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Kim H, Tak S, Lee SD, Park S, Hwang K. Factors associated with the timely diagnosis of malaria and the utilization of types of healthcare facilities: a retrospective study in the Republic of Korea. Osong Public Health Res Perspect 2024; 15:159-167. [PMID: 38621761 PMCID: PMC11082442 DOI: 10.24171/j.phrp.2023.0349] [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: 11/20/2023] [Revised: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND This study aimed to analyze trends in the timely diagnosis of malaria cases over the past 10 years in relation to the utilization of different types of healthcare facilities. METHODS The study included 3,697 confirmed and suspected cases of malaria reported between January 1, 2013, and December 31, 2022, in the national integrative disease and healthcare management system. Some cases lacking a case report or with information missing from the case report were excluded from the analysis. A generalized linear model with a Poisson distribution was constructed to estimate risk ratios and 95% confidence intervals adjusted for other variables, such as distance. RESULTS When cases involving diagnosis >5 days after symptom onset in confirmed patients (5DD) were examined according to the type of healthcare facility, the risk ratio of 5DD cases was found to be higher for tertiary hospitals than for public health facilities. Specifically, the risk ratio was higher when the diagnosis was established at a tertiary hospital, even after a participant had visited primary or secondary hospitals. In an analysis adjusted for the distance to each participant's healthcare facility, the results did not differ substantially from the results of the crude analysis. CONCLUSION It is imperative to improve the diagnostic capabilities of public facilities and raise awareness of malaria at primary healthcare facilities for effective prevention and control.
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Affiliation(s)
- HyunJung Kim
- Division of Control for Zoonotic and Vector Borne Disease, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Sangwoo Tak
- Division of Risk Assessment, Bureau of Public Health Emergency Preparedness, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - So-dam Lee
- Division of Control for Zoonotic and Vector Borne Disease, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Seongwoo Park
- Division of Control for Zoonotic and Vector Borne Disease, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Kyungwon Hwang
- Division of Control for Zoonotic and Vector Borne Disease, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
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Comparison of Rapid Diagnostic Test, Microscopy, and Polymerase Chain Reaction for the Detection of Plasmodium falciparum Malaria in a Low-Transmission Area, Jazan Region, Southwestern Saudi Arabia. Diagnostics (Basel) 2022; 12:diagnostics12061485. [PMID: 35741295 PMCID: PMC9222139 DOI: 10.3390/diagnostics12061485] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
This cross-sectional study aimed to assess the performances of a rapid diagnostic test (RDT)—the AllTest Malaria p.f./p.v., microscopy, and nested polymerase chain reaction (PCR) for diagnosing Plasmodium falciparum malaria in 400 febrile patients from a low-transmission region (Jazan) in southwestern Saudi Arabia. Diagnostic performance of all three methods was compared using microscopy and nested PCR as reference methods. Overall, 42 (10.5%), 48 (12.0%), and 57 (14.3%) samples were found positive by microscopy, RDT, and PCR, respectively. With PCR as reference method, the RDT showed higher sensitivity (79% vs. 71.9%), similar specificity (99.1% vs. 99.7%), and better NLR (0.20 vs. 0.27) and area under the curve (89.0% vs. 85.8%) than microscopy. The sensitivity of RDT and microscopy decreased as age increased, and false negatives were associated with low parasite density. In addition, the sensitivity of RDT and microscopy was higher in non-Saudi than in Saudi participants. Against microscopy, both RDT and PCR showed high sensitivity (83.3% vs. 97.6%), specificity (96.4% vs. 95.5%), and NPVs (98.0% vs. 99.7%), but reduced PPVs (72.9% vs. 71.9%), respectively. The results showed that the performance of the AllTest Malaria p.f./p.v RDT was better than that of microscopy in diagnosing P. falciparum malaria among febrile patients in the Jazan region when nested PCR was used as the reference. However, further studies are required to assess malaria diagnostic methods among asymptomatic individuals in the region.
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Current methods for the detection of Plasmodium parasite species infecting humans. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2022; 2:100086. [PMID: 35434694 PMCID: PMC9006665 DOI: 10.1016/j.crpvbd.2022.100086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
Abstract
Malaria is the world’s fatal parasitic disease. The ability to quickly and accurately identify malaria infection in challenging environments is crucial to allow efficient administration of the best treatment regime for human patients. If those techniques are accessible and efficient, global detection of Plasmodium species will become more sensitive, allowing faster and more precise action to be taken for disease control strategies. Recent advances in technology have enhanced our ability to diagnose different species of Plasmodium parasites with greater sensitivity and specificity. This literature review provides a summary and discussion of the current methods for the diagnosis and identification of Plasmodium spp. in human blood samples. So far not a single method is precise, but advanced technologies give consistent identification of a Plasmodium infection in endemic regions. By using the power of the recent methods, we can provide a broader understanding of the multiplicity of infection and or transmission dynamics of Plasmodium spp. This will result in improved disease control strategies, better-informed policy, and effective treatment for malaria-positive patients. Summary of the methods currently available for the detection of Plasmodium spp. infecting humans. No single method is perfect for every application to identify Plasmodium spp. Newly developed methods give promise for more reliable characterisation of Plasmodium spp.
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Forgie EME, Brooks HM, Barton M, Hawkes MT. Pediatric Malaria: Global and North American Perspectives. Pediatr Clin North Am 2022; 69:47-64. [PMID: 34794676 DOI: 10.1016/j.pcl.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Malaria is a leading cause of death in children less than 5 years of age globally, and a common cause of fever in the returning North American traveler. New tools in the fight against malaria have been developed over the past decades: potent artemisinin derivatives; rapid diagnostic tests; long-lasting insecticidal bed nets; and a new vaccine, RTS,S/AS01. Thwarting these advances, parasite and Anopheles vector resistance are emerging. In the meantime, clinicians will continue to see malaria among febrile travelers from the tropics. Early recognition, diagnosis, and treatment can be lifesaving, but rely on the vigilance of frontline clinicians.
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Affiliation(s)
- Ella M E Forgie
- Department of Anthropology, University of Alberta, Tory Building, 11211 Saskatchewan Drive, Edmonton, Alberta T6G 2H4, Canada
| | - Hannah M Brooks
- Faculty of Nursing, University of Alberta, 5-143 Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada
| | - Michelle Barton
- Department of Paediatrics, Division of Pediatric Infectious Diseases, Schulich School of Medicine, Western University, Children's Health Research Institute, Lawson Health Research Institute, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada
| | - Michael T Hawkes
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada; Department of Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada; School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada; Women and Children's Health Research Institute, Edmonton, Canada.
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Baptista V, Costa MS, Calçada C, Silva M, Gil JP, Veiga MI, Catarino SO. The Future in Sensing Technologies for Malaria Surveillance: A Review of Hemozoin-Based Diagnosis. ACS Sens 2021; 6:3898-3911. [PMID: 34735120 DOI: 10.1021/acssensors.1c01750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Early and effective malaria diagnosis is vital to control the disease spread and to prevent the emergence of severe cases and death. Currently, malaria diagnosis relies on optical microscopy and immuno-rapid tests; however, these require a drop of blood, are time-consuming, or are not specific and sensitive enough for reliable detection of low-level parasitaemia. Thus, there is an urge for simpler, prompt, and accurate alternative diagnostic methods. Particularly, hemozoin has been increasingly recognized as an attractive biomarker for malaria detection. As the disease proliferates, parasites digest host hemoglobin, in the process releasing toxic haem that is detoxified into an insoluble crystal, the hemozoin, which accumulates along with infection progression. Given its magnetic, optical, and acoustic unique features, hemozoin has been explored for new label-free diagnostic methods. Thereby, herein, we review the hemozoin-based malaria detection methods and critically discuss their challenges and potential for the development of an ideal diagnostic device.
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Affiliation(s)
- Vitória Baptista
- Microelectromechanical Systems Research Unit (CMEMS-UMinho), School of Engineering, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3B’s − PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - Mariana S. Costa
- Microelectromechanical Systems Research Unit (CMEMS-UMinho), School of Engineering, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal
| | - Carla Calçada
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3B’s − PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, 3004-504 Coimbra, Portugal
| | - Miguel Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3B’s − PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - José Pedro Gil
- Stockholm Malaria Center, Department of Microbiology and Tumour Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Maria Isabel Veiga
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3B’s − PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - Susana O. Catarino
- Microelectromechanical Systems Research Unit (CMEMS-UMinho), School of Engineering, University of Minho, Campus de Azurém, 4800-058 Guimarães, Portugal
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Comparative analysis of four malaria diagnostic tools and implications for malaria treatment in southwestern Nigeria. Int J Infect Dis 2021; 108:377-381. [PMID: 34044139 DOI: 10.1016/j.ijid.2021.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES One of the problems encountered in malaria control and elimination is inaccurate diagnosis, resulting from the degree of sensitivity of the different malaria diagnostic tools. Even though microscopy remains the gold standard for malaria diagnosis, more sensitive and robust diagnostic tools such as polymerase chain reactions (PCR) are used in research settings to monitor interventions and track sub-microscopic infections due to some of the drawbacks of microscopy. Since diagnosis is a critical determinant for rational malaria treatment, it is imperative that accurate diagnosis must be assured for an effective treatment plan. Therefore, this study compared two routinely used point of care malaria diagnostic tools with two molecular tools and discussed their implication for malaria treatment. DESIGN In this study, 436 individuals with suspected malaria were sampled and systematically tested using four methods, namely rapid diagnostic test (henceforth referred to as malaria RDT- mRDT), microscopy, nested PCR (nPCR), and quantitative PCR (qPCR). Test sensitivities and specificities were compared, and their level of concordance was determined. RESULTS With nPCR as the gold standard, a false positivity rate of 42.2%, 8.9%, and 57.8% was obtained for mRDT, microscopy, and qPCR. Similarly, false negativity rates of 12.5%, 62.5%, and 0.8% were obtained for each of the methods mentioned above, respectively. Of all the tools assessed, qPCR gave the highest sensitivity (99.2%) and moderate specificity (42.2%), followed by the mRDT kit used (87.5%). CONCLUSIONS With the detection of a high false positivity rate based on mRDT and a substantial proportion of sub-microscopic carriers in this study area by nested/quantitative PCR, we recommend that these molecular tools should be in specialized laboratories within the region to (i) track and treat sub-microscopic carriers to prevent their contribution to malaria transmission; (ii) provide reliable epidemiological data using high throughput testing tools for evaluating malaria interventions.
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Li Q, Xie LH, Zhang J, Pybus BS. Identification and Assessment of Plasmodium berghei Merozoites and Cell Cycle by Flow Cytometry. Mil Med 2021; 186:108-115. [PMID: 33499463 DOI: 10.1093/milmed/usaa272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/31/2020] [Accepted: 08/19/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The asexual blood stages of the Plasmodium berghei life cycle including merozoites are attractive targets for transmission blocking vaccines and drugs. Improved understanding of P. berghei life cycle stage growth and development would provide new opportunities to evaluate antimalarial vaccines and drugs. METHODS Blood stage samples from C57BL/6 albino mice infected with P. berghei sporozoites were singly stained with a high binding affinity deoxyribonucleic acid dye, YOYO-1, and measured by flow cytometry (FCM). Duplicate slides were made from samples and stained with diluted Giemsa's and YOYO-1, respectively. Correlated results were compared by FCM, light microscopy, and fluorescent microscopy. RESULTS Complete life cycle stage determination and analysis by FCM is reported to include merozoites, ring forms, trophozoites, immature, and mature schizonts. FCM demonstrated a clear separation between each stage using their unique fluorescence distribution. When compared to light microscopy, a strong correlation (r 2 = 0.925 to 0.974) was observed in determining the ring forms, trophozoites, and schizonts phases, but only a moderate correlation (r 2 = 0.684 to 0.778) was observed for merozoites. The identification and measurement of merozoites suggest that FCM is a useful technique to monitor the entire life stage of the parasite. Initial stage-specific data demonstrated that mefloquine has a mode of action on mature parasite forms, and artesunic acid was rapidly effective against merozoites and other immature and mature parasite forms with higher killing. CONCLUSION Blood stage parasites in each individual life stage, including merozoites, are reliably identified and quantified quickly by FCM, making this technique an ideal alternative to microscopy. This integrated whole life stage model, particularly with confirmed determination of merozoite population, could widely be used for drug and vaccine research in malaria therapy and prophylaxis.
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Affiliation(s)
- Qigui Li
- Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910-7500, USA
| | - Lisa H Xie
- Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910-7500, USA
| | - Jing Zhang
- Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910-7500, USA
| | - Brandon S Pybus
- Experimental Therapeutics Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910-7500, USA
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Varo R, Balanza N, Mayor A, Bassat Q. Diagnosis of clinical malaria in endemic settings. Expert Rev Anti Infect Ther 2020; 19:79-92. [PMID: 32772759 DOI: 10.1080/14787210.2020.1807940] [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] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Malaria continues to be a major global health problem, with over 228 million cases and 405,000 deaths estimated to occur annually. Rapid and accurate diagnosis of malaria is essential to decrease the burden and impact of this disease, particularly in children. We aimed to review the main available techniques for the diagnosis of clinical malaria in endemic settings and explore possible future options to improve its rapid recognition. AREAS COVERED literature relevant to malaria diagnosis was identified through electronic searches in Pubmed, with no language or date restrictions and limited to humans. EXPERT OPINION Light microscopy is still considered the gold standard method for malaria diagnosis and continues to be at the frontline of malaria diagnosis. However, technologies as rapid diagnostic tests, mainly those who detect histidine-rich protein-2, offer an accurate, rapid and affordable alternative for malaria diagnosis in endemic areas. They are now the technique most extended in endemic areas for parasitological confirmation. In these settings, PCR-based assays are usually restricted to research and they are not currently helpful in the management of clinical malaria. Other technologies, such as isothermal methods could be an interesting and alternative approach to PCR in the future.
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Affiliation(s)
- Rosauro Varo
- ISGlobal, Hospital Clínic - Universitat De Barcelona , Barcelona, Spain.,Centro De Investigação Em Saúde De Manhiça (CISM) , Maputo, Mozambique
| | - Núria Balanza
- ISGlobal, Hospital Clínic - Universitat De Barcelona , Barcelona, Spain
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat De Barcelona , Barcelona, Spain.,Centro De Investigação Em Saúde De Manhiça (CISM) , Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat De Barcelona , Barcelona, Spain.,Centro De Investigação Em Saúde De Manhiça (CISM) , Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23 , Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan De Deu (University of Barcelona) , Barcelona, Spain.,Consorcio De Investigación Biomédica En Red De Epidemiología Y Salud Publica (CIBERESP) , Madrid, Spain
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Soniran OT, Abuaku B, Ahorlu CS. Evaluating interventions to improve test, treat, and track (T3) malaria strategy among over-the-counter medicine sellers (OTCMS) in some rural communities of Fanteakwa North district, Ghana: study protocol for a cluster randomized controlled trial. Trials 2020; 21:623. [PMID: 32641094 PMCID: PMC7346649 DOI: 10.1186/s13063-020-04509-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background The World Health Organization initiated test, treat, and track (T3) malaria strategy to support malaria-endemic countries in their efforts to achieve universal coverage with diagnostic testing, antimalarial treatment, and strengthening surveillance systems. Unfortunately, T3 is not adopted by over-the-counter medicine sellers (OTCMS) where many patients with malaria-like symptoms first seek treatment. Sub-Saharan African countries are considering introducing and scaling up RDTs in these outlets to reduce malaria burden. In this context, this study is aimed at improving implementation of the T3 among OTCMS using a number of intervention tools that could be scaled-up easily at the national level. Methods/design The interventions will be evaluated using a two-arm, cluster randomized trial across 8 rural communities (4 clusters per arm), in two adjacent districts (Fanteakwa North and Fanteakwa South districts) of Ghana. A total of 8 OTCMS in the intervention arm and 5 OTCMS in the control arm in the selected communities will participate in the study. In the intervention arm only, subsidized malaria rapid diagnostic test (mRDT) kits will be introduced after the OTCMS have been trained on how to use the kit appropriately. Supervision, technical assistance, feedbacks, and collection of data will be provided on a regular basis at the participating medicine stores. The primary outcome is the proportion of children under 10 years with fever or suspected to have malaria visiting OTCMS and tested (using mRDT) before treatment. Secondary outcomes will include adherence to national malaria treatment guidelines and recommended mRDT retail price. Outcomes will be measured using mainly a household survey supplemented by mystery client survey and a surveillance register on malaria tests conducted by the OTCMS during patient consultations. Data collected will be double entered and verified using Microsoft Access 2010 (Microsoft Inc., Redmond, Washington) and analyzed using STATA version 11.0. Discussion The trial will provide evidence on the combined effectiveness of provider and community interventions in improving adherence to the T3 initiative among OTCMS in rural Ghana. Ethical clearance NMIMR-IRB CPN 086/18-19 Trial registration ISRCTN registry ISRCTN77836926. Registered on 4 November 2019.
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Affiliation(s)
- Olajoju Temidayo Soniran
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.,Akanu Ibiam Federal Polytechnic, Unwana, Ebonyi State, Nigeria
| | - Benjamin Abuaku
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Collins Stephen Ahorlu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
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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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Qureshi NA, Fatima H, Afzal M, Khattak AA, Nawaz MA. Occurrence and seasonal variation of human Plasmodium infection in Punjab Province, Pakistan. BMC Infect Dis 2019; 19:935. [PMID: 31694574 PMCID: PMC6836532 DOI: 10.1186/s12879-019-4590-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/23/2019] [Indexed: 11/26/2022] Open
Abstract
Background Malaria is the fifth leading cause of death worldwide. Pakistan is considered as a moderate malaria-endemic country but still, 177 million individuals are at risk of malaria. Roughly 60% of Pakistan’s population, live in malaria-endemic regions. The present study is based upon the survey of various health care centers in 10 major cities of Northern and Southern Punjab to find out the malarial infection patterns in 2015. The diagnosis, seasonal variations, age and gender-wise distribution of Plasmodium spp. circulating in the study area were also included in the objectives. Methods The malaria-suspected patients ‘16075’ were enrolled for malaria diagnosis using microscopy, out of which 925 were malaria positive which were processed for molecular analysis using nested PCR. The 18S rRNA genes of Plasmodium species were amplified, sequenced, blast and the phylogenetic tree was constructed based on sequences using online integrated tool MEGA7. Results The 364 cases recruited from Northern Punjab with the highest incidence in Rawalpindi (25.5%) and lowest in Chakwal (15.9%). From Southern Punjab 561 cases were enlisted Rajanpur (21.4%) maximum and lowest from Multan and Rahim Yar Khan (18%). The slide positivity rate, annual parasite incidence, and annual blood examination rates were 5.7 per 1000 population, 0.1, and 0.2% respectively. The only P. vivax (66.7%), P. falciparum (23.7%) and mixed infection by these two species (9.6%) were diagnosed. The same trend (P. vivax > P. falciparum > mixed infection) in species identification %age was confirmed from molecular analysis. However, the occurrence of malaria was higher in Southern Punjab (5.5%) as compared to the Northern Punjab (4.0%). The overall malaria percentage occurrence of treatment-seeking patients in all recruited cities of Punjab was 4.9%. The age-group of 1–20 and males among genders were more affected by malaria. The comparison of different seasons showed that the malaria infection was at a peak in Summer and post-monsoon. Conclusion The incidence of malaria was high in the flood infected rural areas of Southern Punjab, Summer, and post-monsoon. The age group (1–20) and gender-wise males were more affected by malaria.
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Affiliation(s)
- Naveeda Akhtar Qureshi
- Department of Animal Science, Faculty of Biological Science, Quaid-i-Azam University, Islamabad, 45320, Pakistan.
| | - Huma Fatima
- Department of Animal Science, Faculty of Biological Science, Quaid-i-Azam University, Islamabad, 45320, Pakistan
| | - Muhammad Afzal
- Department of Animal Science, Faculty of Biological Science, Quaid-i-Azam University, Islamabad, 45320, Pakistan
| | - Aamer Ali Khattak
- Department of Medical Laboratory Technology, University of Haripur, Haripur, Khyber Pakhtunkhwa, 26220, Pakistan
| | - Muhammad Ali Nawaz
- Department of Animal Science, Faculty of Biological Science, Quaid-i-Azam University, Islamabad, 45320, Pakistan
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Highly Sensitive and Rapid Characterization of the Development of Synchronized Blood Stage Malaria Parasites Via Magneto-Optical Hemozoin Quantification. Biomolecules 2019; 9:biom9100579. [PMID: 31591333 PMCID: PMC6843464 DOI: 10.3390/biom9100579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023] Open
Abstract
The rotating-crystal magneto-optical diagnostic (RMOD) technique was developed as a sensitive and rapid platform for malaria diagnosis. Herein, we report a detailed in vivo assessment of the synchronized Plasmodium vinckei lentum strain blood-stage infections by the RMOD method and comparing the results to the unsynchronized Plasmodium yoelii 17X-NL (non-lethal) infections. Furthermore, we assess the hemozoin production and clearance dynamics in chloroquine-treated compared to untreated self-resolving infections by RMOD. The findings of the study suggest that the RMOD signal is directly proportional to the hemozoin content and closely follows the actual parasitemia level. The lack of long-term accumulation of hemozoin in peripheral blood implies a dynamic equilibrium between the hemozoin production rate of the parasites and the immune system’s clearing mechanism. Using parasites with synchronous blood stage cycle, which resemble human malaria parasite infections with Plasmodium falciparum and Plasmodium vivax, we are demonstrating that the RMOD detects both hemozoin production and clearance rates with high sensitivity and temporal resolution. Thus, RMOD technique offers a quantitative tool to follow the maturation of the malaria parasites even on sub-cycle timescales.
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Ahmed R, Devnath K, Bhowmik D, Sharma I. High-Sensitivity Detection of Human Malaria Parasites by the Use of Rapid Diagnostic Tests and Nested Polymerase Chain Reaction in Burdened Communities of North East India. Indian J Med Microbiol 2018; 36:541-546. [DOI: 10.4103/ijmm.ijmm_18_394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mirahmadi H, Shahrakipour A, Mehravaran A, Khorashad AS, Rahmati-Balaghaleh M, Zarean M. Evaluation of malaria multiplex/nested PCR performance at low parasite densities and mixed infection in Iran: A country close to malaria elimination. INFECTION GENETICS AND EVOLUTION 2018; 65:283-287. [PMID: 30096462 DOI: 10.1016/j.meegid.2018.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Malaria is still a major public health problem in subtropical and tropical regions. The rapid and accurate diagnosis of malaria remains a challenge in most of the endemic areas. The primary objective of the present study was to evaluate the performance of multiplex/nested PCR in detecting Plasmodium falciparum at low parasite densities and mixed infection. METHODS The study was performed in the Sistan-Baluchestan province of the southeastern Iran, from May 2015 to July 2016. A total of 105 patients suspected to malaria infection were enrolled in the study. The obtained DNA products, extracted from the thick/thin films, were analyzed by multiplex/nested PCR using genus-specific primers and compared with light microscopy. RESULTS 43 samples were confirmed to be infected by microscopic examination. Among 43 microscopically diagnosed P. falciparum cases, 11.4% (12/105) were confirmed by multiplex/nested PCR, 36.2% (38/105) were confirmed as P. vivax, 1.9% (2/105) had mixed infections with P. falciparum and P. vivax. Among microscopy-negative samples, 10 samples turned malaria-positive in nPCR. In multiplex/nested PCR, the rate of mixed infections was 8.6% (9/105). When compared to LM, the sensitivity, specificity, positive predictive value and negative predictive value of multiplex/nested PCR were calculated to be 82.8, 91.5, 92.3 and 81.1%, respectively. CONCLUSION In this study, we showed that microscopic examination of blood smears does not reliably distinguish Plasmodium species in the case of mixed infections. Therefore, it seems that multiplex/nested PCR is a good candidate for examining the presence of malaria parasites in clinically suspected but microscopically negative cases.
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Affiliation(s)
- Hadi Mirahmadi
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Parasitology and Mycology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Azam Shahrakipour
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Parasitology and Mycology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ahmad Mehravaran
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Parasitology and Mycology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Salami Khorashad
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Parasitology and Mycology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mansour Rahmati-Balaghaleh
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Parasitology and Mycology, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mehdi Zarean
- Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Yin J, Yan H, Li M, Ruan Y, Zhang X, Wang L, Cao C, Xia Z, Zhou S. Competency and challenges in malaria microscopy in China. Biosci Trends 2018; 11:702-705. [PMID: 29311452 DOI: 10.5582/bst.2017.01275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Precise diagnosis is a key measure for malaria control and elimination, and malaria microscopy is still the gold standard method recommended by the World Health Organization (WHO) for malaria diagnosis. Analysis of the competency in malaria microscopy in China will benefit to identify the challenges in this skill and provide some suggestions for improvement in order to reach the requirement of WHO procedures for certification of malaria elimination, and finally contribute to malaria elimination by 2020 in China. According to a series of external assessment activities about malaria microscopy, malaria microscopists from both the national and provincial level but not the levels below provincial level performed quite well in Plasmodium spp identification, but their competency in differentiation of P. ovale and P. vivax and parasite counting by microscopy were not good enough at all levels. Therefore, it is necessary to strengthen the competency in species identification and parasite counting especially at the lower levels in the first line through training and practice as well as regular quality assurance with enough policy support.
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Affiliation(s)
- Jianhai Yin
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Sciences and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health
| | - He Yan
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Sciences and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health
| | - Mei Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Sciences and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health
| | - Yao Ruan
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Sciences and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health
| | - Xueqiang Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Sciences and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health
| | - Liying Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Sciences and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health
| | - Cunli Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Sciences and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health
| | - Zhigui Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Sciences and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health
| | - Shuisen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Ministry of Sciences and Technology, Key Laboratory of Parasite and Vector Biology, Ministry of Health
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16
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Ayanful-Torgby R, Quashie NB, Boampong JN, Williamson KC, Amoah LE. Seasonal variations in Plasmodium falciparum parasite prevalence assessed by varying diagnostic tests in asymptomatic children in southern Ghana. PLoS One 2018; 13:e0199172. [PMID: 29906275 PMCID: PMC6003688 DOI: 10.1371/journal.pone.0199172] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/01/2018] [Indexed: 12/24/2022] Open
Abstract
Plasmodium falciparum infections presenting either as symptomatic or asymptomatic may contain sexual stage parasites (gametocytes) that are crucial to malaria transmission. In this study, the prevalence of microscopic and submicroscopic asexual and gametocyte parasite stages were assessed in asymptomatic children from two communities in southern Ghana. Eighty children aged twelve years and below, none of whom exhibited signs of clinical malaria living in Obom and Cape Coast were sampled twice, one during the rainy (July 2015) and subsequently during the dry (January 2016) season. Venous blood was used to prepare thick and thin blood smears, spot a rapid malaria diagnostic test (PfHRP2 RDT) as well as prepare filter paper blood spots. Blood cell pellets were preserved in Trizol for RNA extraction. Polymerase chain reaction (PCR) and semi-quantitative real time reverse transcriptase PCR (qRT-PCR) were used to determine submicroscopic parasite prevalence. In both sites 87% (95% CI: 78-96) of the asymptomatic individuals surveyed were parasites positive during the 6 month study period. The prevalence of asexual and gametocyte stage parasites in the rainy season were both significantly higher in Obom than in Cape Coast (P < 0.001). Submicroscopic gametocyte prevalence was highest in the rainy season in Obom but in the dry season in Cape Coast. Parasite prevalence determined by PCR was similar to that determined by qRT-PCR in Obom but significantly lower than that determined by qRT-PCR in Cape Coast. Communities with varying parasite prevalence exhibit seasonal variations in the prevalence of gametocyte carriers. Submicroscopic asymptomatic parasite and gametocyte carriage is very high in southern Ghana, even during the dry season in communities with low microscopic parasite prevalence and likely to be missed during national surveillance exercises.
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Affiliation(s)
- Ruth Ayanful-Torgby
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- School of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Neils B. Quashie
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana, Accra, Ghana
| | | | - Kim C. Williamson
- Department of Microbiology, Uniform Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Linda E. Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Ragavan K, Kumar S, Swaraj S, Neethirajan S. Advances in biosensors and optical assays for diagnosis and detection of malaria. Biosens Bioelectron 2018; 105:188-210. [DOI: 10.1016/j.bios.2018.01.037] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 12/22/2022]
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18
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Diallo MA, Diongue K, Seck MC, Ndiaye M, Diallo I, Diedhiou Y, Ndiaye T, Ndiaye YD, Badiane AS, Ndiaye D. Quality control of malaria microscopy reveals misdiagnosed non-falciparum species and other microscopically detectable pathogens in Senegal. Ann Clin Microbiol Antimicrob 2018; 17:8. [PMID: 29544479 PMCID: PMC5853095 DOI: 10.1186/s12941-018-0261-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 03/08/2018] [Indexed: 11/29/2022] Open
Abstract
Background In developing countries, malaria diagnosis relies on microscopy and rapid diagnostic tests. In Senegal, national malaria control program (NMCP) regularly conducts supervisory visits in health services where malaria microscopy is performed. In this study, expert microscopists assessed the performance of laboratory technicians in malaria microscopy. Methods The present external quality assessment (EQA) was conducted in three different areas of malaria transmission. Participants were laboratory technicians previously trained by NMCP on malaria microscopy. Stored read slides were randomly collected for blinded re-checking by expert microscopists. At the same time a set of 8 slides (3 positive P. falciparum and 5 negative slides) were submitted to participants for proficiency testing. Microscopists performance were evaluated on the basis of the errors rates on slide reading—high false positive (HFP), high false negative (HFN), low false positive (LFP) and low false negative (LFN)—and the calculation of their sensitivities and specificities relative to expert microscopy. Data were entered and analysed using Microsoft Excel software. Results A total of 450 stored slides were collected from 17 laboratories for re-checking. Eight laboratories scored 100% of correct reading. Only one major error was recorded (HFP). Six laboratories recorded LFN results: Borrelia, P. ovale, and low parasite densities (95 and 155 p/μl) were missed. Two P. falciparum slides were misidentified as P. malariae and one P. ovale slide as P. vivax. The overall sensitivities and specificities for all participants against expert microscopists were 97.8 and 98.2% respectively; Sensitivities and specificities of hospital microscopists (96.7 and 98.9%) were statistically similar to those of health centre microscopists (98.5 and 97.8% respectively) (p = 0.3993 and p = 0.9412 respectively). Overall, a very good agreement was noted with kappa value of 0.96 (CI95% 93.4–98.6%) relative to expert microscopy. Proficiency testing showed that among the 17 participants, 11 laboratories scored 100% of correct reading. Three LFN and four LFP results were recorded respectively. The P. falciparum slide with Maurer dots was misidentified as P. ovale in 1 centre and the same slide was misread as P. vivax in another centre; No major error (HFP or HFN) was noted. Conclusion EQA of malaria microscopy showed an overall good performance especially regarding P. falciparum detection. However, efforts need to be made addressing the ability to detect non-falciparum species and others endemic blood pathogens such as Borrelia. The further NMCP training sessions and evaluations should consider those aspects to expect high quality-assured capacity for malaria microscopy.
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Affiliation(s)
- Mamadou Alpha Diallo
- Laboratory of Parasitology and Mycology, Cheikh Anta Diop University, Avenue Cheikh Anta Diop, BP 5005 Fann, Dakar, Senegal.
| | - Khadim Diongue
- Laboratory of Parasitology and Mycology, Cheikh Anta Diop University, Avenue Cheikh Anta Diop, BP 5005 Fann, Dakar, Senegal
| | - Mame Cheikh Seck
- Laboratory of Parasitology and Mycology, Cheikh Anta Diop University, Avenue Cheikh Anta Diop, BP 5005 Fann, Dakar, Senegal
| | - Mouhamadou Ndiaye
- Laboratory of Parasitology and Mycology, Cheikh Anta Diop University, Avenue Cheikh Anta Diop, BP 5005 Fann, Dakar, Senegal
| | - Ibrahima Diallo
- National Malaria Control Program (NMCP), Rue Aimé Césaire, Fann Résidence, Dakar, Senegal
| | - Younouss Diedhiou
- Laboratory of Parasitology and Mycology, Cheikh Anta Diop University, Avenue Cheikh Anta Diop, BP 5005 Fann, Dakar, Senegal
| | - Tolla Ndiaye
- Laboratory of Parasitology and Mycology, Cheikh Anta Diop University, Avenue Cheikh Anta Diop, BP 5005 Fann, Dakar, Senegal
| | - Yaye Die Ndiaye
- Laboratory of Parasitology and Mycology, Cheikh Anta Diop University, Avenue Cheikh Anta Diop, BP 5005 Fann, Dakar, Senegal
| | - Aida Sadikh Badiane
- Laboratory of Parasitology and Mycology, Cheikh Anta Diop University, Avenue Cheikh Anta Diop, BP 5005 Fann, Dakar, Senegal
| | - Daouda Ndiaye
- Laboratory of Parasitology and Mycology, Cheikh Anta Diop University, Avenue Cheikh Anta Diop, BP 5005 Fann, Dakar, Senegal
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Patankar S, Sharma S, Rathod PK, Duraisingh MT. Malaria in India: The Need for New Targets for Diagnosis and Detection of Plasmodium vivax. Proteomics Clin Appl 2018; 12:e1700024. [PMID: 29193853 DOI: 10.1002/prca.201700024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/28/2017] [Indexed: 11/08/2022]
Abstract
Plasmodium vivax is a protozoan parasite that is one of the causative agents of human malaria. Due to several occult features of its life cycle, P. vivax threatens to be a problem for the recent efforts toward elimination of malaria globally. With an emphasis on malaria elimination goals, the authors summarize the major gaps in P. vivax diagnosis and describe how proteomics technologies have begun to contribute toward the discovery of antigens that could be used for various technology platforms and applications. The authors suggest areas where, in the future, proteomics technologies could fill in gaps in P. vivax diagnosis that have proved difficult. The discovery of new parasite antigens, host responses, and immune signatures using proteomics technologies will be a key part of the global malaria elimination efforts.
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Affiliation(s)
- Swati Patankar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Shobhona Sharma
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | | | - Manoj T Duraisingh
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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20
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Singh US, Siwal N, Pande V, Das A. Can Mixed Parasite Infections Thwart Targeted Malaria Elimination Program in India? BIOMED RESEARCH INTERNATIONAL 2017; 2017:2847548. [PMID: 28900620 PMCID: PMC5576395 DOI: 10.1155/2017/2847548] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/09/2017] [Accepted: 07/13/2017] [Indexed: 12/31/2022]
Abstract
India is highly endemic to malaria with prevalence of all five species of human malaria parasites of Plasmodium genus. India is set for malaria elimination by 2030. Since cases of mixed Plasmodium species infections remain usually undetected but cause huge disease burden, in order to understand the distributional prevalence of both monospecies infections and mixed species infections in India, we collated published data on the differential infection incidences of the five different malaria parasites based on PCR diagnostic assay. About 11% of total cases were due to mixed species infection. Among several interesting observations on both single and mixed parasitic infections, incidences of Plasmodium falciparum monoinfection were found to be significantly higher than P. vivax monoinfection. Also, P. malariae seems to be emerging as a potential malaria threat in India. Putting all the facts together, it appears that the dream of achieving malaria elimination in India will not be completely successful without dealing with mixed species infection.
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Affiliation(s)
- Upasana Shyamsunder Singh
- Division of Genomic Epidemiology, ICMR-Centre for Research in Medical Entomology, No. 4, Sarojini Street, Chinna Chokkikulam, Madurai 625002, India
| | - Nisha Siwal
- Division of Genomic Epidemiology, ICMR-Centre for Research in Medical Entomology, No. 4, Sarojini Street, Chinna Chokkikulam, Madurai 625002, India
| | - Veena Pande
- Department of Biotechnology, Kumaun University, Nainital 263001, India
| | - Aparup Das
- Division of Genomic Epidemiology, ICMR-Centre for Research in Medical Entomology, No. 4, Sarojini Street, Chinna Chokkikulam, Madurai 625002, India
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21
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Kwenti TE, Kwenti TDB, Njunda LA, Latz A, Tufon KA, Nkuo-Akenji T. Identification of the Plasmodium species in clinical samples from children residing in five epidemiological strata of malaria in Cameroon. Trop Med Health 2017. [PMID: 28630585 PMCID: PMC5471890 DOI: 10.1186/s41182-017-0058-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Malaria in Cameroon was previously known to be caused solely by Plasmodium falciparum but today, evidence points to other Plasmodium species including P. vivax, P. ovale and P. malariae. The purpose of this study was to identify the Plasmodium species in clinical samples from children residing in five epidemiological strata of malaria in Cameroon, so as to advise control policies. Methods One thousand six hundred nine febrile children (≤15 years) were recruited from five epidemiological strata of malaria including the Sudano-sahelian (SS) strata, the High inland plateau (HIP) strata, the South Cameroonian Equatorial forest (SCEF) strata, the High western plateau (HWP) strata and the Coastal (C) strata. Malaria parasites were detected by Giemsa microscopy (GM) while a multiplex polymerase chain reaction (PCR) was used to identify the Plasmodium species. Statistical analysis performed included the Pearson chi-square test, and statistical significance was set at p < 0.05. Results The PCR-adjusted prevalence of malaria was 17.6%. The detection rate of PCR was higher than GM (p = 0.05). However, GM demonstrated a high sensitivity (85.5%) and specificity (100%) and, overall, a perfectly correlated agreement with PCR (97.5%). The prevalence of malaria was significantly higher in children between 60 and 119 months (p < 0.001) and in Limbe (in the Coastal strata) (p < 0.001). Contrariwise, the prevalence of malaria was not associated with gender (p = 0.239). P. falciparum was identified in all (100%) the cases of malaria; P. ovale, P. vivax, P. malariae and P. knowlesi were all absent. No case of mixed infection was identified. Conclusions P. falciparum was the only species causing clinical malaria in the target population, which is contrary to studies that have reported P. vivax, P. malariae and P. ovale as causing clinical malaria in Cameroon.
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Affiliation(s)
- Tebit Emmanuel Kwenti
- Department of Medical Laboratory Sciences, University of Buea, P.B. 63, Buea, Cameroon.,Department of Microbiology and Parasitology, University of Buea, P.B. 63, Buea, Cameroon.,Diagnostic laboratory, Regional Hospital of Buea, P.B. 32, Buea, Cameroon
| | | | - Longdoh Anna Njunda
- Department of Medical Laboratory Sciences, University of Buea, P.B. 63, Buea, Cameroon
| | - Andreas Latz
- Research and Development Department, NovaTec Immundiagnostica GmbH, Dietzenbach, Germany
| | - Kukwah Anthony Tufon
- Department of Microbiology and Parasitology, University of Buea, P.B. 63, Buea, Cameroon
| | - Theresa Nkuo-Akenji
- Department of Microbiology and Parasitology, University of Buea, P.B. 63, Buea, Cameroon
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Owusu-Ofori S, Allain JP, Owusu-Ofori A. Prevention of transfusion-transmitted malaria. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | - A. Owusu-Ofori
- Kwame Nkrumah University of Science and Technology; Kumasi Ghana
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Yentur Doni N, Yildiz Zeyrek F, Seyrek A. Detection of Plasmodium using filter paper and nested PCR for patients with malaria in Sanliurfa, in Turkey. Malar J 2016; 15:299. [PMID: 27234320 PMCID: PMC4884379 DOI: 10.1186/s12936-016-1334-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background The objective of this study to detect Plasmodium and a subspecies of Plasmodium using filter paper in malaria endemic province, Sanliurfa, in Turkey, compare the results of nested PCR (nPCR) with microscopy for the diagnosis of malaria and present the epidemiological data of malaria. Methods This study was carried out in malaria-endemic Sanliurfa between 2008 and 2011. Finger prick blood samples, thick and thin Giemsa-stained blood smears, were collected from 153 malaria-suspected farmworkers. The Giemsa-stained blood smears were examined microscopically. The obtained DNA products, extracted from blood-spotted filter papers or from the thick blood smears, were analysed by nPCR to amplify the 18S ssrRNA Plasmodium gene with genus and specific primers. The results of the microscopy were compared to the nPCR results. Results Of the specimens, 7.2 % were determined as Plasmodium-positive by microscopy, whereas 9.8 % were determined as Plasmodium-positive by nPCR. Of the positive Plasmodium specimens, 93.33 % were identified as P. vivax. Four out of the 15 specimens that were microscopically diagnosed as negative were Plasmodium-positive with nPCR. When compared to the microscopy, the sensitivity, specificity, and positive predictive values of the nPCR were determined as 100, 97.2 and 73.3 %, respectively. nPCR was determined to be more sensitive and specific than microscopy. Conclusions This study revealed that the accurate diagnosis of malaria by nPCR was compulsory in malaria-endemic Sanliurfa and nPCR should be applied routinely in laboratory studies.
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Affiliation(s)
- Nebiye Yentur Doni
- Department of Medical Microbiology, Vocational School of Health Services, Harran University, İpekyol Avenue No: 1, 63050, Sanliurfa, Turkey.
| | - Fadile Yildiz Zeyrek
- Department of Medical Microbiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Adnan Seyrek
- Department of Medical Microbiology, Faculty of Medicine, Fırat University, Elazig, Turkey
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Lee K, Gupta KC, Park SY, Kang IK. Anti-IgG-anchored liquid crystal microdroplets for label free detection of IgG. J Mater Chem B 2016; 4:704-715. [DOI: 10.1039/c5tb02131f] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIgG anchored LC microdroplets showing configurational transition from radial (a) to bipolar (b) upon interaction with IgG.
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Affiliation(s)
- Kyubae Lee
- Department of Polymer Science and Engineering
- Kyungpook National University
- Daegu 702-701
- Republic of Korea
| | - Kailash Chandra Gupta
- Department of Polymer Science and Engineering
- Kyungpook National University
- Daegu 702-701
- Republic of Korea
- Polymer Research Laboratory
| | - Soo-Young Park
- Department of Polymer Science and Engineering
- Kyungpook National University
- Daegu 702-701
- Republic of Korea
| | - Inn-Kyu Kang
- Department of Polymer Science and Engineering
- Kyungpook National University
- Daegu 702-701
- Republic of Korea
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25
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Golassa L, Baliraine FN, Enweji N, Erko B, Swedberg G, Aseffa A. Microscopic and molecular evidence of the presence of asymptomatic Plasmodium falciparum and Plasmodium vivax infections in an area with low, seasonal and unstable malaria transmission in Ethiopia. BMC Infect Dis 2015; 15:310. [PMID: 26242405 PMCID: PMC4526179 DOI: 10.1186/s12879-015-1070-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The presence of asymptomatic infections has serious implications for malaria elimination campaigns. Since asymptomatic carriers do not seek treatment for their infection and may become gametocyte carriers, they undoubtedly contribute to the persistence of malaria transmission in a population. The presence of asymptomatic parasitemias was noted in areas with seasonal malaria transmission. In Ethiopia there is a paucity of data regarding the prevalence of asymptomatic malaria carriage. This study was undertaken to assess the presence and prevalence of asymptomatic Plasmodium falciparum and Plasmodium vivax infections in south-central Oromia, Ethiopia. METHODS A total of 1094 apparently healthy individuals ≥ 2 years of age in south-central Oromia, Ethiopia, an area with seasonal and unstable malaria transmission, were screened for the presence of asymptomatic plasmodial infections. Finger-prick blood samples were taken from each participant for blood film preparation for microscopy and the rapid diagnostic test (RDT). Blood samples were also spotted on Whatman 3MM filter paper for parasite DNA extraction. RESULTS The prevalence of asymptomatic Plasmodium carriage (P. falciparum, P. vivax and mixed species) was 5.0 % (55/1,094) as determined by microscopy, while the prevalence as determined using RDT was 8.2 % (90/1,094). PCR was done on 47 of 55 microscopy-confirmed and on 79 of 90 RDT-confirmed samples. PCR detected parasite DNA in 89.4 % (42/47) of the microscopy-positive samples and in 77.2 % (61/79) of the RDT-positive samples. No significant difference was observed in the prevalence of asymptomatic P. falciparum or P. vivax infections in the study area (P > 0.1). However, the prevalence of asymptomatic parasitaemia was significantly associated with gender (OR = 0.47, P = 0.015; being higher in males than females) and age (X(2) = 25, P < 0.001; being higher in younger than in older individuals). Age and parasite densities had an inverse relationship. CONCLUSIONS This study confirms the presence of asymptomatic P. falciparum and P. vivax infections in south-central Oromia, an area with low, seasonal and unstable malaria transmission in Ethiopia. Of 55 microscopically confirmed asymptomatic infections, P. falciparum monoinfection accounted for 45.5 % and of 90 RDT positive asymptomatic infections, 66.7 % were P. falciparum. Although not statistically significant, P. falciparum accounted for a relatively large number of the asymptomatic infections as determined by both tests. The prevalence of asymptomatic parasitaemia was highest in the younger age group. HRP-2-based RDTs specific for P. falciparum showed high false positivity rate compared to Plasmodium lactate dehydrogenase (pLDH) specific to P. vivax. Although microscopy and RDT detected substantial numbers of asymptomatic infections in apparently healthy inhabitants, the use of a highly sensitive molecular diagnostics offers a more accurate assessment of the magnitude of asymptomatic infections.
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Affiliation(s)
- Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia. .,Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | | | - Nizar Enweji
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.
| | - Berhanu Erko
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Göte Swedberg
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
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Hagen RM, Hinz R, Tannich E, Frickmann H. Comparison of two real-time PCR assays for the detection of malaria parasites from hemolytic blood samples - Short communication. Eur J Microbiol Immunol (Bp) 2015; 5:159-63. [PMID: 26185684 PMCID: PMC4500067 DOI: 10.1556/1886.2015.00006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 02/28/2015] [Indexed: 12/27/2022] Open
Abstract
We compared the performance of an in-house and a commercial malaria polymerase chain reaction (PCR) assay using freeze-thawed hemolytic blood samples. A total of 116 freeze-thawed ethylenediamine tetraacetic acid (EDTA) blood samples of patients with suspicion of malaria were analyzed by an in-house as well as by a commercially available real-time PCR. Concordant malaria negative PCR results were reported for 39 samples and malaria-positive PCR results for 67 samples. The in-house assay further detected one case of Plasmodium falciparum infection, which was negative in the commercial assay as well as five cases of P. falciparum malaria and three cases of Plasmodium vivax malaria, which showed sample inhibition in the commercial assay. The commercial malaria assay was positive in spite of a negative in-house PCR result in one case. In all concordant results, cycle threshold values of P. falciparum-positive samples were lower in the commercial PCR than in the in-house assay. Although Ct values of the commercial PCR kit suggest higher sensitivity in case of concordant results, it is prone to inhibition if it is applied to hemolytic freeze-thawed blood samples. The number of misidentifications was, however, identical for both real-time PCR assays.
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Affiliation(s)
- Ralf Matthias Hagen
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg , Germany
| | - Rebecca Hinz
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg , Germany
| | - Egbert Tannich
- Bernhard Nocht Institute for Tropical Medicine Hamburg , Germany
| | - Hagen Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg , Germany ; Institute for Microbiology, Virology and Hygiene, University Medicine Rostock , Germany
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Simple Real-Time PCR and Amplicon Sequencing Method for Identification of Plasmodium Species in Human Whole Blood. J Clin Microbiol 2015; 53:2251-7. [PMID: 25972416 DOI: 10.1128/jcm.00542-15] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/04/2015] [Indexed: 01/04/2023] Open
Abstract
Malaria is the leading identifiable cause of fever in returning travelers. Accurate Plasmodium species identification has therapy implications for P. vivax and P. ovale, which have dormant liver stages requiring primaquine. Compared to microscopy, nucleic acid tests have improved specificity for species identification and higher sensitivity for mixed infections. Here, we describe a SYBR green-based real-time PCR assay for Plasmodium species identification from whole blood, which uses a panel of reactions to detect species-specific non-18S rRNA gene targets. A pan-Plasmodium 18S rRNA target is also amplified to allow species identification or confirmation by sequencing if necessary. An evaluation of assay accuracy, performed on 76 clinical samples (56 positives using thin smear microscopy as the reference method and 20 negatives), demonstrated clinical sensitivities of 95.2% for P. falciparum (20/21 positives detected) and 100% for the Plasmodium genus (52/52), P. vivax (20/20), P. ovale (9/9), and P. malariae (6/6). The sensitivity of the P. knowlesi-specific PCR was evaluated using spiked whole blood samples (100% [10/10 detected]). The specificities of the real-time PCR primers were 94.2% for P. vivax (49/52) and 100% for P. falciparum (51/51), P. ovale (62/62), P. malariae (69/69), and P. knowlesi (52/52). Thirty-three specimens were used to test species identification by sequencing the pan-Plasmodium 18S rRNA PCR product, with correct identification in all cases. The real-time PCR assay also identified two samples with mixed P. falciparum and P. ovale infection, which was confirmed by sequencing. The assay described here can be integrated into a malaria testing algorithm in low-prevalence areas, allowing definitive Plasmodium species identification shortly after malaria diagnosis by microscopy.
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Li P, Zhao Z, Wang Y, Xing H, Parker DM, Yang Z, Baum E, Li W, Sattabongkot J, Sirichaisinthop J, Li S, Yan G, Cui L, Fan Q. Nested PCR detection of malaria directly using blood filter paper samples from epidemiological surveys. Malar J 2014; 13:175. [PMID: 24884761 PMCID: PMC4022400 DOI: 10.1186/1475-2875-13-175] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/01/2014] [Indexed: 11/25/2022] Open
Abstract
Background Nested PCR is considered a sensitive and specific method for detecting malaria parasites and is especially useful in epidemiological surveys. However, the preparation of DNA templates for PCR is often time-consuming and costly. Methods A simplified PCR method was developed to directly use a small blood filter paper square (2 × 2 mm) as the DNA template after treatment with saponin. This filter paper-based nested PCR method (FP-PCR) was compared to microscopy and standard nested PCR with DNA extracted by using a Qiagen DNA mini kit from filter paper blood spots of 204 febrile cases. The FP-PCR technique was further applied to evaluate malaria infections in 1,708 participants from cross-sectional epidemiological surveys conducted in Myanmar and Thailand. Results The FP-PCR method had a detection limit of ~0.2 parasites/μL blood, estimated using cultured Plasmodium falciparum parasites. With 204 field samples, the sensitivity of the FP-PCR method was comparable to that of the standard nested PCR method, which was significantly higher than that of microscopy. Application of the FP-PCR method in large cross-sectional studies conducted in Myanmar and Thailand detected 1.9% (12/638) and 6.2% (66/1,070) asymptomatic Plasmodium infections, respectively, as compared to the detection rates of 1.3% (8/638) and 0.04% (4/1,070) by microscopy. Conclusion This FP-PCR method was much more sensitive than microscopy in detecting Plasmodium infections. It drastically increased the detection sensitivity of asymptomatic infections in cross-sectional surveys conducted in Thailand and Myanmar, suggesting that this FP-PCR method has a potential for future applications in malaria epidemiology studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Liwang Cui
- Dalian Institute of Biotechnology, Dalian, Liaoning, China.
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Kamau E, Alemayehu S, Feghali KC, Juma DW, Blackstone GM, Marion WR, Obare P, Ogutu B, Ockenhouse CF. Sample-ready multiplex qPCR assay for detection of malaria. Malar J 2014; 13:158. [PMID: 24767409 PMCID: PMC4026594 DOI: 10.1186/1475-2875-13-158] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/10/2014] [Indexed: 11/17/2022] Open
Abstract
Background Microscopy and antigen detecting rapid diagnostic tests are the diagnostic tests of choice in management of clinical malaria. However, due to their limitations, the need to utilize more sensitive methods such as real-time PCR (qPCR) is evident as more studies are now utilizing molecular methods in detection of malaria. Some of the challenges that continue to limit the widespread utilization of qPCR include lack of assay standardization, assay variability, risk of contamination, and the need for cold-chain. Lyophilization of molecular assays can overcome some of these limitations and potentially enable widespread qPCR utilization. Methods A recently published multiplex malaria qPCR assay was lyophilized by freezing drying into Sample-Ready™ format (MMSR). MMSR assay contained all the required reagents for qPCR including primers and probes, requiring only the addition of water and sample to perform qPCR. The performance of the MMSR assay was compared to the non-freeze dried, “wet” assay. Stability studies were done by maintaining the MMSR assays at four different ambient temperatures of 4°C, room temperature (RT), 37°C and 42°C over a period of 42 days, tested at seven-day intervals. Plasmodium falciparum and Plasmodium vivax DNAs were used for analysis of the MMSR assay either as single or mixed parasites, at two different concentrations. The CT values and the standard deviations (SD) were used in the analysis of the assay performance. Results The limit of detection for the MMSR assay was 0.244 parasites/μL for Plasmodium spp. (PLU) and P. falciparum (FAL) assay targets compared to “wet” assay which was 0.39 and 3.13 parasites/μL for PLU and FAL assay targets, respectively. The MMSR assay performed with high efficiencies similar to those of the “wet” assay and was stable at 37°C for 42 days, with estimated shelf-life of 5 months. When used to analyse field clinical samples, MMSR assay performed with 100% sensitivity and specificity compared to the “wet” assay. Conclusion The MMSR assay has the same robust performance characteristics as the “wet” assay and is highly stable. Availability of MMSR assay allows flexibility and provides an option in choosing assay for malaria diagnostics depending on the application, needs and budget.
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Affiliation(s)
- Edwin Kamau
- Walter Reed Army Institute of Research, Military Malaria Research Program, Malaria Vaccine Branch, 503 Robert Grant Ave, Silver Spring, Maryland, USA.
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Boggild A, Brophy J, Charlebois P, Crockett M, Geduld J, Ghesquiere W, McDonald P, Plourde P, Teitelbaum P, Tepper M, Schofield S, McCarthy A. Summary of recommendations for the diagnosis and treatment of malaria by the Committee to Advise on Tropical Medicine and Travel (CATMAT). CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2014; 40:133-143. [PMID: 29769894 PMCID: PMC5864436 DOI: 10.14745/ccdr.v40i07a02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND On behalf of the Public Health Agency of Canada, the Committee to Advise on Tropical Medicine and Travel (CATMAT) developed the Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers for Canadian health care providers who are preparing patients for travel to malaria-endemic areas and treating travellers who have returned ill. These recommendations aim to achieve appropriate diagnosis and management of malaria, a disease that is still uncommon in Canada. OBJECTIVE To provide recommendations on the appropriate diagnosis and treatment of malaria. METHODS CATMAT reviewed all major sources of information on malaria diagnosis and treatment, as well as recent research and national and international epidemiological data, to tailor guidelines to the Canadian context. The evidence-based medicine recommendations were developed with associated rating scales for the strength and quality of the evidence. RECOMMENDATIONS Malarial management depends on rapid identification of the disease, as well as identification of the malaria species and level of parasitemia. Microscopic identification of blood samples is both rapid and accurate but can be done only by trained laboratory technicians. Rapid diagnostic tests are widely available, are simple to use and do not require specialized laboratory equipment or training; however, they do not provide the level of parasitemia and do require verification. Polymerase chain reaction (PCR), although still limited in availability, is emerging as the gold standard for high sensitivity and specificity in identifying the species.
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Affiliation(s)
- A Boggild
- University Health Network, Toronto General Hospital (Toronto, ON)
| | - J Brophy
- Division of Infectious Diseases, Children’s Hospital of Eastern Ontario (Ottawa, ON)
| | - P Charlebois
- Internal Medicine, Canadian Forces Health Services Centre (Atlantic) (Halifax, NS)
| | - M Crockett
- Paediatrics and Child Health, University of Manitoba (Winnipeg, MB)
| | - J Geduld
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada (Ottawa, ON)
| | - W Ghesquiere
- Infectious Diseases and Internal Medicine, University of British Columbia (Victoria, BC)
| | - P McDonald
- Therapeutic Products Directorate, Health Canada (Ottawa, ON)
| | - P Plourde
- Faculty of Medicine, University of Manitoba (Winnipeg, MB)
| | | | - M Tepper
- Communicable Disease Control Program, Directorate of Force Health Protection (Ottawa, ON)
| | - S Schofield
- Pest Management Entomology, Directorate of Forces Health Protection (Ottawa, ON)
| | - A McCarthy
- Tropical Medicine and International Health Clinic, Division of Infectious Disease, Ottawa Hospital General Campus (Ottawa, ON)
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Sin MLY, Mach KE, Wong PK, Liao JC. Advances and challenges in biosensor-based diagnosis of infectious diseases. Expert Rev Mol Diagn 2014; 14:225-44. [PMID: 24524681 DOI: 10.1586/14737159.2014.888313] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Rapid diagnosis of infectious diseases and timely initiation of appropriate treatment are critical determinants that promote optimal clinical outcomes and general public health. Conventional in vitro diagnostics for infectious diseases are time-consuming and require centralized laboratories, experienced personnel and bulky equipment. Recent advances in biosensor technologies have potential to deliver point-of-care diagnostics that match or surpass conventional standards in regards to time, accuracy and cost. Broadly classified as either label-free or labeled, modern biosensors exploit micro- and nanofabrication technologies and diverse sensing strategies including optical, electrical and mechanical transducers. Despite clinical need, translation of biosensors from research laboratories to clinical applications has remained limited to a few notable examples, such as the glucose sensor. Challenges to be overcome include sample preparation, matrix effects and system integration. We review the advances of biosensors for infectious disease diagnostics and discuss the critical challenges that need to be overcome in order to implement integrated diagnostic biosensors in real world settings.
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Affiliation(s)
- Mandy L Y Sin
- Department of Urology, Stanford University School of Medicine , Stanford, CA 94305-5118 , USA
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Molecular and Microscopic-Based Characterization of Plasmodium spp. in Fars and Hormozgan Provinces, South of Iran. J Trop Med 2014; 2014:935469. [PMID: 24799917 PMCID: PMC3988939 DOI: 10.1155/2014/935469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 11/09/2013] [Accepted: 11/10/2013] [Indexed: 11/17/2022] Open
Abstract
Despite malaria control programs in recent years, malaria transmission has not been eliminated in Iran. Molecular techniques including PCR, which has proved more sensitive and specific than microscopic examination methods, help to detect infection in low levels of parasitemia and mixed infections. Main our objectives were setting up nested PCR for detection of malaria and evaluating PCR based on plasmodia DNA from blood smears in Fars province, the comparison of this method with traditional microscopy and also evaluate the data in comparison with its neighboring province, Hormozgan. A total of 149 malaria positive samples including 116, 19, and 14 samples from Shiraz, Jask, and Lengeh ports were utilized in this study, respectively. Blood slides were prepared for microscopic observation. DNA from thin smears was extracted and nested PCR was analyzed using rPLU5 and rPLU6 for genus specification, rFAL1, rFAL2, and rVIV1, rVIV2 for P. falciparum and P. vivax detection, respectively. The results showed that 126 (84.6%), 16 (10.7%), and 7 (4.7%) out of 149 cases were positive for P. vivax, P. falciparum, and mixed infections, respectively, by microscopy. The PCR indicated that 95 (63.7%), 15 (10.1%), and 22 (14.8%) cases were infected with P. vivax, P. falciparum, and mixed mentioned species, respectively, and 17 (11.4%) cases were uninfected. Our results confirmed the considerable sensitivity of nested PCR for detection of the mixed infections. Simultaneous application of PCR even based on microscopy slides can facilitate access to the highest level of confidence in malaria researches.
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Bottieau E, Vekemans M, Van Gompel A. Therapy of vector-borne protozoan infections in nonendemic settings. Expert Rev Anti Infect Ther 2014; 9:583-608. [DOI: 10.1586/eri.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ikwuobe JO, Faragher BE, Alawode G, Lalloo DG. The impact of rapid malaria diagnostic tests upon anti-malarial sales in community pharmacies in Gwagwalada, Nigeria. Malar J 2013; 12:380. [PMID: 24172163 PMCID: PMC4228493 DOI: 10.1186/1475-2875-12-380] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 10/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid diagnostics tests for malaria (RDT) have become established as a practical solution to the challenges of parasitological confirmation of malaria before treatment in the public sector. However, little is known of their impact in private health sector facilities, such as pharmacies and drug shops. This study aimed to assess the incidence of malaria among unwell patients seeking anti-malarial treatment in two community pharmacies in Nigeria and measure the impact RDTs have on anti-malarial sales. METHODS This was a comparison study of two pharmacies located in the suburbs of Gwagwalada, in the Federal Capital Territory of Nigeria, between May and July 2012. In the intervention arm, patients seeking to purchase anti-malarials had an RDT performed before treatment while the control pharmacy continued normal routine practice. RESULTS A total of 1,226 participants were enrolled into the study. The incidence of malaria in the intervention arm (n = 619) was 13.6% and adolescent participants had a statistically significant higher incidence (26.0%) compared to adults (11.9%) (P = 0.001). A history of fever in the last 48 hours was associated with a statistically significant higher incidence of malaria (28.3%) (P < 0.001). Having a RDT test reduced the chance of purchasing an anti-malarial by 42% (95% CI: 38%-46%) compared to not having a test. 51.6% (276) of the study participants with a RDT negative result still purchased anti-malarials, especially if anti-malarials had been recommended by a health professional (58.9%) compared to self-referral (44.2%) (P = 0.001). Patients with RDT negative results were also more likely to purchase an anti-malarial if there was a reported malaria positive laboratory test prior to presentation (66.2%; P = 0.007), a history of fever in the last 48 hours (60.5%; P = 0.027), and primary school education or less (69.4%; P = 0.009). After adjusting for age group and gender differences, having at least a secondary school education reduced the chance of buying an anti-malarial (OR 0.504 (95% CI: 0.256-0.993)) compared to having primary education or lower. CONCLUSION The study highlights the enormous potential for improving appropriate prescription of anti-malarials in pharmacies and preventing unnecessary use of artemisinin combination therapy (ACT).
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Affiliation(s)
- John O Ikwuobe
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
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Kamau E, Alemayehu S, Feghali KC, Saunders D, Ockenhouse CF. Multiplex qPCR for detection and absolute quantification of malaria. PLoS One 2013; 8:e71539. [PMID: 24009663 PMCID: PMC3756973 DOI: 10.1371/journal.pone.0071539] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 06/29/2013] [Indexed: 11/18/2022] Open
Abstract
We describe development of an absolute multiplex quantitative real-time PCR for detection of Plasmodium spp., P. falciparum and P. vivax targets in order to produce an assay amenable to high throughput but with reduced costs. Important qPCR experimental details and information that is critical to performance and reliability of assay results were investigated. Inhibition studies were performed to test and compare co-purification of PCR inhibitors in samples extracted from whole blood using either the manual or automated methods. To establish the most optimal qPCR reaction volume, volume titration of the reaction master mix was performed starting at 10 µl to 1 µl reaction master mix with 1 µl of template DNA in each reaction. As the reaction volume decreased, qPCR assays became more efficient with 1 µl reaction master mix being the most efficient. For more accurate quantification of parasites in a sample, we developed plasmid DNAs for all the three assay targets for absolute quantification. All of absolute qPCR assays performed with efficiency of more than 94%, R(2) values greater than 0.99 and the STDEV of each replicate was <0.167. Linear regression plots generated from absolute qPCR assays were used to estimate the corresponding parasite density from relative qPCR in terms of parasite/µl. One copy of plasmid DNA was established to be equivalent to 0.1 parasite/µl for Plasmodium spp. assay, 0.281 parasites for P. falciparum assay and 0.127 parasite/µl for P. vivax assay. This study demonstrates for the first time use of plasmid DNA in absolute quantification of malaria parasite. The use of plasmid DNA standard in quantification of malaria parasite will be critical as efforts are underway to harmonize molecular assays used in diagnosis of malaria.
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Affiliation(s)
- Edwin Kamau
- Military Malaria Research Program, Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
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Alemayehu S, Feghali KC, Cowden J, Komisar J, Ockenhouse CF, Kamau E. Comparative evaluation of published real-time PCR assays for the detection of malaria following MIQE guidelines. Malar J 2013; 12:277. [PMID: 23927553 PMCID: PMC3750446 DOI: 10.1186/1475-2875-12-277] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of malaria-specific quantitative real-time PCR (qPCR) is increasing due to its high sensitivity, speciation and quantification of malaria parasites. However, due to the lack of consensus or standardized methods in performing qPCR, it is difficult to evaluate and/or compare the quality of work reported by different authors for a cross-study and/or cross-platform assay analysis. METHODS The performances of seven published qPCR assays that detect Plasmodium spp or Plasmodium falciparum were compared using standard DNA and samples from a clinical trial. Amplification and qPCR measurements were performed using the Applied Biosystems 7500 Fast Real-Time PCR System. All the analyses were automatically established using the default settings. For the TaqMan probe format, the assays were performed in the background of QuantiFast Probe Master Mix whereas in SYBR Green format, the assays were performed in the background of QuantiFast SYBR Green Master Mix and QuantiTect SYBR Green Master Mix background. RESULTS Assays with high PCR efficiencies outperformed those with low efficiencies in all categories including sensitivity, precision and consistency regardless of the assay format and background. With the exception of one assay, all assays evaluated showed lower sensitivity compared to what have been published. When samples from a malaria challenge study were analysed, the qPCR assay with the overall best performance detected parasites in subjects earliest and with most consistency. CONCLUSION The data demonstrate the need for increased consensus and guidelines that will encourage better experimental practices, allowing more consistent and unambiguous interpretation of qPCR results.
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Affiliation(s)
- Saba Alemayehu
- Military Malaria Research Program, Malaria Vaccine Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, USA
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Wangai LN, Karau MG, Njiruh PN, Sabah O, Kimani FT, Magoma G, Kiambo N. Sensitivity of microscopy compared to molecular diagnosis of p. Falciparum: implications on malaria treatment in epidemic areas in kenya. Afr J Infect Dis 2013; 5:1-6. [PMID: 23878701 PMCID: PMC3497842 DOI: 10.4314/ajid.v5i1.66504] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Detection of Plasmodium species by microscopy has been the gold standard for diagnosis of malaria for more than a century. Despite the fact that there is a significant decline in the number of positive cases reported from microscopy, antimalarial drugs prescriptions are on continuous increase as patients present with symptoms of malaria. This makes it difficult to establish accuracy, sensitivity and specificity of light microscopy in diagnosis of malaria in epidemic areas. This study was designed to compare microscopy with polymerase chain reaction as diagnostic methods for malaria in three epidemic areas in Kenya. A total of 356 patients presenting with malaria symptoms were diagnosed by microscopy and dried blood filter paper spots were collected from patient in Kisii, West Pokot and Narok districts. Plasmodium falciparum DNA was extracted from the dried blood filter samples. Primers specific for the Plasmodium Species were designed and used in a two step amplification of the Pfmdr gene. The PCR products were analyzed in ethidium bromide stained 1.5% agarose gel. It was found that 72 out of 350 specimens diagnosed as negative were positive for P. falciparum by nested PCR, while 6 which were microscopy positive were confirmed so by nested PCR. This study demonstrates that there is a high level of misdiagnosis which may either lead to denial for deserved treatment or undeserved treatment. Nested PCR detection of malaria parasites is a very useful complement to microscopy although it is expensive and takes long time. Additionally, smear negative patients suspected to have malaria should be subjected to PCR diagnosis to improve rational drug use. The economic burden of misdiagnosis and mistreatment of malaria outweighs that of PCR diagnosis, hence this diagnostic mode could be tenable in the long run even in rural areas.
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Affiliation(s)
- Laura Nyawira Wangai
- Institute of Tropical Medicine and Infectious Diseases (ITROMID), P.O. Box 54840-00200 Nairobi, Kenya ; Jomo Kenyatta University of Agriculture and Technology (JKUAT), Biochemistry Department, P.O. Box 62000-00200, Nairobi, Kenya
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Owusu-Ofori AK, Betson M, Parry CM, Stothard JR, Bates I. Transfusion-transmitted malaria in Ghana. Clin Infect Dis 2013; 56:1735-41. [PMID: 23463635 DOI: 10.1093/cid/cit130] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, the prevalence of malaria parasitemia in blood donors varies from 0.6% to 50%. Although the burden of TTM in malaria-endemic countries is unknown, it is recommended that all donated blood is screened for malaria parasites. This study aimed to establish the incidence of TTM and identify a suitable screening test. METHODS Pregnant women, children, and immunocompromised malaria-negative transfusion recipients in a teaching hospital in Ghana were recruited over the course of 1 year. Parasites detected in recipients within 14 days of the transfusion were genotyped and compared to parasites in the transfused blood. The presence of genotypically identical parasites in the recipient and the transfused blood confirmed transfusion-transmitted malaria. Four malaria screening tests were compared to assess their usefulness in the context of African blood banks. RESULTS Of the 50 patients who received transfusions that were positive for Plasmodium falciparum by polymerase chain reaction (PCR), 7 recipients developed PCR-detectable parasitemia. In only 1 of the 50 recipients (2%) was the parasite identical to that in the transfused blood. The prevalence of P. falciparum malaria in transfused blood was 4.7% (21/445) by microscopy, 13.7% (60/440) by rapid diagnostic test, 18% (78/436) by PCR, and 22.2% (98/442) by enzyme immunoassay. CONCLUSIONS Although malaria parasites are commonly detected in blood donors in malaria-endemic areas, transfusion-transmitted malaria occurs infrequently. Policies recommend screening blood donors for malaria, but none of the commonly used methods is sufficiently sensitive to be used by blood banks in malaria-endemic countries.
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Affiliation(s)
- Alex K Owusu-Ofori
- Department of Clinical Microbiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
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Song HO, Lee B, Bhusal RP, Park B, Yu K, Chong CK, Cho P, Kim SY, Kim HS, Park H. Development of a novel fluorophore for real-time biomonitoring system. PLoS One 2012; 7:e48459. [PMID: 23133635 PMCID: PMC3487730 DOI: 10.1371/journal.pone.0048459] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 09/26/2012] [Indexed: 01/01/2023] Open
Abstract
Rapid in-field diagnosis is very important to prevent the outbreak of various infectious and contagious diseases. Highly sensitive and quantitative detection of diseases can be performed using fluorescent immunochemical assay with specific antigen-antibody binding and a good quality fluorophore. This can lead to the development of a small, portable, quantitative biosensor to transmit diagnostic results to a control center in order to systematically prevent disease outbreaks. In this study, we developed a novel fluorophore, coumarin-derived dendrimer, with high emission intensity, strong signal brightness, and high photostability. It is easily coupled with biomolecules and emits strong and stable fluorescence at 590 nm with excitation at 455 nm. Application to fluorescent immunochromatographic test (FICT) showed that the novel coumarin-derived dendrimer bioconjugate could detect antigens at amount as low as 0.1 ng. The clinical results and the spectral characteristics of the novel coumarin-derived dendrimer open, for the first time, the possibility of developing a cost/energy efficient LED-based portable quantitative biosensor for point-of-care (POC) disease diagnosis, which can permit real time monitoring (U-healthcare system) by a disease control center.
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Affiliation(s)
- Hyun-Ok Song
- Zoonosis Research Center, Department of Infection Biology, Wonkwang University College of Medicine, Iksan, Jeonbuk, Republic of Korea
| | - Binna Lee
- Zoonosis Research Center, Department of Infection Biology, Wonkwang University College of Medicine, Iksan, Jeonbuk, Republic of Korea
| | - Ram Prasad Bhusal
- College of Pharmacy, Institute of Pharmaceutical Research and Development, Wonkwang University, Iksan, Jeonbuk, Republic of Korea
| | - Byounghun Park
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Kyoungsik Yu
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Chom-Kyu Chong
- Department of Biochemistry, Division of Life Science, Chungbuk National University, Cheongju, Chungbuk, Republic of Korea
| | - PyoYun Cho
- Zoonosis Research Center, Department of Infection Biology, Wonkwang University College of Medicine, Iksan, Jeonbuk, Republic of Korea
| | - Sung Yeon Kim
- College of Pharmacy, Institute of Pharmaceutical Research and Development, Wonkwang University, Iksan, Jeonbuk, Republic of Korea
| | - Hak Sung Kim
- College of Pharmacy, Institute of Pharmaceutical Research and Development, Wonkwang University, Iksan, Jeonbuk, Republic of Korea
- * E-mail: (HSK); (HP)
| | - Hyun Park
- Zoonosis Research Center, Department of Infection Biology, Wonkwang University College of Medicine, Iksan, Jeonbuk, Republic of Korea
- * E-mail: (HSK); (HP)
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Direct blood PCR in combination with nucleic acid lateral flow immunoassay for detection of Plasmodium species in settings where malaria is endemic. J Clin Microbiol 2012; 50:3520-5. [PMID: 22915610 DOI: 10.1128/jcm.01426-12] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Declining malaria transmission and known difficulties with current diagnostic tools for malaria, such as microscopy and rapid diagnostic tests (RDTs) in particular at low parasite densities, still warrant the search for sensitive diagnostic tests. Molecular tests need substantial simplification before implementation in clinical settings in countries where malaria is endemic. Direct blood PCR (db-PCR), circumventing DNA extraction, to detect Plasmodium was developed and adapted to be visualized by nucleic acid lateral flow immunoassay (NALFIA). The assay was evaluated in the laboratory against samples from confirmed Sudanese patients (n = 51), returning travelers (n = 214), samples from the Dutch Blood Bank (n = 100), and in the field in Burkina Faso (n = 283) and Thailand (n = 381) on suspected malaria cases and compared to RDT and microscopy. The sensitivity and specificity of db-PCR-NALFIA compared to the initial diagnosis in the laboratory were 94.4% (95% confidence interval [CI] = 0.909 to 0.969) and 97.4% (95% CI = 0.909 to 0.969), respectively. In Burkina Faso, the sensitivity was 94.8% (95% CI = 0.88.7 to 97.9%), and the specificity was 82.4% (95% CI = 75.4 to 87.7%) compared to microscopy and 93.3% (95% CI = 87.4 to 96.7%) and 91.4% (95% CI = 85.2 to 95.3%) compared to RDT. In Thailand, the sensitivity and specificity were 93.4% (CI = 86.4 to 97.1%) and 90.9 (95% CI = 86.7 to 93.9%), respectively, compared to microscopy and 95.6% (95% CI = 88.5 to 98.6%) and 87.1% (95% CI = 82.5 to 90.6) compared to RDT. db-PCR-NALFIA is highly sensitive and specific for easy and rapid detection of Plasmodium parasites and can be easily used in countries where malaria is endemic. The inability of the device to discriminate Plasmodium species requires further investigation.
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Mens PF, Moers APHA, de Bes LM, Flint J, Sak JRS, Keereecharoen L, van Overmeir C, Verweij JJ, Hallett RL, Wihokhoen B, Proux S, Schallig HDFH, van Amerongen A. Development, validation and evaluation of a rapid PCR-nucleic acid lateral flow immuno-assay for the detection of Plasmodium and the differentiation between Plasmodium falciparum and Plasmodium vivax. Malar J 2012; 11:279. [PMID: 22900750 PMCID: PMC3459699 DOI: 10.1186/1475-2875-11-279] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 08/13/2012] [Indexed: 11/26/2022] Open
Abstract
Background Molecular tools are very sensitive and specific and could be an alternative for the diagnosis of malaria. The complexity and need for expensive equipment may hamper implementation and, therefore, simplifications to current protocols are warranted. Methods A PCR detecting the different Plasmodium species and differentiating between Plasmodium falciparum and Plasmodium vivax was developed and combined with a nucleic acid lateral flow immuno-assay (PCR-NALFIA) for amplicon detection. The assay was thoroughly evaluated for the analytical sensitivity and specificity in the laboratory, the robustness and reproducibility in a ring trial and accuracy and predictive value in a field trial. Results The analytical sensitivity and specificity were 0.978 (95% CI: 0.932–0.994) and 0.980 (95% CI: 0.924-0.997), respectively, and were slightly less sensitive for the detection of P. vivax than for P. falciparum. The reproducibility tested in three laboratories was very good (k = 0.83). This evaluation showed that the PCR machine used could influence the results. Accuracy was evaluated in Thailand and compared to expert microscopy and rapid diagnostic tests (RDTs). The overall and P. falciparum-specific sensitivity and specificity was good ranging from 0.86-1 and 0.95-0.98 respectively, compared to microscopy. Plasmodium vivax detection was better than the sensitivity of RDT, but slightly less than microscopy performed in this study. Conclusion PCR-NALFIA is a sensitive, specific and robust assay able to identify Plasmodium species with good accuracy. Extensive testing including a ring trial can identify possible bottlenecks before implementation and is therefore essential to perform in additon to other evaluations.
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Affiliation(s)
- Petra F Mens
- Koninklijk Instituut voor de Tropen / Royal Tropical Institute, Biomedical Research, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands.
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Gold nanoparticle-based fluorescence immunoassay for malaria antigen detection. Anal Bioanal Chem 2011; 402:1019-27. [PMID: 22089818 DOI: 10.1007/s00216-011-5489-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 10/04/2011] [Accepted: 10/09/2011] [Indexed: 10/15/2022]
Abstract
The development of rapid detection assays for malaria diagnostics is an area of intensive research, as the traditional microscopic analysis of blood smears is cumbersome and requires skilled personnel. Here, we describe a simple and sensitive immunoassay that successfully detects malaria antigens in infected blood cultures. This homogeneous assay is based on the fluorescence quenching of cyanine 3B (Cy3B)-labeled recombinant Plasmodium falciparum heat shock protein 70 (PfHsp70) upon binding to gold nanoparticles (AuNPs) functionalized with an anti-Hsp70 monoclonal antibody. Upon competition with the free antigen, the Cy3B-labeled recombinant PfHsp70 is released to solution resulting in an increase of fluorescence intensity. Two types of AuNP-antibody conjugates were used as probes, one obtained by electrostatic adsorption of the antibody on AuNPs surface and the other by covalent bonding using protein cross-linking agents. In comparison with cross-linked antibodies, electrostatic adsorption of the antibodies to the AuNPs surfaces generated conjugates with increased activity and linearity of response, within a range of antigen concentration from 8.2 to 23.8 μg.mL(-1). The estimated LOD for the assay is 2.4 μg.mL(-1) and the LOQ is 7.3 μg.mL(-1). The fluorescence immunoassay was successfully applied to the detection of antigen in malaria-infected human blood cultures at a 3% parasitemia level, and is assumed to detect parasite densities as low as 1,000 parasites.μL(-1).
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Taylor BJ, Martin KA, Arango E, Agudelo OM, Maestre A, Yanow SK. Real-time PCR detection of Plasmodium directly from whole blood and filter paper samples. Malar J 2011; 10:244. [PMID: 21851640 PMCID: PMC3171379 DOI: 10.1186/1475-2875-10-244] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/19/2011] [Indexed: 11/18/2022] Open
Abstract
Background Real-time PCR is a sensitive and specific method for the analysis of Plasmodium DNA. However, prior purification of genomic DNA from blood is necessary since PCR inhibitors and quenching of fluorophores from blood prevent efficient amplification and detection of PCR products. Methods Reagents designed to specifically overcome PCR inhibition and quenching of fluorescence were evaluated for real-time PCR amplification of Plasmodium DNA directly from blood. Whole blood from clinical samples and dried blood spots collected in the field in Colombia were tested. Results Amplification and fluorescence detection by real-time PCR were optimal with 40× SYBR® Green dye and 5% blood volume in the PCR reaction. Plasmodium DNA was detected directly from both whole blood and dried blood spots from clinical samples. The sensitivity and specificity ranged from 93-100% compared with PCR performed on purified Plasmodium DNA. Conclusions The methodology described facilitates high-throughput testing of blood samples collected in the field by fluorescence-based real-time PCR. This method can be applied to a broad range of clinical studies with the advantages of immediate sample testing, lower experimental costs and time-savings.
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Affiliation(s)
- Brian J Taylor
- Department of Oncology, University of Alberta, Edmonton, Canada
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Hawkes M, Opoka RO, Namasopo S, Miller C, Thorpe KE, Lavery JV, Conroy AL, Liles WC, John CC, Kain KC. Inhaled nitric oxide for the adjunctive therapy of severe malaria: protocol for a randomized controlled trial. Trials 2011; 12:176. [PMID: 21752262 PMCID: PMC3151218 DOI: 10.1186/1745-6215-12-176] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 07/13/2011] [Indexed: 12/22/2022] Open
Abstract
Background Severe malaria remains a major cause of global morbidity and mortality. Despite the use of potent anti-parasitic agents, the mortality rate in severe malaria remains high. Adjunctive therapies that target the underlying pathophysiology of severe malaria may further reduce morbidity and mortality. Endothelial activation plays a central role in the pathogenesis of severe malaria, of which angiopoietin-2 (Ang-2) has recently been shown to function as a key regulator. Nitric oxide (NO) is a major inhibitor of Ang-2 release from endothelium and has been shown to decrease endothelial inflammation and reduce the adhesion of parasitized erythrocytes. Low-flow inhaled nitric oxide (iNO) gas is a US FDA-approved treatment for hypoxic respiratory failure in neonates. Methods/Design This prospective, parallel arm, randomized, placebo-controlled, blinded clinical trial compares adjunctive continuous inhaled nitric oxide at 80 ppm to placebo (both arms receiving standard anti-malarial therapy), among Ugandan children aged 1-10 years of age with severe malaria. The primary endpoint is the longitudinal change in Ang-2, an objective and quantitative biomarker of malaria severity, which will be analysed using a mixed-effects linear model. Secondary endpoints include mortality, recovery time, parasite clearance and neurocognitive sequelae. Discussion Noteworthy aspects of this trial design include its efficient sample size supported by a computer simulation study to evaluate statistical power, meticulous attention to complex ethical issues in a cross-cultural setting, and innovative strategies for safety monitoring and blinding to treatment allocation in a resource-constrained setting in sub-Saharan Africa. Trial Registration ClinicalTrials.gov Identifier: NCT01255215
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Affiliation(s)
- Michael Hawkes
- Institute of Medical Sciences, University of Toronto, Canada
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Cnops L, Van Esbroeck M, Bottieau E, Jacobs J. Giemsa-stained thick blood films as a source of DNA for Plasmodium species-specific real-time PCR. Malar J 2010; 9:370. [PMID: 21176207 PMCID: PMC3016375 DOI: 10.1186/1475-2875-9-370] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 12/22/2010] [Indexed: 12/03/2022] Open
Abstract
Background This study describes the use of thick blood films (TBF) as specimens for DNA amplification with the Plasmodium species-specific real-time PCR that was recently validated on whole blood samples. Methods The panel of 135 Giemsa-stained clinical TBFs represented single infections of the four Plasmodium species with varying parasite densities or only gametocytes, mixed infections, and negative samples and was stored for up to 12 years. Half of the Giemsa-stained TBF was scraped off by a sterile scalpel and collected into phosphate buffered saline. DNA was extracted with the Qiagen DNA mini kit with minor modifications. DNA was amplified with the 18S rRNA real-time PCR targeting the four Plasmodium species with four species-specific primers and probes in combination with one genus-specific reverse primer. Results of the PCR on TBF were compared to those of the PCR on whole blood and to microscopy. Results Correct identification for single species infections was obtained for all TBF samples with Plasmodium falciparum (n = 50), Plasmodium vivax (n = 25), Plasmodium ovale (n = 25) and in all but one samples with Plasmodium malariae (n = 10). Compared to whole blood samples, higher Ct-values were observed by PCR on TBF with a mean difference of 5.93. Four out of five mixed infections were correctly identified with PCR on TBF. None of the negative samples (n = 20) gave a PCR signal. PCR on TBF showed a detection limit of 0.2 asexual parasites/μl compared to 0.02/μl for whole blood. Intra-run variation was higher for PCR on TBF (%CV 1.90) compared to PCR on whole blood (%CV 0.54). Compared to microscopy, PCR on TBF generated three more species identifications in samples containing a single species and detected the same four mixed-infections. Conclusions Giemsa-stained TBFs are a reliable source of DNA for Plasmodium real-time PCR analysis, allowing applications in reference and research settings in case whole blood samples are not available.
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Affiliation(s)
- Lieselotte Cnops
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
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Abstract
Nonhuman primates (NHPs) are commonly used for biomedical research because of the high level of gene homology that underlies physiologic similarity to human beings. Malaria parasites of the genus Plasmodium cause one of the most frequent parasitic diseases of NHPs originating from tropical and subtropical areas and as such represent a significant research confounder. Malaria in NHPs presents a diagnostic challenge especially to those laboratories that see no more than a few malaria cases per year in NHPs. The accurate and timely diagnosis of malaria infection in NHPs facilitates the appropriate treatment of individuals infected with the malaria parasites. Conventional microscopy based on the examination of Giemsa-stained thick and thin blood films remains the mainstay of laboratory diagnosis of malaria infection because of the high diagnostic sensitivity and specificity and also the capability for Plasmodium species identification and parasite counts. This procedure is recognized as technically difficult and time-consuming, requiring considerable training to obtain the necessary skills. In the past few years, efforts to replace the traditional but tedious reading of blood films have led to different techniques for the detection of malaria parasites, including fluorescence microscopy, detection of intraleukocytic hemozoin or malaria pigment using automated blood cell analyzers, immunochromatographic rapid diagnostic tests based on malaria antigen detection, and PCR assays. These techniques offer new approaches for diagnosing malaria in NHPs. This review focuses on the available laboratory diagnostic tools for malaria in NHPs.
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Affiliation(s)
- Mehrdad Ameri
- Department of Clinical Pathology, Wyeth Research, Chazy, NY, USA.
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Bisoffi Z, Sirima SB, Menten J, Pattaro C, Angheben A, Gobbi F, Tinto H, Lodesani C, Neya B, Gobbo M, Van den Ende J. Accuracy of a rapid diagnostic test on the diagnosis of malaria infection and of malaria-attributable fever during low and high transmission season in Burkina Faso. Malar J 2010; 9:192. [PMID: 20609211 PMCID: PMC2914059 DOI: 10.1186/1475-2875-9-192] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 07/07/2010] [Indexed: 11/10/2022] Open
Abstract
Background Malaria management policies currently recommend that the treatment should only be administered after laboratory confirmation. Where microscopy is not available, rapid diagnostic tests (RDTs) are the usual alternative. Conclusive evidence is still lacking on the safety of a test-based strategy for children. Moreover, no formal attempt has been made to estimate RDTs accuracy on malaria-attributable fever. This study aims at estimating the accuracy of a RDT for the diagnosis of both malaria infection and malaria - attributable fever, in a region of Burkina Faso with a typically seasonal malaria transmission pattern. Methods Cross-sectional study. Subjects: all patients aged > 6 months consulting during the study periods. Gold standard for the diagnosis of malaria infection was microscopy. Gold standard for malaria-attributable fever was the number of fevers attributable to malaria, estimated by comparing parasite densities of febrile versus non-febrile subjects. Exclusion criteria: severe clinical condition needing urgent care. Results In the dry season, 186/852 patients with fever (22%) and 213/1,382 patients without fever (15%) had a Plasmodium falciparum infection. In the rainy season, this proportion was 841/1,317 (64%) and 623/1,669 (37%), respectively. The attributable fraction of fever to malaria was 11% and 69%, respectively. The RDT was positive in 113/400 (28.3%) fever cases in the dry season, and in 443/650 (68.2%) in the rainy season. In the dry season, the RDT sensitivity and specificity for malaria infection were 86% and 90% respectively. In the rainy season they were 94% and 78% respectively. In the dry season, the RDT sensitivity and specificity for malaria-attributable fever were 94% and 75%, the positive predictive value (PPV) was 9% and the negative predictive value (NPV) was 99.8%. In the rainy season the test sensitivity for malaria-attributable fever was 97% and specificity was 55%. The PPV ranged from 38% for adults to 82% for infants, while the NPV ranged from 84% for infants to over 99% for adults. Conclusions In the dry season the RDT has a low positive predictive value, but a very high negative predictive value for malaria-attributable fever. In the rainy season the negative test safely excludes malaria in adults but not in children.
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Affiliation(s)
- Zeno Bisoffi
- Centre for Tropical Diseases, S, Cuore Hospital, 37024 Negrar, Verona, Italy.
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Abstract
The uses of metabolic profiling technologies such as mass spectrometry and nuclear magnetic resonance spectroscopy in parasitology have been multi-faceted. Traditional uses of spectroscopic platforms focused on determining the chemical composition of drugs or natural products used for treatment of parasitic infection. A natural progression of the use of these tools led to the generation of chemical profiles of the parasite in in vitro systems, monitoring the response of the parasite to chemotherapeutics, profiling metabolic consequences in the host organism and to deriving host-parasite interactions. With the dawn of the post-genomic era the paradigm in many research areas shifted towards Systems Biology and the integration of biomolecular interactions at the level of the gene, protein and metabolite. Although these technologies have yet to deliver their full potential, metabolic profiling has a key role to play in defining diagnostic or even prognostic metabolic signatures of parasitic infection and in deciphering the molecular mechanisms underpinning the development of parasite-induced pathologies. The strengths and weaknesses of the various spectroscopic technologies and analytical strategies are summarized here with respect to achieving these goals.
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Hawkes M, Katsuva JP, Masumbuko CK. Use and limitations of malaria rapid diagnostic testing by community health workers in war-torn Democratic Republic of Congo. Malar J 2009; 8:308. [PMID: 20028563 PMCID: PMC2804690 DOI: 10.1186/1475-2875-8-308] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 12/23/2009] [Indexed: 11/25/2022] Open
Abstract
Background Accurate and practical malaria diagnostics, such as immunochromatographic rapid diagnostic tests (RDTs), have the potential to avert unnecessary treatments and save lives. Volunteer community health workers (CHWs) represent a potentially valuable human resource for expanding this technology to where it is most needed, remote rural communities in sub-Saharan Africa with limited health facilities and personnel. This study reports on a training programme for CHWs to incorporate RDTs into their management strategy for febrile children in the Democratic Republic of Congo, a tropical African setting ravaged by human conflict. Methods Prospective cohort study, satisfaction questionnaire and decision analysis. Results Twelve CHWs were trained to safely and accurately perform and interpret RDTs, then successfully implemented rapid diagnostic testing in their remote community in a cohort of 357 febrile children. CHWs were uniformly positive in evaluating RDTs for their utility and ease of use. However, high malaria prevalence in this cohort (93% by RDTs, 88% by light microscopy) limited the cost-effectiveness of RDTs compared to presumptive treatment of all febrile children, as evidenced by findings from a simplified decision analysis. Conclusions CHWs can safely and effectively use RDTs in their management of febrile children; however, cost-effectiveness of RDTs is limited in zones of high malaria prevalence.
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Affiliation(s)
- Michael Hawkes
- University of Toronto, 101 College St, Suite 10-401, Toronto, Ontario, Canada.
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Gillet P, Mori M, Van Esbroeck M, Van den Ende J, Jacobs J. Assessment of the prozone effect in malaria rapid diagnostic tests. Malar J 2009; 8:271. [PMID: 19948018 PMCID: PMC2789093 DOI: 10.1186/1475-2875-8-271] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 11/30/2009] [Indexed: 11/23/2022] Open
Abstract
Background The prozone effect (or high doses-hook phenomenon) consists of false-negative or false-low results in immunological tests, due to an excess of either antigens or antibodies. Although frequently cited as a cause of false-negative results in malaria rapid diagnostic tests (RDTs), especially at high parasite densities of Plasmodium falciparum, it has been poorly documented. In this study, a panel of malaria RDTs was challenged with clinical samples with P. falciparum hyperparasitaemia (> 5% infected red blood cells). Methods Twenty-two RDT brands were tested with seven samples, both undiluted and upon 10 ×, 50 × and 100 × dilutions in NaCl 0.9%. The P. falciparum targets included histidine-rich protein-2 (HRP-2, n = 17) and P. falciparum-specific parasite lactate dehydrogenase (Pf-pLDH, n = 5). Test lines intensities were recorded in the following categories: negative, faint, weak, medium or strong. The prozone effect was defined as an increase in test line intensity of at least one category after dilution, if observed upon duplicate testing and by two readers. Results Sixteen of the 17 HRP-2 based RDTs were affected by prozone: the prozone effect was observed in at least one RDT sample/brand combination for 16/17 HRP-2 based RDTs in 6/7 samples, but not for any of the Pf-pLDH tests. The HRP-2 line intensities of the undiluted sample/brand combinations with prozone effect (n = 51) included a single negative (1.9%) and 29 faint and weak readings (56.9%). The other target lens (P. vivax-pLDH, pan-specific pLDH and aldolase) did not show a prozone effect. Conclusion This study confirms the prozone effect as a cause of false-negative HRP-2 RDTs in samples with hyperparasitaemia.
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Affiliation(s)
- Philippe Gillet
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Nationalestraat 155, B 2000 Antwerp, Belgium.
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