaemia in areas of high prevalence. There is evidence, however, that home fortification at this iron dose may cause gastrointestinal adverse events including diarrhoea. Providing a low dose of highly absorbable iron (3 mg iron as NaFeEDTA) may be safer because the decreased amount of iron in the gut lumen can possibly reduce the burden of these adverse effects whilst resulting in similar or higher amounts of absorbed iron. Objective To show non-inferiority of home fortification with 3 mg iron as NaFeEDTA compared with 12.5 mg iron as encapsulated ferrous fumarate, with haemoglobin response as the primary outcome. Design 338 Kenyan children aged 12-36 months will be randomly allocated to daily home fortification with either: a) 3 mg iron as NaFeEDTA (experimental treatment), b) 12.5 mg iron as encapsulated ferrous fumarate (reference), or c) placebo. At baseline, after 30 days of intervention and within 100 days post-intervention, blood samples will be assessed for primary outcome (haemoglobin concentration), iron status markers, Plasmodium parasitaemia and inflammation markers. Urine and stool samples will be assessed for hepcidin concentrations and inflammation, respectively. Adherence will be assessed by self-reporting, sachet counts and by an electronic monitoring device. Conclusion If daily home fortification with a low dose of iron (3 mg NaFeEDTA) has similar or superior efficacy to a high dose (12.5 mg ferrous fumarate) then it would be the preferred choice for treatment of iron deficiency anaemia in children.
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Affiliation(s)
- Emily M Teshome
- MRCG Keneba, MRC Unit The Gambia, Banjul, Gambia.,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Walter Otieno
- Maseno University, School of Medicine, Maseno, Kenya
| | - Sofie R Terwel
- Wageningen University, Cell Biology and Immunology Group, Division of Human Nutrition, Wageningen, The Netherlands
| | - Victor Osoti
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | - Ayşe Y Demir
- Meander Medical Centre, Laboratory for Clinical Chemistry, Amersfoort, The Netherlands
| | - Pauline E A Andango
- Maseno University, School of Public Health and Community Development, Maseno, Kenya
| | - Andrew M Prentice
- MRCG Keneba, MRC Unit The Gambia, Banjul, Gambia.,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Hans Verhoef
- MRCG Keneba, MRC Unit The Gambia, Banjul, Gambia.,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.,Wageningen University, Cell Biology and Immunology Group, Division of Human Nutrition, Wageningen, The Netherlands
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Parsel SM, Gustafson SA, Friedlander E, Shnyra AA, Adegbulu AJ, Liu Y, Parrish NM, Jamal SA, Lofthus E, Ayuk L, Awasom C, Henry CJ, McArthur CP. Malaria over-diagnosis in Cameroon: diagnostic accuracy of Fluorescence and Staining Technologies (FAST) Malaria Stain and LED microscopy versus Giemsa and bright field microscopy validated by polymerase chain reaction. Infect Dis Poverty 2017; 6:32. [PMID: 28372570 PMCID: PMC5379548 DOI: 10.1186/s40249-017-0251-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/25/2017] [Indexed: 12/03/2022] Open
Abstract
Background Malaria is a major world health issue and its continued burden is due, in part, to difficulties in the diagnosis of the illness. The World Health Organization recommends confirmatory testing using microscopy-based techniques or rapid diagnostic tests (RDT) for all cases of suspected malaria. In regions where Plasmodium species are indigenous, there are multiple etiologies of fever leading to misdiagnoses, especially in populations where HIV is prevalent and children. To determine the frequency of malaria infection in febrile patients over an 8-month period at the Regional Hospital in Bamenda, Cameroon, we evaluated the clinical efficacy of the Flourescence and Staining Technology (FAST) Malaria stain and ParaLens AdvanceTM microscopy system (FM) and compared it with conventional bright field microscopy and Giemsa stain (GS). Methods Peripheral blood samples from 522 patients with a clinical diagnosis of “suspected malaria” were evaluated using GS and FM methods. A nested PCR assay was the gold standard to compare the two methods. PCR positivity, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Results Four hundred ninety nine samples were included in the final analysis. Of these, 30 were positive via PCR (6.01%) with a mean PPV of 19.62% and 27.99% for GS and FM, respectively. The mean NPV was 95.01% and 95.28% for GS and FM, respectively. Sensitivity was 26.67% in both groups and specificity was 92.78% and 96.21% for GS and FM, respectively. An increased level of diagnostic discrepancy was observed between technicians based upon skill level using GS, which was not seen with FM. Conclusions The frequency of malarial infections confirmed via PCR among patients presenting with fever and other symptoms of malaria was dramatically lower than that anticipated based upon physicians’ clinical suspicions. A correlation between technician skill and accuracy of malaria diagnosis using GS was observed that was less pronounced using FM. Additionally, FM increased the specificity and improved the PPV, suggesting this relatively low cost approach could be useful in resource-limited environments. Anecdotally, physicians were reluctant to not treat all patients symptomatically before results were known and in spite of a negative microscopic diagnosis, highlighting the need for further physician education to avoid this practice of overtreatment. A larger study in an area with a known high prevalence is being planned to compare the two microscopy methods against available RDTs. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0251-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sean M Parsel
- Department of Pathology, Kansas City University of Medicine and Biosciences, 1750 Independence Ave, Kansas, MO, 64106, USA. .,Department of Otolaryngology, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70115, USA.
| | - Steven A Gustafson
- Department of Pathology, Kansas City University of Medicine and Biosciences, 1750 Independence Ave, Kansas, MO, 64106, USA
| | - Edward Friedlander
- Department of Pathology, Kansas City University of Medicine and Biosciences, 1750 Independence Ave, Kansas, MO, 64106, USA
| | - Alexander A Shnyra
- Department of Pharmacology and Microbiology, Kansas City University of Medicine and Biosciences, 1750 Independence Ave, Kansas, MO, 64106, USA
| | | | - Ying Liu
- Department of Biostatistics and Epidemiology, East Tennessee State University, P.O. Box 70259, Johnson, TN, 37614, USA
| | - Nicole M Parrish
- Department of Pathology, Division of Microbiology, Johns Hopkins Medical Institute, Meyer B1-193, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Syed A Jamal
- Rockhurst University, 1100 Rockhurst Rd, Kansas, MO, 64110, USA
| | - Eve Lofthus
- University of Missouri-Kansas City, School of Dentistry, 650 E 25th Street, Kansas, MO, 64108, USA
| | - Leo Ayuk
- Cameroon Ministry of Health Regional Hospital, Bamenda, Cameroon
| | - Charles Awasom
- Cameroon Ministry of Health Regional Hospital, Bamenda, Cameroon
| | - Carolyn J Henry
- Department of Veterinary Medicine and Surgery, University of Missouri, 900 East Campus Drive, Columbia, MO, 65211, USA
| | - Carole P McArthur
- University of Missouri-Kansas City, School of Dentistry, 650 E 25th Street, Kansas, MO, 64108, USA
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Kang JM, Cho PY, Moe M, Lee J, Jun H, Lee HW, Ahn SK, Kim TI, Pak JH, Myint MK, Lin K, Kim TS, Na BK. Comparison of the diagnostic performance of microscopic examination with nested polymerase chain reaction for optimum malaria diagnosis in Upper Myanmar. Malar J 2017; 16:119. [PMID: 28302168 PMCID: PMC5356273 DOI: 10.1186/s12936-017-1765-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/28/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Accurate diagnosis of Plasmodium infection is crucial for prompt malaria treatment and surveillance. Microscopic examination has been widely applied as the gold standard for malaria diagnosis in most part of malaria endemic areas, but its diagnostic value has been questioned, particularly in submicroscopic malaria. In this study, the diagnostic performance of microscopic examination and nested polymerase chain reaction (PCR) was evaluated to establish optimal malaria diagnosis method in Myanmar. METHODS A total of 1125 blood samples collected from residents in the villages and towns located in Naung Cho, Pyin Oo Lwin, Tha Beik Kyin townships and Mandalay of Upper Myanmar were screened by microscopic examination and species-specific nested PCR method. RESULTS Among the 1125 blood samples, 261 samples were confirmed to be infected with malaria by microscopic examination. Evaluation of the 1125 samples by species-specific nested PCR analysis revealed that the agreement between microscopic examination and nested PCR was 87.3% (261/299). Nested PCR successfully detected 38 Plasmodium falciparum or Plasmodium vivax infections, which were missed in microscopic examination. Microscopic examinations also either misdiagnosed the infected Plasmodium species, or did not detect mixed infections with different Plasmodium species in 31 cases. CONCLUSIONS The nested PCR method is more reliable than conventional microscopic examination for the diagnosis of malaria infections, and this is particularly true in cases of mixed infections and submicroscopic infections. Given the observed higher sensitivity and specificity of nested PCR, the molecular method holds enormous promise in malaria diagnosis and species differentiation, and can be applied as an effective monitoring tool for malaria surveillance, control and elimination in Myanmar.
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Affiliation(s)
- Jung-Mi Kang
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea.,BK21Plus Team for Anti-Aging Biotechnology and Industry, Department of Convergence Medical Science, Gyeongsang National University, Jinju, 52727, Republic of Korea
| | - Pyo-Yun Cho
- Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Mya Moe
- Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar
| | - Jinyoung Lee
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea
| | - Hojong Jun
- Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Hyeong-Woo Lee
- Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Seong Kyu Ahn
- Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Tae Im Kim
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea
| | - Jhang Ho Pak
- Department of Convergence Medicine, University of Ulsan College of Medicine and Asan Institute for Life Sciences, Asan Medical Center, Seoul, 05505, Republic of Korea
| | - Moe Kyaw Myint
- Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar
| | - Khin Lin
- Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar.
| | - Tong-Soo Kim
- Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea.
| | - Byoung-Kuk Na
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea. .,BK21Plus Team for Anti-Aging Biotechnology and Industry, Department of Convergence Medical Science, Gyeongsang National University, Jinju, 52727, Republic of Korea.
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Tarimo DS, Minjas JN, Bygbjerg IC. Malaria diagnosis and treatment under the strategy of the integrated management of childhood illness (IMCI): relevance of laboratory support from the rapid immunochromatographic tests of ICT Malaria P.f/P.v and OptiMal. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2016. [DOI: 10.1080/00034983.2001.11813657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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John SM, Sudarsanam A, Sitaram U, Moody AH. Evaluation of OptiMAL™, a dipstick test for the diagnosis of malaria. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2016. [DOI: 10.1080/00034983.1998.11813320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Xu C, Wei QK, Li J, Xiao T, Yin K, Zhao CL, Wang YB, Kong XL, Zhao GH, Sun H, Liu X, Huang BC. Characteristics of Imported Malaria and Species of Plasmodium Involved in Shandong Province, China (2012-2014). THE KOREAN JOURNAL OF PARASITOLOGY 2016; 54:407-14. [PMID: 27658591 PMCID: PMC5040091 DOI: 10.3347/kjp.2016.54.4.407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/19/2016] [Accepted: 05/24/2016] [Indexed: 02/04/2023]
Abstract
Malaria remains a serious public health problem in Shandong Province, China; therefore, it is important to explore the characteristics of the current malaria prevalence situation in the province. In this study, data of malaria cases reported in Shandong during 2012-2014 were analyzed, and Plasmodium species were confirmed by smear microscopy and nested-PCR. A total of 374 malaria cases were reported, 80.8% of which were reported from 6 prefectures. Of all cases, P. falciparum was dominant (81.3%), followed by P. vivax (11.8%); P. ovale and P. malariae together accounted for 6.4% of cases. Notably, for the first time since 2012, no indigenous case had been reported in Shandong Province, a situation that continued through 2014. Total 95.2% of cases were imported from Africa. The ratio of male/female was 92.5:1, and 96.8% of cases occurred in people 20-54 years of age. Farmers or laborers represented 77.5% of cases. No significant trends of monthly pattern were found in the reported cases. All patients were in good condition after treatment, except for 3 who died. These results indicate that imported malaria has increased significantly since 2012 in Shandong Province, especially for P. falciparum, and there is an emergence of species diversity.
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Affiliation(s)
- Chao Xu
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Qing-Kuan Wei
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Jin Li
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Ting Xiao
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Kun Yin
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Chang-Lei Zhao
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Yong-Bin Wang
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Xiang-Li Kong
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Gui-Hua Zhao
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Hui Sun
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Xin Liu
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
| | - Bing-Cheng Huang
- Shandong Academy of Medical Sciences, Shandong Institute of Parasitic Diseases, Shandong Provincial Reference Laboratory for Malaria Diagnosis, Jining, Shandong Province 272033, People's Republic of China
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Tay A, Pavesi A, Yazdi SR, Lim CT, Warkiani ME. Advances in microfluidics in combating infectious diseases. Biotechnol Adv 2016; 34:404-421. [PMID: 26854743 PMCID: PMC7125941 DOI: 10.1016/j.biotechadv.2016.02.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 12/11/2022]
Abstract
One of the important pursuits in science and engineering research today is to develop low-cost and user-friendly technologies to improve the health of people. Over the past decade, research efforts in microfluidics have been made to develop methods that can facilitate low-cost diagnosis of infectious diseases, especially in resource-poor settings. Here, we provide an overview of the recent advances in microfluidic devices for point-of-care (POC) diagnostics for infectious diseases and emphasis is placed on malaria, sepsis and AIDS/HIV. Other infectious diseases such as SARS, tuberculosis, and dengue are also briefly discussed. These infectious diseases are chosen as they contribute the most to disability-adjusted life-years (DALYs) lost according to the World Health Organization (WHO). The current state of research in this area is evaluated and projection toward future applications and accompanying challenges are also discussed.
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Affiliation(s)
- Andy Tay
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore 117575, Singapore; Department of Bioengineering, University of California Los Angeles, CA 90025, United States
| | - Andrea Pavesi
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602, Singapore
| | - Saeed Rismani Yazdi
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602, Singapore; Polytechnic University of Milan, Milan 20133, Italy
| | - Chwee Teck Lim
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602, Singapore; Mechanobiology Institute, National University of Singapore, Singapore 117411, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore 117575, Singapore
| | - Majid Ebrahimi Warkiani
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602, Singapore; School of Mechanical and Manufacturing Engineering, Australian Centre for NanoMedicine, University of New South Wales, Sydney, NSW 2052, Australia.
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Cho SJ, Lee J, Lee HJ, Jo HY, Sinniah M, Kim HY, Chong CK, Song HO. A Novel Malaria Pf/Pv Ab Rapid Diagnostic Test Using a Differential Diagnostic Marker Identified by Network Biology. Int J Biol Sci 2016; 12:824-35. [PMID: 27313496 PMCID: PMC4910601 DOI: 10.7150/ijbs.14408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/06/2016] [Indexed: 11/05/2022] Open
Abstract
Rapid diagnostic tests (RDTs) can detect anti-malaria antibodies in human blood. As they can detect parasite infection at the low parasite density, they are useful in endemic areas where light infection and/or re-infection of parasites are common. Thus, malaria antibody tests can be used for screening bloods in blood banks to prevent transfusion-transmitted malaria (TTM), an emerging problem in malaria endemic areas. However, only a few malaria antibody tests are available in the microwell-based assay format and these are not suitable for field application. A novel malaria antibody (Ab)-based RDT using a differential diagnostic marker for falciparum and vivax malaria was developed as a suitable high-throughput assay that is sensitive and practical for blood screening. The marker, merozoite surface protein 1 (MSP1) was discovered by generation of a Plasmodium-specific network and the hierarchical organization of modularity in the network. Clinical evaluation revealed that the novel Malaria Pf/Pv Ab RDT shows improved sensitivity (98%) and specificity (99.7%) compared with the performance of a commercial kit, SD BioLine Malaria P.f/P.v (95.1% sensitivity and 99.1% specificity). The novel Malaria Pf/Pv Ab RDT has potential for use as a cost-effective blood-screening tool for malaria and in turn, reduces TTM risk in endemic areas.
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Affiliation(s)
- Sung Jin Cho
- 1. Department of Bioinformatics, College of Natural Sciences, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Jihoo Lee
- 2. Department of Biochemistry, College of Natural Sciences, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Hyun Jae Lee
- 1. Department of Bioinformatics, College of Natural Sciences, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Hyun-Young Jo
- 3. Laboratory Medicine, Chungbuk National University Hospital, Cheongju, Chungbuk, Republic of Korea
| | | | - Hak-Yong Kim
- 2. Department of Biochemistry, College of Natural Sciences, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - Chom-Kyu Chong
- 5. GenBody Inc., Dankook Biotech Business IC, Cheonan, Chungnam, Republic of Korea
| | - Hyun-Ok Song
- 6. Department of Infection Biology, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea
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Nam J, Shin Y, Tan JKS, Lim YB, Lim CT, Kim S. High-throughput malaria parasite separation using a viscoelastic fluid for ultrasensitive PCR detection. LAB ON A CHIP 2016; 16:2086-2092. [PMID: 27160315 DOI: 10.1039/c6lc00162a] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A novel microfluidic device for high-throughput particle separation using a viscoelastic fluid, which enables the rapid detection of extremely rare malaria parasites by using PCR analysis, is proposed. Our device consists of two segments: the 1st stage for sheathless pre-alignment and the 2nd stage for separation based on size-dependent viscoelasticity-induced lateral migration. The use of a high-aspect ratio channel and a viscoelastic polymer solution with low viscosity enables high-throughput processing. The device performance was first optimized using synthetic particles. A mixture of 2 and 10 μm particles was focused at the center plane in the 1st stage. The smaller particles, serving as surrogates for malaria parasites, were subsequently separated in the 2nd stage with a recovery rate of ∼96% at 400 μl min(-1). Finally, separation of the malaria parasites from the white blood cells was performed. At 400 μl min(-1), almost all white blood cells were removed and the malaria parasites were separated with a ∼94% recovery rate and ∼99% purity. Although the initial concentration of the malaria parasites was too low to be detected by PCR analysis, WBC depletion and buffer removal increased the parasite concentration sufficiently such that PCR detection was possible.
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Affiliation(s)
- Jeonghun Nam
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, 117575, Singapore.
| | - Yong Shin
- Department of Convergence Medicine, Biomedical Engineering Research Center, University of Ulsan College of Medicine & Asan Institute for Life Sciences, Asan Medical Center, 88 Olympicro-43gil, Songpa-gu, Seoul, Republic of Korea
| | - Justin Kok Soon Tan
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, 117575, Singapore.
| | - Ying Bena Lim
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, 117575, Singapore. and Infectious Diseases (ID) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore
| | - Chwee Teck Lim
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, 117575, Singapore.
| | - Sangho Kim
- Department of Biomedical Engineering, National University of Singapore, 9 Engineering Drive 1, 117575, Singapore. and Department of Surgery, National University of Singapore, 1E Kent Ridge Road, 119228, Singapore
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Nahavandi M. Continuous-Flow Separation of Malaria-Infected Human Erythrocytes Using DC Dielectrophoresis: An Electrokinetic Modeling and Simulation. Ind Eng Chem Res 2016. [DOI: 10.1021/acs.iecr.6b00660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Milad Nahavandi
- Department of Chemical & Materials Engineering, University of Idaho, Moscow, Idaho 83844, United States
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Lack of knowledge regarding the microscopic diagnosis of malaria by technicians of the laboratory network in Luanda, Angola. BIOMEDICA 2016; 36:149-55. [PMID: 27622448 DOI: 10.7705/biomedica.v36i1.2623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/28/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Malaria is still one of the most important public health problems worldwide. The diagnosis of this disease is still mainly based on thick blood films. OBJECTIVE To evaluate the knowledge about malaria diagnosis of the technicians of the public health network in Luanda, Angola, by means of a survey. MATERIALS AND METHODS This survey was carried out in three phases. In the first one, open interviews were done to technicians related with the different procedures for malaria diagnosis. In the second one, a preliminary questionnaire was prepared and evaluated. In the third phase, a definitive questionnaire was applied to 120 technicians from Luanda between April and July, 2013. The proportions of correct and incorrect answers were compared for every question of the survey. RESULTS Significantly higher proportions of incorrect answers (p<0.05) were found in the questions related to clinical manifestations, 68/52 (p<0.05), species of Plasmodium according to geographical areas, 76/44 (p<0.05), the type of granulations according to species, 96/24 (p<0.01), the class of microscope magnifying glasses used to observe the thick smear, 105/15 (p<0.01), the thick smear report, 76/44 (p<0.01), the time and preparation of different stain solutions, 81/39 (p<0.01), and the number of parasites counted per 200 leukocytes, 96/24 (p<0.01). CONCLUSIONS Various failures for the microscopic diagnosis of malaria were observed amongst the evaluated technicians. These results will be useful as a baseline study before applying an educational intervention aimed to improve the quality of malaria diagnosis in Luanda's laboratory network.
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Amoah LE, Abankwa J, Oppong A. Plasmodium falciparum histidine rich protein-2 diversity and the implications for PfHRP 2: based malaria rapid diagnostic tests in Ghana. Malar J 2016; 15:101. [PMID: 26891848 PMCID: PMC4759916 DOI: 10.1186/s12936-016-1159-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background Malaria rapid diagnostic tests (RDTs) play a key role in malaria management and control. The PfHRP-2 based RDT is the most widely used RDT for malaria diagnosis in Ghana. Deletion of pfhrp2 in Plasmodium falciparum parasites affect the diagnostic accuracy of PfHRP-2 based RDT kits. Identifying the prevalence and distribution of P. falciparum parasites with deleted pfhrp2 is important for malaria control. Aim The purpose of this study was to identify and confirm the prevalence of pfhrp2 deletant P. falciparum parasites circulating within different regions of Ghana. Methods DNA was extracted from the membrane of spent CareStart™ PfHRP-2 RDT kits and dried filter paper blood blots using Chelex-100. Exon 2 of pfhrp2 and pfhrp3 genes were amplified by polymerase chain reaction (PCR), resolved by agarose gel electrophoresis and visualized under UV light. Results Microscopic analysis of blood smears from samples that were PfHRP-2 RDT positive revealed a parasite prevalence of 54/114 (47.4 %) and 2/26 (7.7 %) in Accra and Cape Coast, respectively. PCR analysis increased parasite prevalence in the RDT positive samples to 94/114 (82.5 %) and 6/26 (23.1 %) in Accra and Cape Coast respectively. The exon 2 of the pfhrp2 gene was deleted in 18/54 (33.3 %) of the microscopy confirmed and 36.2 % (34/94) of the PCR confirmed RDT positive samples collected in Accra. No RDT sample, confirmed to contain parasites by either PCR or microscopy was negative by pfhrp2 exon 2 PCR in Cape Coast. A survey of an additional 558 DBS revealed that 22.4 % (46/205) and 40 % (44/110) of PCR positive samples in Accra and Cape Coast, respectively, lacked the exon 2 region of pfhrp2 and possibly the entire pfhrp2 gene. Conclusions A high number of P. falciparum parasites, which lack pfhrp2 exon 2 gene have been identified in two communities in Ghana. Continuous nationwide monitoring of the prevalence of pfhrp2 deletant parasites would be essential to malaria control. The use of RDT kits that are effective at malaria diagnosis despite deletion of pfhrp2, such as the PfHRP-2/PfLDH combo RDT kit could enhance the diagnosis of clinical malaria in Ghana.
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Affiliation(s)
- Linda Eva Amoah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
| | - Joana Abankwa
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
| | - Akua Oppong
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
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Rapid Point-of-Care Diagnosis of Malaria and Dengue Infection. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Holmström O, Linder N, Lundin M, Moilanen H, Suutala A, Turkki R, Joensuu H, Isola J, Diwan V, Lundin J. Quantification of Estrogen Receptor-Alpha Expression in Human Breast Carcinomas With a Miniaturized, Low-Cost Digital Microscope: A Comparison with a High-End Whole Slide-Scanner. PLoS One 2015; 10:e0144688. [PMID: 26659386 PMCID: PMC4684374 DOI: 10.1371/journal.pone.0144688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/23/2015] [Indexed: 01/07/2023] Open
Abstract
Introduction A significant barrier to medical diagnostics in low-resource environments is the lack of medical care and equipment. Here we present a low-cost, cloud-connected digital microscope for applications at the point-of-care. We evaluate the performance of the device in the digital assessment of estrogen receptor-alpha (ER) expression in breast cancer samples. Studies suggest computer-assisted analysis of tumor samples digitized with whole slide-scanners may be comparable to manual scoring, here we study whether similar results can be obtained with the device presented. Materials and Methods A total of 170 samples of human breast carcinoma, immunostained for ER expression, were digitized with a high-end slide-scanner and the point-of-care microscope. Corresponding regions from the samples were extracted, and ER status was determined visually and digitally. Samples were classified as ER negative (<1% ER positivity) or positive, and further into weakly (1–10% positivity) and strongly positive. Interobserver agreement (Cohen’s kappa) was measured and correlation coefficients (Pearson’s product-momentum) were calculated for comparison of the methods. Results Correlation and interobserver agreement (r = 0.98, p < 0.001, kappa = 0.84, CI95% = 0.75–0.94) were strong in the results from both devices. Concordance of the point-of-care microscope and the manual scoring was good (r = 0.94, p < 0.001, kappa = 0.71, CI95% = 0.61–0.80), and comparable to the concordance between the slide scanner and manual scoring (r = 0.93, p < 0.001, kappa = 0.69, CI95% = 0.60–0.78). Fourteen (8%) discrepant cases between manual and device-based scoring were present with the slide scanner, and 16 (9%) with the point-of-care microscope, all representing samples of low ER expression. Conclusions Tumor ER status can be accurately quantified with a low-cost imaging device and digital image-analysis, with results comparable to conventional computer-assisted or manual scoring. This technology could potentially be expanded for other histopathological applications at the point-of-care.
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Affiliation(s)
- Oscar Holmström
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Nina Linder
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Lundin
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Hannu Moilanen
- Center of Microscopy and Nanotechnology, University of Oulu, Oulu, Finland
| | - Antti Suutala
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Riku Turkki
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Heikki Joensuu
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jorma Isola
- BioMediTech, University of Tampere, Tampere, Finland
| | - Vinod Diwan
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Johan Lundin
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Chaponda EB, Chandramohan D, Michelo C, Mharakurwa S, Chipeta J, Chico RM. High burden of malaria infection in pregnant women in a rural district of Zambia: a cross-sectional study. Malar J 2015; 14:380. [PMID: 26423819 PMCID: PMC4590700 DOI: 10.1186/s12936-015-0866-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/22/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Malaria continues to be a major health problem in low-income countries. Consequently, malaria control remains a public health priority in endemic countries such as Zambia. Pregnant women and children under 5 years of age are among groups at high risk of malaria infection. Malaria infection is associated with adverse birth outcomes that affect the mother, foetus, and infant. Infection with HIV has been shown to increase the risk of malaria infection in pregnancy. The prevalence and the predictors of malaria infection among pregnant women resident in the Nchelenge District of northern Zambia were investigated. METHODS Between November 2013 and April 2014, pregnant women in the catchment areas of two health centres were recruited during their first antenatal care visit. HIV testing was conducted as part of routine care. In addition, blood samples were collected from 1086 participants and tested for malaria infection using standard microscopy and polymerase chain reaction (PCR) techniques specific for Plasmodium falciparum. Multivariate logistic regression were conducted to examine the predictors of malaria infection. RESULTS The prevalence of malaria identified by microscopy was 31.8 % (95 % confidence intervals [CI], 29.0-34.5; N = 1079) and by PCR was 57.8 % (95 % CI, 54.9-60.8; N = 1074). HIV infection was 13.2 % among women on their first antenatal visit; the prevalence of malaria detected by PCR among HIV-uninfected and HIV-infected women was 56.7 % (531/936) and 65.2 % (90/138), respectively. In the final model, the risk of malaria infection was 81 % higher among pregnant women recruited from Nchelenge health centre compared to those attending the Kashikishi health centre (adjusted odds ratio = 1.81; 95 % CI, 1.38-2.37, P < 0.001), and HIV-infected women across health centres had a 46 % greater risk of malaria infection compared to HIV-uninfected women (adjusted odds ratio = 1.46; 95 %, 1.00-2.13, P = 0.045). CONCLUSION High burden of malaria detected by PCR in these pregnant women suggests that past prevention efforts have had limited effect. To reduce this burden of malaria sustainably, there is clear need to strengthen existing interventions and, possibly, to change approaches so as to improve targeting of groups most affected by malaria.
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Affiliation(s)
- Enesia Banda Chaponda
- Department of Biological Sciences, University of Zambia, Lusaka, Zambia. .,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Charles Michelo
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
| | - Sungano Mharakurwa
- Africa University, Mutare, Zimbabwe. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - James Chipeta
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, P.O. Box 50110, Lusaka, Zambia.
| | - R Matthew Chico
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Breakdown of deterministic lateral displacement efficiency for non-dilute suspensions: A numerical study. Med Eng Phys 2015; 37:845-54. [PMID: 26143149 DOI: 10.1016/j.medengphy.2015.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 11/20/2022]
Abstract
We investigate the effect of particle volume fraction on the efficiency of deterministic lateral displacement (DLD) devices. DLD is a popular passive sorting technique for microfluidic applications. Yet, it has been designed for treating dilute suspensions, and its efficiency for denser samples is not well known. We perform 3D simulations based on the immersed-boundary, lattice-Boltzmann and finite-element methods to model the flow of red blood cells (RBCs) in different DLD devices. We quantify the DLD efficiency in terms of appropriate "failure" probabilities and RBC counts in designated device outlets. Our main result is that the displacement mode breaks down upon an increase of RBC volume fraction, while the zigzag mode remains relatively robust. This suggests that the separation of larger particles (such as white blood cells) from a dense RBC background is simpler than separating smaller particles (such as platelets) from the same background. The observed breakdown stems from non-deterministic particle collisions interfering with the designed deterministic nature of DLD devices. Therefore, we postulate that dense suspension effects generally hamper efficient particle separation in devices based on deterministic principles.
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Wide-field pathology imaging using on-chip microscopy. Virchows Arch 2015; 467:3-7. [DOI: 10.1007/s00428-015-1782-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/04/2015] [Indexed: 11/30/2022]
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Warkiani ME, Tay AKP, Khoo BL, Xiaofeng X, Han J, Lim CT. Malaria detection using inertial microfluidics. LAB ON A CHIP 2015; 15:1101-9. [PMID: 25537768 DOI: 10.1039/c4lc01058b] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Diagnosis of malaria at the early stage of infection is challenging due to the difficulty in detecting low abundance parasites from blood. Molecular methods such as real-time polymerase chain reaction (qPCR) can be especially useful for detecting low parasitemia levels due to their high sensitivity and their ability to recognize different malarial species and strains. Unfortunately, the accuracy of qPCR-based malaria detection can be compromised by many factors, including the limited specificity of primers, presence of PCR inhibitors in blood serum and DNA contamination from nucleated blood cells. Here, we use a label-free, shear-modulated inertial microfluidic system to enrich malaria parasites from blood so as to facilitate a more reliable and specific PCR-based malaria detection. This technique capitalizes on cell focusing behaviors in high aspect ratio microchannels coupled with pinched flow dynamics to isolate ring-stage malaria parasites from lysed blood containing white blood cells (WBCs). In this high aspect ratio (ratio of the channel height to the width) platform, the high shear rate along the channel width causes the dispersed WBCs at the inlet to migrate and align into two streams near the channel sidewalls while the malaria parasites remain unfocused. Sensitive detection of parasites at spiked densities ranging from 10(3) to 10(4)Plasmodium falciparum parasites per mL (~2-10 per μL) has been demonstrated; they have also been quantified in whole blood using qPCR. This is approximately 100-fold more sensitive than the gold standard conventional microscopy analysis of thick blood smears. The simplicity of this device makes it ideal for integration with an automatic system for ultra-fast and accurate detection despite low levels of parasitemia. It can also help in malaria screening and elimination efforts.
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Affiliation(s)
- Majid Ebrahimi Warkiani
- BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore.
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Plouffe BD, Murthy SK, Lewis LH. Fundamentals and application of magnetic particles in cell isolation and enrichment: a review. REPORTS ON PROGRESS IN PHYSICS. PHYSICAL SOCIETY (GREAT BRITAIN) 2015; 78:016601. [PMID: 25471081 PMCID: PMC4310825 DOI: 10.1088/0034-4885/78/1/016601] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Magnetic sorting using magnetic beads has become a routine methodology for the separation of key cell populations from biological suspensions. Due to the inherent ability of magnets to provide forces at a distance, magnetic cell manipulation is now a standardized process step in numerous processes in tissue engineering, medicine, and in fundamental biological research. Herein we review the current status of magnetic particles to enable isolation and separation of cells, with a strong focus on the fundamental governing physical phenomena, properties and syntheses of magnetic particles and on current applications of magnet-based cell separation in laboratory and clinical settings. We highlight the contribution of cell separation to biomedical research and medicine and detail modern cell-separation methods (both magnetic and non-magnetic). In addition to a review of the current state-of-the-art in magnet-based cell sorting, we discuss current challenges and available opportunities for further research, development and commercialization of magnetic particle-based cell-separation systems.
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Affiliation(s)
- Brian D Plouffe
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA. The Barnett Institute of Chemical and Biological Analysis, Northeastern University, Boston, MA 02115, USA
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Coskun AF, Cetin AE, Galarreta BC, Alvarez DA, Altug H, Ozcan A. Lensfree optofluidic plasmonic sensor for real-time and label-free monitoring of molecular binding events over a wide field-of-view. Sci Rep 2014; 4:6789. [PMID: 25346102 DOI: 10.1038/lsa.2014.3] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/21/2013] [Accepted: 10/06/2014] [Indexed: 05/28/2023] Open
Abstract
We demonstrate a high-throughput biosensing device that utilizes microfluidics based plasmonic microarrays incorporated with dual-color on-chip imaging toward real-time and label-free monitoring of biomolecular interactions over a wide field-of-view of >20 mm(2). Weighing 40 grams with 8.8 cm in height, this biosensor utilizes an opto-electronic imager chip to record the diffraction patterns of plasmonic nanoapertures embedded within microfluidic channels, enabling real-time analyte exchange. This plasmonic chip is simultaneously illuminated by two different light-emitting-diodes that are spectrally located at the right and left sides of the plasmonic resonance mode, yielding two different diffraction patterns for each nanoaperture array. Refractive index changes of the medium surrounding the near-field of the nanostructures, e.g., due to molecular binding events, induce a frequency shift in the plasmonic modes of the nanoaperture array, causing a signal enhancement in one of the diffraction patterns while suppressing the other. Based on ratiometric analysis of these diffraction images acquired at the detector-array, we demonstrate the proof-of-concept of this biosensor by monitoring in real-time biomolecular interactions of protein A/G with immunoglobulin G (IgG) antibody. For high-throughput on-chip fabrication of these biosensors, we also introduce a deep ultra-violet lithography technique to simultaneously pattern thousands of plasmonic arrays in a cost-effective manner.
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Affiliation(s)
- Ahmet F Coskun
- 1] Departments of Electrical Engineering and Bioengineering, University of California, Los Angeles (UCLA), CA 90095, USA [2] Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, 91125
| | - Arif E Cetin
- 1] Department of Electrical and Computer Engineering, Boston University, MA 02215, USA [2] Bioengineering Department, Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne CH-1015 Switzerland
| | - Betty C Galarreta
- 1] Department of Electrical and Computer Engineering, Boston University, MA 02215, USA [2] Pontificia Universidad Catolica del Peru, Departamento de Ciencias-Quimica, Avenida Universitaria 1801, Lima 32, Peru
| | | | - Hatice Altug
- 1] Department of Electrical and Computer Engineering, Boston University, MA 02215, USA [2] Bioengineering Department, Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne CH-1015 Switzerland
| | - Aydogan Ozcan
- 1] Departments of Electrical Engineering and Bioengineering, University of California, Los Angeles (UCLA), CA 90095, USA [2] California NanoSystems Institute, University of California, Los Angeles (UCLA), CA 90095, USA
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Jain P, Chakma B, Patra S, Goswami P. Potential biomarkers and their applications for rapid and reliable detection of malaria. BIOMED RESEARCH INTERNATIONAL 2014; 2014:852645. [PMID: 24804253 PMCID: PMC3996934 DOI: 10.1155/2014/852645] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 02/11/2014] [Indexed: 12/21/2022]
Abstract
Malaria has been responsible for the highest mortality in most malaria endemic countries. Even after decades of malaria control campaigns, it still persists as a disease of high mortality due to improper diagnosis and rapidly evolving drug resistant malarial parasites. For efficient and economical malaria management, WHO recommends that all malaria suspected patients should receive proper diagnosis before administering drugs. It is thus imperative to develop fast, economical, and accurate techniques for diagnosis of malaria. In this regard an in-depth knowledge on malaria biomarkers is important to identify an appropriate biorecognition element and utilize it prudently to develop a reliable detection technique for diagnosis of the disease. Among the various biomarkers, plasmodial lactate dehydrogenase and histidine-rich protein II (HRP II) have received increasing attention for developing rapid and reliable detection techniques for malaria. The widely used rapid detection tests (RDTs) for malaria succumb to many drawbacks which promotes exploration of more efficient economical detection techniques. This paper provides an overview on the current status of malaria biomarkers, along with their potential utilization for developing different malaria diagnostic techniques and advanced biosensors.
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Affiliation(s)
- Priyamvada Jain
- Department of Biotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Babina Chakma
- Department of Biotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Sanjukta Patra
- Department of Biotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Pranab Goswami
- Department of Biotechnology, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
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Pakalapati D, Garg S, Middha S, Acharya J, Subudhi AK, Boopathi AP, Saxena V, Kochar SK, Kochar DK, Das A. Development and evaluation of a 28S rRNA gene-based nested PCR assay for P. falciparum and P. vivax. Pathog Glob Health 2014; 107:180-8. [PMID: 23816509 DOI: 10.1179/2047773213y.0000000090] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The 28S rRNA gene was amplified and sequenced from P. falciparum and P. vivax isolates collected from northwest India. Based upon the sequence diversity of the Plasmodium 28SrRNA gene in comparison with its human counterpart, various nested polymerase chain reaction (PCR) primers were designed from the 3R region of the 28SrRNA gene and evaluated on field isolates. This is the first report demonstrating the utility of this gene for species-specific diagnosis of malaria for these two species, prevalent in India. The initial evaluation on 363 clinical isolates indicated that, in comparison with microscopy, which showed sensitivity and specificity of 85·39% and 100% respectively, the sensitivity and specificity of the nested PCR assay was found to be 99·08% and 100% respectively. This assay was also successful in detecting mixed infections that are undetected by microscopy. Our results demonstrate the utility of the 28S rRNA gene as a diagnostic target for the detection of the major plasmodial species infecting humans.
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Affiliation(s)
- Deepak Pakalapati
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Rajasthan, India
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Maltha J, Guiraud I, Lompo P, Kaboré B, Gillet P, Van Geet C, Tinto H, Jacobs J. Accuracy of PfHRP2 versus Pf-pLDH antigen detection by malaria rapid diagnostic tests in hospitalized children in a seasonal hyperendemic malaria transmission area in Burkina Faso. Malar J 2014; 13:20. [PMID: 24418119 PMCID: PMC3896846 DOI: 10.1186/1475-2875-13-20] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In most sub-Saharan African countries malaria rapid diagnostic tests (RDTs) are now used for the diagnosis of malaria. Most RDTs used detect Plasmodium falciparum histidine-rich protein-2 (PfHRP2), though P. falciparum-specific parasite lactate dehydrogenase (Pf-pLDH)-detecting RDTs may have advantages over PfHRP2-detecting RDTs. Only few data are available on the use of RDTs in severe illness and the present study compared Pf-pLDH to PfHRP2-detection. METHODS Hospitalized children aged one month to 14 years presenting with fever or severe illness were included over one year. Venous blood samples were drawn for malaria diagnosis (microscopy and RDT), culture and complete blood count. Leftovers were stored at -80 °C and used for additional RDT analysis and PCR. An RDT targeting both PfHRP2 and Pf-pLDH was performed on all samples for direct comparison of diagnostic accuracy with microscopy as reference method. PCR was performed to explore false-positive RDT results. RESULTS In 376 of 694 (54.2%) included children, malaria was microscopically confirmed. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value were 100.0, 70.9, 69.4 and 100.0%, respectively for PfHRP2-detection and 98.7, 94.0, 91.6 and 99.1%, respectively for Pf-pLDH-detection. Specificity and PPV were significantly lower for PfHRP2-detection (p <0.001). For both detection antigens, specificity was lowest for children one to five years and in the rainy season. PPV for both antigens was highest in the rainy season, because of higher malaria prevalence. False positive PfHRP2 results were associated with prior anti-malarial treatment and positive PCR results (98/114 (86.0%) samples tested). CONCLUSION Among children presenting with severe febrile illness in a seasonal hyperendemic malaria transmission area, the present study observed similar sensitivity but lower specificity and PPV of PfHRP2 compared to Pf-pLDH-detection. Further studies should assess the diagnostic accuracy and safety of an appropriate Pf-pLDH-detecting RDT in field settings and if satisfying, replacement of PfHRP2 by Pf-pLDH-detecting RDTs should be considered.
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Affiliation(s)
- Jessica Maltha
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, B 2000, Antwerp, Belgium.
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Ughasoro MD, Okoli CC, Uzochukwu BS. Qualitative study of presumptive treatment of childhood malaria in third tier tertiary hospitals in southeast Nigeria: a focus group and in-depth study. Malar J 2013; 12:436. [PMID: 24289161 PMCID: PMC4220678 DOI: 10.1186/1475-2875-12-436] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 11/25/2013] [Indexed: 11/24/2022] Open
Abstract
Background Presumptive treatment of childhood-malaria (PTCM) is common in Nigeria. Delayed laboratory result is blamed, with little attention on patients’ and providers’ roles. This study aimed to determine patient, provider and laboratory attributes that sustain PTCM in Nigeria. Methods Data collection was from focus-group discussions for parents/guardians, and in-depth interviews involving providers and laboratory scientists in two tertiary hospitals. Results All parents/guardians agreed to a malaria test. Majority accepted to come back later for full treatment, provided that some treatment was commenced. Majority affirmed that their interests are on their children’s improvement. The providers practice presumptive treatment of childhood malaria, for the following reasons: (1) malaria is endemic and should be suspected and treated; (2) microscopy takes two days to be available and parents want immediate treatment for their children, thus delay may lead to self-medication; (3) relying on results for decision to treat creates an impression of incompetence; (4) rapid diagnostic test kits (RDTs) are not available in the consulting rooms and there is doubt about their reliability; (5) patients have already wasted time before being reviewed, so wasting more time on investigation is not advisable; (6) withhold of malaria treatment may be feasible in suspected uncomplicated malaria, but if severe, then anti-malarial treatment has to start immediately. Interviews of laboratory scientists showed that (1) malaria microscopy test cannot be urgent; it is done in batches and takes 24 hours to be ready; (2) a request of malaria test with other investigations on the same form, contributes to the delay; (3) RDTs are unavailable in the facilities. Conclusions Provision of RDTs is the only feasible means to treatment of confirmed malaria at the time healthcare providers review a patient on day zero. In facilities that depend on microscopy; a common practice in resource poor countries, healthcare providers can depend on parental willingness to return later for full medication, to commence adjunctive care with antipyretics and multivitamins for uncomplicated malaria. In complicated malaria, supportive care - intravenous fluids, blood transfusion, oxygen therapy - can be commenced while awaiting the inclusion of anti-malarial drugs when the diagnosis of malaria is confirmed.
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Affiliation(s)
- Maduka D Ughasoro
- Department of Paediatrics, University of Nigeria Enugu Campus, Enugu, Nigeria.
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Assessment of Clinical Diagnosis, Microscopy, Rapid Diagnostic Tests, and Polymerase Chain Reaction in the Diagnosis of Plasmodium falciparum in Nigeria. Malar Res Treat 2013; 2013:308069. [PMID: 24371538 PMCID: PMC3859170 DOI: 10.1155/2013/308069] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/29/2013] [Accepted: 09/30/2013] [Indexed: 11/17/2022] Open
Abstract
This study compares the performance of clinical diagnosis and three laboratory diagnostic methods (thick film microscopy (TFM), rapid diagnostic test (RDT), and polymerase chain reaction (PCR)) for the diagnosis of Plasmodium falciparum in Nigeria. Using clinical criteria, 217 children were recruited into the study out of which 106 (48.8%) were positive by TFM, 84 (38.7%) by RDT, and 125 (57.6%) by PCR. Using a composite reference method generated from the three diagnostic methods, 71 (32.7%) patients were found to be truly infected and 90 (41.5%) truly uninfected, while 56 (25.8%) were misidentified as infected or noninfected. When each of the 3 diagnostic methods was compared with the composite reference, PCR had sensitivity of 97.3%, specificity of 62.5%, positive predictive value (PPV) of 56.8%, and negative predictive value (NPV) of 97.8%; microscopy had sensitivity of 77.2%, specificity of 72%, PPV of 66.9%, and NPV of 81.1%, while RDT had sensitivity of 62.3%, specificity of 87.4%, PPV of 67.7%, and NPV of 84.5%. PCR test performed best among the three methods followed by TFM and RDT in that order. The result of this study shows that clinical diagnosis cannot be relied upon for accurate diagnosis of P. falciparum in endemic areas.
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