Image analysis and machine learning for detecting malaria

Diagnostic accuracy of an automated microscope solution (miLab™) in detecting malaria parasites in symptomatic patients at point-of-care in Sudan: a case-control study

BACKGROUND

Microscopic detection of malaria parasites is labour-intensive, time-consuming, and expertise-demanding. Moreover, the slide interpretation is highly dependent on the staining technique and the technician's expertise. Therefore, there is a growing interest in next-generation, fully- or semi-integrated microscopes that can improve slide preparation and examination. This study aimed to evaluate the clinical performance of miLab™ (Noul Inc., Republic of Korea), a fully-integrated automated microscopy device for the detection of malaria parasites in symptomatic patients at point-of-care in Sudan.

METHODS

This was a prospective, case-control diagnostic accuracy study conducted in primary health care facilities in rural Khartoum, Sudan in 2020. According to the outcomes of routine on-site microscopy testing, 100 malaria-positive and 90 malaria-negative patients who presented at the health facility and were 5 years of age or older were enrolled consecutively. All consenting patients underwent miLab™ testing and received a negative or suspected result. For the primary analysis, the suspected results were regarded as positive (automated mode). For the secondary analysis, the operator reviewed the suspected results and categorized them as either negative or positive (corrected mode). Nested polymerase chain reaction (PCR) was used as the reference standard, and expert light microscopy as the comparator.

RESULTS

Out of the 190 patients, malaria diagnosis was confirmed by PCR in 112 and excluded in 78. The sensitivity of miLab™ was 91.1% (95% confidence interval [CI] 84.2-95.6%) and the specificity was 66.7% (95% Cl 55.1-67.7%) in the automated mode. The specificity increased to 96.2% (95% Cl 89.6-99.2%), with operator intervention in the corrected mode. Concordance of miLab with expert microscopy was substantial (kappa 0.65 [95% CI 0.54-0.76]) in the automated mode, but almost perfect (kappa 0.97 [95% CI 0.95-0.99]) in the corrected mode. A mean difference of 0.359 was found in the Bland-Altman analysis of the agreement between expert microscopy and miLab™ for quantifying parasite counts.

CONCLUSION

When used in a clinical context, miLab™ demonstrated high sensitivity but low specificity. Expert intervention was shown to be required to improve the device's specificity in its current version. miLab™ in the corrected mode performed similar to expert microscopy. Before clinical application, more refinement is needed to ensure full workflow automation and eliminate human intervention. Trial registration ClinicalTrials.gov: NCT04558515.

Development of a low-cost robotized 3D-prototype for automated optical microscopy diagnosis: An open-source system

In a clinical context, conventional optical microscopy is commonly used for the visualization of biological samples for diagnosis. However, the availability of molecular techniques and rapid diagnostic tests are reducing the use of conventional microscopy, and consequently the number of experienced professionals starts to decrease. Moreover, the continuous visualization during long periods of time through an optical microscope could affect the final diagnosis results due to induced human errors and fatigue. Therefore, microscopy automation is a challenge to be achieved and address this problem. The aim of the study is to develop a low-cost automated system for the visualization of microbiological/parasitological samples by using a conventional optical microscope, and specially designed for its implementation in resource-poor settings laboratories. A 3D-prototype to automate the majority of conventional optical microscopes was designed. Pieces were built with 3D-printing technology and polylactic acid biodegradable material with Tinkercad/Ultimaker Cura 5.1 slicing softwares. The system's components were divided into three subgroups: microscope stage pieces, storage/autofocus-pieces, and smartphone pieces. The prototype is based on servo motors, controlled by Arduino open-source electronic platform, to emulate the X-Y and auto-focus (Z) movements of the microscope. An average time of 27.00 ± 2.58 seconds is required to auto-focus a single FoV. Auto-focus evaluation demonstrates a mean average maximum Laplacian value of 11.83 with tested images. The whole automation process is controlled by a smartphone device, which is responsible for acquiring images for further diagnosis via convolutional neural networks. The prototype is specially designed for resource-poor settings, where microscopy diagnosis is still a routine process. The coalescence between convolutional neural network predictive models and the automation of the movements of a conventional optical microscope confer the system a wide range of image-based diagnosis applications. The accessibility of the system could help improve diagnostics and provide new tools to laboratories worldwide.

Application of machine learning in a rodent malaria model for rapid, accurate, and consistent parasite counts

Rodent malaria models serve as important preclinical antimalarial and vaccine testing tools. Evaluating treatment outcomes in these models often requires manually counting parasite-infected red blood cells (iRBCs), a time-consuming process, which can be inconsistent between individuals and labs. We have developed an easy-to-use machine learning (ML)-based software, Malaria Screener R, to expedite and standardize such studies by automating the counting of Plasmodium iRBCs in rodents. This software can process Giemsa-stained blood smear images captured by any camera-equipped microscope. It features an intuitive graphical user interface that facilitates image processing and visualization of the results. The software has been developed as a desktop application that processes images on standard Windows and Mac OS computers. A previous ML model created by the authors designed to count P. falciparum -infected human RBCs did not perform well counting Plasmodium -infected mouse RBCs. We leveraged that model by loading the pre-trained weights and training the algorithm with newly collected data to target P. yoelii and P. berghei mouse iRBCs. This new model reliably measured both P. yoelii and P. berghei parasitemia (R 2 = 0.9916). Additional rounds of training data to incorporate variances due to length of Giemsa staining, microscopes etc, have produced a generalizable model, meeting WHO Competency Level 1 for the sub-category of parasite counting using independent microscopes. Reliable, automated analyses of blood-stage parasitemia will facilitate rapid and consistent evaluation of novel vaccines and antimalarials across labs in an easily accessible in vivo malaria model.

MALrisk: a machine-learning–based tool to predict imported malaria in returned travellers with fever

BACKGROUND

Early diagnosis is key to reducing the morbi-mortality associated with P. falciparum malaria among international travellers. However, access to microbiological tests can be challenging for some healthcare settings. Artificial Intelligence could improve the management of febrile travellers.

METHODS

Data from a multicentric prospective study of febrile travellers was obtained to build a machine-learning model to predict malaria cases among travellers presenting with fever. Demographic characteristics, clinical and laboratory variables were leveraged as features. Eleven machine-learning classification models were evaluated by 50-fold cross-validation in a Training set. Then, the model with the best performance, defined by the Area Under the Curve (AUC), was chosen for parameter optimization and evaluation in the Test set. Finally, a reduced model was elaborated with those features that contributed most to the model.

RESULTS

Out of eleven machine-learning models, XGBoost presented the best performance (mean AUC of 0.98 and a mean F1 score of 0.78). A reduced model (MALrisk) was developed using only six features: Africa as a travel destination, platelet count, rash, respiratory symptoms, hyperbilirubinemia and chemoprophylaxis intake. MALrisk predicted malaria cases with 100% (95%CI 96-100) sensitivity and 72% (95%CI 68-75) specificity.

CONCLUSIONS

The MALrisk can aid in the timely identification of malaria in non-endemic settings, allowing the initiation of empiric antimalarials and reinforcing the need for urgent transfer in healthcare facilities with no access to malaria diagnostic tests. This resource could be easily scalable to a digital application and could reduce the morbidity associated with late diagnosis.

Automatic patient-level recognition of four Plasmodium species on thin blood smear by a real-time detection transformer (RT-DETR) object detection algorithm: a proof-of-concept and evaluation

Malaria remains a global health problem, with 247 million cases and 619,000 deaths in 2021. Diagnosis of Plasmodium species is important for administering the appropriate treatment. The gold-standard diagnosis for accurate species identification remains the thin blood smear. Nevertheless, this method is time-consuming and requires highly skilled and trained microscopists. To overcome these issues, new diagnostic tools based on deep learning are emerging. This study aimed to evaluate the performances of a real-time detection transformer (RT-DETR) object detection algorithm to discriminate Plasmodium species on thin blood smear images. The algorithm was trained and validated on a data set consisting in 24,720 images from 475 thin blood smears corresponding to 2,002,597 labels. Performances were calculated with a test data set of 4,508 images from 170 smears corresponding to 358,825 labels coming from six French university hospitals. At the patient level, the RT-DETR algorithm exhibited an overall accuracy of 79.4% (135/170) with a recall of 74% (40/54) and 81.9% (95/116) for negative and positive smears, respectively. Among Plasmodium-positive smears, the global accuracy was 82.7% (91/110) with a recall of 90% (38/42), 81.8% (18/22), and 76.1% (35/46) for P. falciparum, P. malariae, and P. ovale/vivax, respectively. The RT-DETR model achieved a World Health Organization (WHO) competence level 2 for species identification. Besides, the RT-DETR algorithm may be run in real-time on low-cost devices such as a smartphone and could be suitable for deployment in low-resource setting areas lacking microscopy experts.IMPORTANCEMalaria remains a global health problem, with 247 million cases and 619,000 deaths in 2021. Diagnosis of Plasmodium species is important for administering the appropriate treatment. The gold-standard diagnosis for accurate species identification remains the thin blood smear. Nevertheless, this method is time-consuming and requires highly skilled and trained microscopists. To overcome these issues, new diagnostic tools based on deep learning are emerging. This study aimed to evaluate the performances of a real-time detection transformer (RT-DETR) object detection algorithm to discriminate Plasmodium species on thin blood smear images. Performances were calculated with a test data set of 4,508 images from 170 smears coming from six French university hospitals. The RT-DETR model achieved a World Health Organization (WHO) competence level 2 for species identification. Besides, the RT-DETR algorithm may be run in real-time on low-cost devices and could be suitable for deployment in low-resource setting areas.

Microscopic parasite malaria classification using best feature selection based on generalized normal distribution optimization

Malaria disease can indeed be fatal if not identified and treated promptly. Due to advancements in the malaria diagnostic process, microscopy techniques are employed for blood cell analysis. Unfortunately, the diagnostic process of malaria via microscopy depends on microscopic skills. To overcome such issues, machine/deep learning algorithms can be proposed for more accurate and efficient detection of malaria. Therefore, a method is proposed for classifying malaria parasites that consist of three phases. The bilateral filter is applied to enhance image quality. After that shape-based and deep features are extracted. In shape-based pyramid histograms of oriented gradients (PHOG) features are derived with the dimension of N × 300. Deep features are derived from the residual network (ResNet)-50, and ResNet-18 at fully connected layers having the dimension of N × 1,000 respectively. The features obtained are fused serially, resulting in a dimensionality of N × 2,300. From this set, N × 498 features are chosen using the generalized normal distribution optimization (GNDO) method. The proposed method is accessed on a microscopic malarial parasite imaging dataset providing 99% classification accuracy which is better than as compared to recently published work.

Prediction of malaria positivity using patients' demographic and environmental features and clinical symptoms to complement parasitological confirmation before treatment

BACKGROUND

Current malaria diagnosis methods that rely on microscopy and Histidine Rich Protein-2 (HRP2)-based rapid diagnostic tests (RDT) have drawbacks that necessitate the development of improved and complementary malaria diagnostic methods to overcome some or all these limitations. Consequently, the addition of automated detection and classification of malaria using laboratory methods can provide patients with more accurate and faster diagnosis. Therefore, this study used a machine-learning model to predict Plasmodium falciparum (Pf) antigen positivity (presence of malaria) based on sociodemographic behaviour, environment, and clinical features.

METHOD

Data from 200 Nigerian patients were used to develop predictive models using nested cross-validation and sequential backward feature selection (SBFS), with 80% of the dataset randomly selected for training and optimisation and the remaining 20% for testing the models. Outcomes were classified as Pf-positive or Pf-negative, corresponding to the presence or absence of malaria, respectively.

RESULTS

Among the three machine learning models examined, the penalised logistic regression model had the best area under the receiver operating characteristic curve for the training set (AUC = 84%; 95% confidence interval [CI]: 75-93%) and test set (AUC = 83%; 95% CI: 63-100%). Increased odds of malaria were associated with higher body weight (adjusted odds ratio (AOR) = 4.50, 95% CI: 2.27 to 8.01, p < 0.0001). Even though the association between the odds of having malaria and body temperature was not significant, patients with high body temperature had higher odds of testing positive for the Pf antigen than those who did not have high body temperature (AOR = 1.40, 95% CI: 0.99 to 1.91, p = 0.068). In addition, patients who had bushes in their surroundings (AOR = 2.60, 95% CI: 1.30 to 4.66, p = 0.006) or experienced fever (AOR = 2.10, 95% CI: 0.88 to 4.24, p = 0.099), headache (AOR = 2.07; 95% CI: 0.95 to 3.95, p = 0.068), muscle pain (AOR = 1.49; 95% CI: 0.66 to 3.39, p = 0.333), and vomiting (AOR = 2.32; 95% CI: 0.85 to 6.82, p = 0.097) were more likely to experience malaria. In contrast, decreased odds of malaria were associated with age (AOR = 0.62, 95% CI: 0.41 to 0.90, p = 0.012) and BMI (AOR = 0.47, 95% CI: 0.26 to 0.80, p = 0.006).

CONCLUSION

Newly developed routinely collected baseline sociodemographic, environmental, and clinical features to predict Pf antigen positivity may be a valuable tool for clinical decision-making.

Application of Deep Learning in Clinical Settings for Detecting and Classifying Malaria Parasites in Thin Blood Smears

Background

Scarcity of annotated image data sets of thin blood smears makes expert-level differentiation among Plasmodium species challenging. Here, we aimed to establish a deep learning algorithm for identifying and classifying malaria parasites in thin blood smears and evaluate its performance and clinical prospect.

Methods

You Only Look Once v7 was used as the backbone network for training the artificial intelligence algorithm model. The training, validation, and test sets for each malaria parasite category were randomly selected. A comprehensive analysis was performed on 12 708 thin blood smear images of various infective stages of 12 546 malaria parasites, including P falciparum, P vivax, P malariae, P ovale, P knowlesi, and P cynomolgi. Peripheral blood samples were obtained from 380 patients diagnosed with malaria. Additionally, blood samples from monkeys diagnosed with malaria were used to analyze P cynomolgi. The accuracy for detecting Plasmodium-infected blood cells was assessed through various evaluation metrics.

Results

The total time to identify 1116 malaria parasites was 13 seconds, with an average analysis time of 0.01 seconds for each parasite in the test set. The average precision was 0.902, with a recall and precision of infected erythrocytes of 96.0% and 94.9%, respectively. Sensitivity and specificity exceeded 96.8% and 99.3%, with an area under the receiver operating characteristic curve >0.999. The highest sensitivity (97.8%) and specificity (99.8%) were observed for trophozoites and merozoites.

Conclusions

The algorithm can help facilitate the clinical and morphologic examination of malaria parasites.

Efficient Malaria Parasite Detection From Diverse Images of Thick Blood Smears for Cross-Regional Model Accuracy

Goal: The purpose of this work is to improve malaria diagnosis efficiency by integrating smartphones with microscopes. This integration involves image acquisition and algorithmic detection of malaria parasites in various thick blood smear (TBS) datasets sourced from different global regions, including low-quality images from Sub-Saharan Africa. Methods: This approach combines image segmentation and a convolutional neural network (CNN) to distinguish between white blood cells, artifacts, and malaria parasites. A portable system integrates a microscope with a graphical user interface to facilitate rapid malaria detection from smartphone images. We trained the CNN model using open-source data from the Chittagong Medical College Hospital, Bangladesh. Results: The validation process, using microscopic TBS from both the training dataset and an additional dataset from Sub-Saharan Africa, demonstrated that the proposed model achieved an accuracy of 97.74% ± 0.05% and an F1-score of 97.75% ± 0.04%. Remarkably, our proposed model with AlexNet surpasses the reported literature performance of 96.32%. Conclusions: This algorithm shows promise in aiding malaria-stricken regions, especially those with limited resources.

AIDMAN: An AI-based object detection system for malaria diagnosis from smartphone thin-blood-smear images

Malaria is a significant public health concern, with ∼95% of cases occurring in Africa, but accurate and timely diagnosis is problematic in remote and low-income areas. Here, we developed an artificial intelligence-based object detection system for malaria diagnosis (AIDMAN). In this system, the YOLOv5 model is used to detect cells in a thin blood smear. An attentional aligner model (AAM) is then applied for cellular classification that consists of multi-scale features, a local context aligner, and multi-scale attention. Finally, a convolutional neural network classifier is applied for diagnosis using blood-smear images, reducing interference caused by false positive cells. The results demonstrate that AIDMAN handles interference well, with a diagnostic accuracy of 98.62% for cells and 97% for blood-smear images. The prospective clinical validation accuracy of 98.44% is comparable to that of microscopists. AIDMAN shows clinically acceptable detection of malaria parasites and could aid malaria diagnosis, especially in areas lacking experienced parasitologists and equipment.

Intelligent diagnostic model for malaria parasite detection and classification using imperative inception-based capsule neural networks

Malaria is an acute fever sickness caused by the Plasmodium parasite and spread by infected Anopheles female mosquitoes. It causes catastrophic illness if left untreated for an extended period, and delaying exact treatment might result in the development of further complications. The most prevalent method now available for detecting malaria is the microscope. Under a microscope, blood smears are typically examined for malaria diagnosis. Despite its advantages, this method is time-consuming, subjective, and requires highly skilled personnel. Therefore, an automated malaria diagnosis system is imperative for ensuring accurate and efficient treatment. This research develops an innovative approach utilizing an urgent, inception-based capsule network to distinguish parasitized and uninfected cells from microscopic images. This diagnostic model incorporates neural networks based on Inception and Imperative Capsule networks. The inception block extracts rich characteristics from images of malaria cells using a pre-trained model, such as Inception V3, which facilitates efficient representation learning. Subsequently, the dynamic imperative capsule neural network detects malaria parasites in microscopic images by classifying them into parasitized and healthy cells, enabling the detection of malaria parasites. The experiment results demonstrate a significant improvement in malaria parasite recognition. Compared to traditional manual microscopy, the proposed system is more accurate and faster. Finally, this study demonstrates the need to provide robust and efficient diagnostic solutions by leveraging state-of-the-art technologies to combat malaria.

Embryo ploidy status classification through computer-assisted morphology assessment

BACKGROUND

Preimplantation genetic testing for aneuploidy has been proven to be effective in determining the embryo's chromosomal or ploidy status. The test requires a biopsy of embryonic cells on day 3, 5, or 6 from which complete information on the chromosomes would be obtained. The main drawbacks of preimplantation genetic testing for aneuploidy include its relatively invasive approach and the lack of research studies on the long-term effects of preimplantation genetic testing for aneuploidy.

OBJECTIVE

Computer-assisted predictive modeling through machine learning and deep learning algorithms has been proposed to minimize the use of invasive preimplantation genetic testing for aneuploidy. The capability to predict morphologic characteristics of embryo ploidy status creates a meaningful support system for decision-making before further treatment.

STUDY DESIGN

Image processing is a component in developing a predictive model specialized in image classification through which a model is able to differentiate images based on unique features. Image processing is obtained through image augmentation to capture segmented embryos and perform feature extraction. Furthermore, multiple machine learning and deep learning algorithms were used to create prediction-based modeling, and all of the prediction models undergo similar model performance assessments to determine the best model prediction algorithm.

RESULTS

An efficient artificial intelligence model that can predict embryo ploidy status was developed using image processing through a histogram of oriented gradient and then followed by principal component analysis. The gradient boosting algorithm showed an advantage against other algorithms and yielded an accuracy of 0.74, an aneuploid precision of 0.83, and an aneuploid predictive value (recall) of 0.84.

CONCLUSION

This research study proved that machine-assisted technology perceives the embryo differently than human observation and determined that further research on in vitro fertilization is needed. The study finding serves as a basis for developing a better computer-assisted prediction model.

Fast detection of slender bodies in high density microscopy data

Computer-aided analysis of biological microscopy data has seen a massive improvement with the utilization of general-purpose deep learning techniques. Yet, in microscopy studies of multi-organism systems, the problem of collision and overlap remains challenging. This is particularly true for systems composed of slender bodies such as swimming nematodes, swimming spermatozoa, or the beating of eukaryotic or prokaryotic flagella. Here, we develop a end-to-end deep learning approach to extract precise shape trajectories of generally motile and overlapping slender bodies. Our method works in low resolution settings where feature keypoints are hard to define and detect. Detection is fast and we demonstrate the ability to track thousands of overlapping organisms simultaneously. While our approach is agnostic to area of application, we present it in the setting of and exemplify its usability on dense experiments of swimming Caenorhabditis elegans. The model training is achieved purely on synthetic data, utilizing a physics-based model for nematode motility, and we demonstrate the model's ability to generalize from simulations to experimental videos.

Tile-based microscopic image processing for malaria screening using a deep learning approach

BACKGROUND

Manual microscopic examination remains the golden standard for malaria diagnosis. But it is laborious, and pathologists with experience are needed for accurate diagnosis. The need for computer-aided diagnosis methods is driven by the enormous workload and difficulties associated with manual microscopy based examination. While the importance of computer-aided diagnosis is increasing at an enormous pace, fostered by the advancement of deep learning algorithms, there are still challenges in detecting small objects such as malaria parasites in microscopic images of blood films. The state-of-the-art (SOTA) deep learning-based object detection models are inefficient in detecting small objects accurately because they are underrepresented on benchmark datasets. The performance of these models is affected by the loss of detailed spatial information due to in-network feature map downscaling. This is due to the fact that the SOTA models cannot directly process high-resolution images due to their low-resolution network input layer.

METHODS

In this study, an efficient and robust tile-based image processing method is proposed to enhance the performance of malaria parasites detection SOTA models. Three variants of YOLOV4-based object detectors are adopted considering their detection accuracy and speed. These models were trained using tiles generated from 1780 high-resolution P. falciparum-infected thick smear microscopic images. The tiling of high-resolution images improves the performance of the object detection models. The detection accuracy and the generalization capability of these models have been evaluated using three datasets acquired from different regions.

RESULTS

The best-performing model using the proposed tile-based approach outperforms the baseline method significantly (Recall, [95.3%] vs [57%] and Average Precision, [87.1%] vs [76%]). Furthermore, the proposed method has outperformed the existing approaches that used different machine learning techniques evaluated on similar datasets.

CONCLUSIONS

The experimental results show that the proposed method significantly improves P. falciparum detection from thick smear microscopic images while maintaining real-time detection speed. Furthermore, the proposed method has the potential to assist and reduce the workload of laboratory technicians in malaria-endemic remote areas of developing countries where there is a critical skill gap and a shortage of experts.

Imaging as a (pre)clinical tool in parasitology

Imaging of parasites is central to diagnosis of many parasitic diseases and has thus far played an important role in the development of antiparasitic strategies. The development of novel imaging technologies has revolutionized medicine in fields other than parasitology and has also opened up new avenues for the visualization of parasites. Here we review the role imaging technology has played so far in parasitology and how it may spur further advancement. We point out possibilities to improve current microscopy-based diagnostic methods and how to extend them with radiological imaging modalities. We also highlight in vivo tracking of parasites as a readout for efficacy of new antiparasitic strategies and as a source of fundamental insights for rational design.

Optimization of null point in Look-Locker images for myocardial late gadolinium enhancement imaging using deep learning and a smartphone

OBJECTIVES

To determine the optimal inversion time (TI) from Look-Locker scout images using a convolutional neural network (CNN) and to investigate the feasibility of correcting TI using a smartphone.

METHODS

In this retrospective study, TI-scout images were extracted using a Look-Locker approach from 1113 consecutive cardiac MR examinations performed between 2017 and 2020 with myocardial late gadolinium enhancement. Reference TI null points were independently determined visually by an experienced radiologist and an experienced cardiologist, and quantitatively measured. A CNN was developed to evaluate deviation of TI from the null point and then implemented in PC and smartphone applications. Images on 4 K or 3-megapixel monitors were captured by a smartphone, and CNN performance on each monitor was determined. Optimal, undercorrection, and overcorrection rates using deep learning on the PC and smartphone were calculated. For patient analysis, TI category differences in pre- and post-correction were evaluated using the TI null point used in late gadolinium enhancement imaging.

RESULTS

For PC, 96.4% (772/749) of images were classified as optimal, with under- and overcorrection rates of 1.2% (9/749) and 2.4% (18/749), respectively. For 4 K images, 93.5% (700/749) of images were classified as optimal, with under- and overcorrection rates of 3.9% (29/749) and 2.7% (20/749), respectively. For 3-megapixel images, 89.6% (671/749) of images were classified as optimal, with under- and overcorrection rates of 3.3% (25/749) and 7.0% (53/749), respectively. On patient-based evaluations, subjects classified as within optimal range increased from 72.0% (77/107) to 91.6% (98/107) using the CNN.

CONCLUSIONS

Optimizing TI on Look-Locker images was feasible using deep learning and a smartphone.

KEY POINTS

• A deep learning model corrected TI-scout images to within optimal null point for LGE imaging. • By capturing the TI-scout image on the monitor with a smartphone, the deviation of the TI from the null point can be immediately determined. • Using this model, TI null points can be set to the same degree as that by an experienced radiological technologist.

Robust Image Processing Framework for Intelligent Multi-Stage Malaria Parasite Recognition of Thick and Thin Smear Images

Malaria is a pressing medical issue in tropical and subtropical regions. Currently, the manual microscopic examination remains the gold standard malaria diagnosis method. Nevertheless, this procedure required highly skilled lab technicians to prepare and examine the slides. Therefore, a framework encompassing image processing and machine learning is proposed due to inconsistencies in manual inspection, counting, and staging. Here, a standardized segmentation framework utilizing thresholding and clustering is developed to segment parasites' stages of P. falciparum and P. vivax species. Moreover, a multi-stage classifier is designed for recognizing parasite species and staging in both species. Experimental results indicate the effectiveness of segmenting thick smear images based on Phansalkar thresholding garnered an accuracy of 99.86%. The employment of variance and new transferring process for the clustered members, enhanced k-means (EKM) clustering has successfully segmented all malaria stages with accuracy and an F1-score of 99.20% and 0.9033, respectively. In addition, the accuracies of parasite detection, species recognition, and staging obtained through a random forest (RF) accounted for 86.89%, 98.82%, and 90.78%, respectively, simultaneously. The proposed framework enables versatile malaria parasite detection and staging with an interactive result, paving the path for future improvements by utilizing the proposed framework on all others malaria species.

Patient-level performance evaluation of a smartphone-based malaria diagnostic application

BACKGROUND

Microscopic examination is commonly used for malaria diagnosis in the field. However, the lack of well-trained microscopists in malaria-endemic areas impacted the most by the disease is a severe problem. Besides, the examination process is time-consuming and prone to human error. Automated diagnostic systems based on machine learning offer great potential to overcome these problems. This study aims to evaluate Malaria Screener, a smartphone-based application for malaria diagnosis.

METHODS

A total of 190 patients were recruited at two sites in rural areas near Khartoum, Sudan. The Malaria Screener mobile application was deployed to screen Giemsa-stained blood smears. Both expert microscopy and nested PCR were performed to use as reference standards. First, Malaria Screener was evaluated using the two reference standards. Then, during post-study experiments, the evaluation was repeated for a newly developed algorithm, PlasmodiumVF-Net.

RESULTS

Malaria Screener reached 74.1% (95% CI 63.5-83.0) accuracy in detecting Plasmodium falciparum malaria using expert microscopy as the reference after a threshold calibration. It reached 71.8% (95% CI 61.0-81.0) accuracy when compared with PCR. The achieved accuracies meet the WHO Level 3 requirement for parasite detection. The processing time for each smear varies from 5 to 15 min, depending on the concentration of white blood cells (WBCs). In the post-study experiment, Malaria Screener reached 91.8% (95% CI 83.8-96.6) accuracy when patient-level results were calculated with a different method. This accuracy meets the WHO Level 1 requirement for parasite detection. In addition, PlasmodiumVF-Net, a newly developed algorithm, reached 83.1% (95% CI 77.0-88.1) accuracy when compared with expert microscopy and 81.0% (95% CI 74.6-86.3) accuracy when compared with PCR, reaching the WHO Level 2 requirement for detecting both Plasmodium falciparum and Plasmodium vivax malaria, without using the testing sites data for training or calibration. Results reported for both Malaria Screener and PlasmodiumVF-Net used thick smears for diagnosis. In this paper, both systems were not assessed in species identification and parasite counting, which are still under development.

CONCLUSION

Malaria Screener showed the potential to be deployed in resource-limited areas to facilitate routine malaria screening. It is the first smartphone-based system for malaria diagnosis evaluated on the patient-level in a natural field environment. Thus, the results in the field reported here can serve as a reference for future studies.

Towards digital diagnosis of malaria: How far have we reached?

The need for precise and early diagnosis of malaria and its distinction from other febrile illnesses is no doubt a prerequisite, primarily when standard rapid diagnostic tests (RDTs) cannot be totally relied upon. At the time of disease outbreaks, the pressure on hospital staff remains high and the chances of human error increase. Therefore, in the era of digitalisation of medicine as well as diagnostic approaches, various technologies such as artificial intelligence (AI) and machine learning (ML) should be deployed to further aid the diagnosis, especially in endemic and epidemic situations. Computational techniques are now more at the forefront than ever, and the interest in developing such efficient technologies is continuously increasing. A comprehensive understanding of these digital technologies is needed to maintain the scientific rigour in these attempts. This would enhance the implementation of these novel technologies for malaria diagnosis. This review highlights the progression, strengths, and limitations of various computing techniques so far employed to diagnose malaria.

Geographical classification of malaria parasites through applying machine learning to whole genome sequence data

Malaria, caused by Plasmodium parasites, is a major global health challenge. Whole genome sequencing (WGS) of Plasmodium falciparum and Plasmodium vivax genomes is providing insights into parasite genetic diversity, transmission patterns, and can inform decision making for clinical and surveillance purposes. Advances in sequencing technologies are helping to generate timely and big genomic datasets, with the prospect of applying Artificial Intelligence analytical techniques (e.g., machine learning) to support programmatic malaria control and elimination. Here, we assess the potential of applying deep learning convolutional neural network approaches to predict the geographic origin of infections (continents, countries, GPS locations) using WGS data of P. falciparum (n = 5957; 27 countries) and P. vivax (n = 659; 13 countries) isolates. Using identified high-quality genome-wide single nucleotide polymorphisms (SNPs) (P. falciparum: 750 k, P. vivax: 588 k), an analysis of population structure and ancestry revealed clustering at the country-level. When predicting locations for both species, classification (compared to regression) methods had the lowest distance errors, and > 90% accuracy at a country level. Our work demonstrates the utility of machine learning approaches for geo-classification of malaria parasites. With timelier WGS data generation across more malaria-affected regions, the performance of machine learning approaches for geo-classification will improve, thereby supporting disease control activities.

Application of machine and deep learning algorithms in optical microscopic detection of Plasmodium: A malaria diagnostic tool for the future

Machine and deep learning techniques are prevalent in the medical discipline due to their high level of accuracy in disease diagnosis. One such disease is malaria caused by Plasmodium falciparum and transmitted by the female anopheles mosquito. According to the World Health Organisation (WHO), millions of people are infected annually, leading to inevitable deaths in the infected population. Statistical records show that early detection of malaria parasites could prevent deaths and machine learning (ML) has proved helpful in the early detection of malarial parasites. Human error is identified to be a major cause of inaccurate diagnostics in the traditional microscopy malaria diagnosis method. Therefore, the method would be more reliable if human expert dependency is restricted or entirely removed, and thus, the motivation of this paper. This study presents a systematic review to understand the prevalent machine learning algorithms applied to a low-cost, portable optical microscope in the automation of blood film interpretation for malaria parasite detection. Peer-reviewed papers were downloaded from selected reputable databases eg. Elsevier, IEEExplore, Pubmed, Scopus, Web of Science, etc. The extant literature suggests that convolutional neural network (CNN) and its variants (deep learning) account for 41.9% of the microscopy malaria diagnosis using machine learning with a prediction accuracy of 99.23%. Thus, the findings suggest that early detection of the malaria parasite has improved through the application of CNN and other ML algorithms on microscopic malaria parasite detection.

A Systematic Review of Applications of Machine Learning and Other Soft Computing Techniques for the Diagnosis of Tropical Diseases

This systematic literature aims to identify soft computing techniques currently utilized in diagnosing tropical febrile diseases and explore the data characteristics and features used for diagnoses, algorithm accuracy, and the limitations of current studies. The goal of this study is therefore centralized around determining the extent to which soft computing techniques have positively impacted the quality of physician care and their effectiveness in tropical disease diagnosis. The study has used PRISMA guidelines to identify paper selection and inclusion/exclusion criteria. It was determined that the highest frequency of articles utilized ensemble techniques for classification, prediction, analysis, diagnosis, etc., over single machine learning techniques, followed by neural networks. The results identified dengue fever as the most studied disease, followed by malaria and tuberculosis. It was also revealed that accuracy was the most common metric utilized to evaluate the predictive capability of a classification mode. The information presented within these studies benefits frontline healthcare workers who could depend on soft computing techniques for accurate diagnoses of tropical diseases. Although our research shows an increasing interest in using machine learning techniques for diagnosing tropical diseases, there still needs to be more studies. Hence, recommendations and directions for future research are proposed.

Advances and challenges in automated malaria diagnosis using digital microscopy imaging with artificial intelligence tools: A review

Malaria is an infectious disease caused by parasites of the genus Plasmodium spp. It is transmitted to humans by the bite of an infected female Anopheles mosquito. It is the most common disease in resource-poor settings, with 241 million malaria cases reported in 2020 according to the World Health Organization. Optical microscopy examination of blood smears is the gold standard technique for malaria diagnosis; however, it is a time-consuming method and a well-trained microscopist is needed to perform the microbiological diagnosis. New techniques based on digital imaging analysis by deep learning and artificial intelligence methods are a challenging alternative tool for the diagnosis of infectious diseases. In particular, systems based on Convolutional Neural Networks for image detection of the malaria parasites emulate the microscopy visualization of an expert. Microscope automation provides a fast and low-cost diagnosis, requiring less supervision. Smartphones are a suitable option for microscopic diagnosis, allowing image capture and software identification of parasites. In addition, image analysis techniques could be a fast and optimal solution for the diagnosis of malaria, tuberculosis, or Neglected Tropical Diseases in endemic areas with low resources. The implementation of automated diagnosis by using smartphone applications and new digital imaging technologies in low-income areas is a challenge to achieve. Moreover, automating the movement of the microscope slide and image autofocusing of the samples by hardware implementation would systemize the procedure. These new diagnostic tools would join the global effort to fight against pandemic malaria and other infectious and poverty-related diseases.

Evaluating the Performance of Deep Learning Frameworks for Malaria Parasite Detection Using Microscopic Images of Peripheral Blood Smears

Malaria is a significant health concern in many third-world countries, especially for pregnant women and young children. It accounted for about 229 million cases and 600,000 mortality globally in 2019. Hence, rapid and accurate detection is vital. This study is focused on achieving three goals. The first is to develop a deep learning framework capable of automating and accurately classifying malaria parasites using microscopic images of thin and thick peripheral blood smears. The second is to report which of the two peripheral blood smears is the most appropriate for use in accurately detecting malaria parasites in peripheral blood smears. Finally, we evaluate the performance of our proposed model with commonly used transfer learning models. We proposed a convolutional neural network capable of accurately predicting the presence of malaria parasites using microscopic images of thin and thick peripheral blood smears. Model evaluation was carried out using commonly used evaluation metrics, and the outcome proved satisfactory. The proposed model performed better when thick peripheral smears were used with accuracy, precision, and sensitivity of 96.97%, 97.00%, and 97.00%. Identifying the most appropriate peripheral blood smear is vital for improved accuracy, rapid smear preparation, and rapid diagnosis of patients, especially in regions where malaria is endemic.

Malaria Detection Accelerated: Combing a High-Throughput NanoZoomer Platform with a ParasiteMacro Algorithm

Eradication of malaria, a mosquito-borne parasitic disease that hijacks human red blood cells, is a global priority. Microscopy remains the gold standard hallmark for diagnosis and estimation of parasitemia for malaria, to date. However, this approach is time-consuming and requires much expertise especially in malaria-endemic countries or in areas with low-density malaria infection. Thus, there is a need for accurate malaria diagnosis/parasitemia estimation with standardized, fast, and more reliable methods. To this end, we performed a proof-of-concept study using the automated imaging (NanoZoomer) platform to detect the malarial parasite in infected blood. The approach can be used as a steppingstone for malaria diagnosis and parasitemia estimation. Additionally, we created an algorithm (ParasiteMacro) compatible with free online imaging software (ImageJ) that can be used with low magnification objectives (e.g., 5×, 10×, and 20×) both in the NanoZoomer and routine microscope. The novel approach to estimate malarial parasitemia based on modern technologies compared to manual light microscopy demonstrated 100% sensitivity, 87% specificity, a 100% negative predictive value (NPV) and a 93% positive predictive value (PPV). The manual and automated malaria counts showed a good Pearson correlation for low- (R2 = 0.9377, r = 0.9683 and p < 0.0001) as well as high- parasitemia (R2 = 0.8170, r = 0.9044 and p < 0.0001) with low estimation errors. Our robust strategy that identifies and quantifies malaria can play a pivotal role in disease control strategies.

Reducing data dimension boosts neural network-based stage-specific malaria detection

Although malaria has been known for more than 4 thousand years¹, it still imposes a global burden with approx. 240 million annual cases². Improvement in diagnostic techniques is a prerequisite for its global elimination. Despite its main limitations, being time-consuming and subjective, light microscopy on Giemsa-stained blood smears is still the gold-standard diagnostic method used worldwide. Autonomous computer assisted recognition of malaria infected red blood cells (RBCs) using neural networks (NNs) has the potential to overcome these deficiencies, if a fast, high-accuracy detection can be achieved using low computational power and limited sets of microscopy images for training the NN. Here, we report on a novel NN-based scheme that is capable of the high-speed classification of RBCs into four categories—healthy ones and three classes of infected ones according to the parasite age—with an accuracy as high as 98%. Importantly, we observe that a smart reduction of data dimension, using characteristic one-dimensional cross-sections of the RBC images, not only speeds up the classification but also significantly improves its performance with respect to the usual two-dimensional NN schemes. Via comparative studies on RBC images recorded by two additional techniques, fluorescence and atomic force microscopy, we demonstrate that our method is universally applicable for different types of microscopy images. This robustness against imaging platform-specific features is crucial for diagnostic applications. Our approach for the reduction of data dimension could be straightforwardly generalised for the classification of different parasites, cells and other types of objects.

Multi-outputs Gaussian process for predicting Burkina Faso COVID-19 spread using correlations from the weather parameters

The novel coronavirus has affected all regions of the world, but each country has experienced different rates of infection. In West Africa, in particular, infection rates remain low as compared to other parts of the world. This heterogeneity in the spread of COVID-19 raises a lot of questions that are still unanswered. However, some studies point out that people's mobility, size of gatherings, rate of testing, and weather have a great impact on the COVID-19 spread. In this work, we first evaluate the correlation between meteorological parameters and COVID-19 cases using Spearman's rank correlation. Secondly, multi-output Gaussian processes (MOGP) are used to predict the daily confirmed COVID-19 cases by exploring its relationships with meteorological parameters. The number of daily reported COVID-19 cases, as well as, weather variables collected from March 9, 2020, to October 18, 2021, were used in the analysis. The weather variables considered in the analysis are the mean temperature, relative humidity, wind direction, insolation, precipitation, and wind speed. The predicting model was constructed exploiting the correlation between the data of the daily confirmed COVID-19 cases and data of the weather variables. The results show that a significant correlation between the daily confirmed COVID-19 cases was found with humidity, wind direction, wind speed, and insolation. These parameters are used to construct the predictive model using the Multi-Output Gaussian process (MOGP). Different combinations of the data of meteorological parameters together with the data of daily reported COVID-19 cases were used to derive different models. We found that the best predictor is obtained using the combination of Humidity and insolation. This model is then used to predict the daily confirmed COVID-19 cases knowing the humidity and Insolation.

Risk score prediction model based on single nucleotide polymorphism for predicting malaria: a machine learning approach

Background

The malaria risk prediction is currently limited to using advanced statistical methods, such as time series and cluster analysis on epidemiological data. Nevertheless, machine learning models have been explored to study the complexity of malaria through blood smear images and environmental data. However, to the best of our knowledge, no study analyses the contribution of Single Nucleotide Polymorphisms (SNPs) to malaria using a machine learning model. More specifically, this study aims to quantify an individual's susceptibility to the development of malaria by using risk scores obtained from the cumulative effects of SNPs, known as weighted genetic risk scores (wGRS).

Results

We proposed an SNP-based feature extraction algorithm that incorporates the susceptibility information of an individual to malaria to generate the feature set. However, it can become computationally expensive for a machine learning model to learn from many SNPs. Therefore, we reduced the feature set by employing the Logistic Regression and Recursive Feature Elimination (LR-RFE) method to select SNPs that improve the efficacy of our model. Next, we calculated the wGRS of the selected feature set, which is used as the model's target variables. Moreover, to compare the performance of the wGRS-only model, we calculated and evaluated the combination of wGRS with genotype frequency (wGRS + GF). Finally, Light Gradient Boosting Machine (LightGBM), eXtreme Gradient Boosting (XGBoost), and Ridge regression algorithms are utilized to establish the machine learning models for malaria risk prediction.

Conclusions

Our proposed approach identified SNP rs334 as the most contributing feature with an importance score of 6.224 compared to the baseline, with an importance score of 1.1314. This is an important result as prior studies have proven that rs334 is a major genetic risk factor for malaria. The analysis and comparison of the three machine learning models demonstrated that LightGBM achieves the highest model performance with a Mean Absolute Error (MAE) score of 0.0373. Furthermore, based on wGRS + GF, all models performed significantly better than wGRS alone, in which LightGBM obtained the best performance (0.0033 MAE score).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12859-022-04870-0.

Detection of Ticks and Tick-Borne Pathogens of Urban Stray Dogs in South Africa

This study aimed to identify ticks infesting dogs admitted to the Potchefstroom Animal Welfare Society (PAWS) and to detect tick-borne pathogens they are harbouring. A total of 592 ticks were collected from 61 stray dogs admitted to PAWS originating from several suburbs in and near Potchefstroom, South Africa. The dog ticks were identified as Haemaphysalis elliptica (39%) and Rhipicephalus sanguineus (61%) by both morphological and DNA analyses. Of these ticks, H. elliptica consisted of 67.5% (156/231) and 32.5% (75/231) female and male ticks, respectively, whilst R. sanguineus consisted of 48.5% (175/361) and 51.5% (186/361) female and male ticks, respectively. Microscopic examination of blood smears from engorged female ticks indicated overall occurrences of 0.5% (1/204) for Babesia spp. from R. sanguineus, 1% (2/204) of Anaplasma spp. from H. elliptica, and 22% (45/204) of Rickettsia spp. from both H. elliptica and R. sanguineus. Using pooled samples molecular detection of tick-borne pathogens indicated overall occurrences of 1% (1/104) for A. phagocytophilum in H. elliptica, 9.6% (10/104) of Rickettsia spp. in H. elliptica and R. sanguineus, 5.8% (6/104) of Ehrlichia canis in H. elliptica and R. sanguineus, and 13.5% (14/104) of Coxiella spp. in both H. elliptica and R. sanguineus. Additionally, PCR detected 6.5% (2/31) of Coxiella spp. DNA from H. elliptica eggs. Our data indicate that urban stray dogs admitted at PAWS are infested by H. elliptica and R. sanguineus ticks which are harbouring several pathogenic organisms known to cause tick-borne diseases.

Transforming Rapid Diagnostic Tests for Precision Public Health: Open Guidelines for Manufacturers and Users

BACKGROUND

Precision public health (PPH) can maximize impact by targeting surveillance and interventions by temporal, spatial, and epidemiological characteristics. Although rapid diagnostic tests (RDTs) have enabled ubiquitous point-of-care testing in low-resource settings, their impact has been less than anticipated, owing in part to lack of features to streamline data capture and analysis.

OBJECTIVE

We aimed to transform the RDT into a tool for PPH by defining information and data axioms and an information utilization index (IUI); identifying design features to maximize the IUI; and producing open guidelines (OGs) for modular RDT features that enable links with digital health tools to create an RDT-OG system.

METHODS

We reviewed published papers and conducted a survey with experts or users of RDTs in the sectors of technology, manufacturing, and deployment to define features and axioms for information utilization. We developed an IUI, ranging from 0% to 100%, and calculated this index for 33 World Health Organization-prequalified RDTs. RDT-OG specifications were developed to maximize the IUI; the feasibility and specifications were assessed through developing malaria and COVID-19 RDTs based on OGs for use in Kenya and Indonesia.

RESULTS

The survey respondents (n=33) included 16 researchers, 7 technologists, 3 manufacturers, 2 doctors or nurses, and 5 other users. They were most concerned about the proper use of RDTs (30/33, 91%), their interpretation (28/33, 85%), and reliability (26/33, 79%), and were confident that smartphone-based RDT readers could address some reliability concerns (28/33, 85%), and that readers were more important for complex or multiplex RDTs (33/33, 100%). The IUI of prequalified RDTs ranged from 13% to 75% (median 33%). In contrast, the IUI for an RDT-OG prototype was 91%. The RDT open guideline system that was developed was shown to be feasible by (1) creating a reference RDT-OG prototype; (2) implementing its features and capabilities on a smartphone RDT reader, cloud information system, and Fast Healthcare Interoperability Resources; and (3) analyzing the potential public health impact of RDT-OG integration with laboratory, surveillance, and vital statistics systems.

CONCLUSIONS

Policy makers and manufacturers can define, adopt, and synergize with RDT-OGs and digital health initiatives. The RDT-OG approach could enable real-time diagnostic and epidemiological monitoring with adaptive interventions to facilitate control or elimination of current and emerging diseases through PPH.

Computational Models-Based Detection of Peripheral Malarial Parasites in Blood Smears

The most common human parasite as per the medical experts is the malarial disease, which is caused by a protozoan parasite, and Plasmodium falciparum, a common parasite in humans. A microscopist with expertise in malaria diagnosis must conduct this complex procedure to identify the stages of infection. This epidemic is an ongoing disease in some parts of the world, which is commonly found. A Kaggle repository was used to upload the data collected from the NIH portal. The dataset contains 27558 samples, of which 13779 samples carry parasites and 13779 samples do not. This paper focuses on two of the most common deep transfer learning methods. Unlike other feature extractors, VGG-19's fine-tuning and pretraining made it an ideal feature extractor. Several image classification models, including VGG-19, have been pretrained on larger datasets. Additionally, deep learning strategies based on pretrained models are proposed for detecting malarial parasite cases in the early stages, in addition to an accuracy rating of 98.34^∗ 0.51%.

Explainable Transformer-Based Deep Learning Model for the Detection of Malaria Parasites from Blood Cell Images

Malaria is a life-threatening disease caused by female anopheles mosquito bites. Various plasmodium parasites spread in the victim’s blood cells and keep their life in a critical situation. If not treated at the early stage, malaria can cause even death. Microscopy is a familiar process for diagnosing malaria, collecting the victim’s blood samples, and counting the parasite and red blood cells. However, the microscopy process is time-consuming and can produce an erroneous result in some cases. With the recent success of machine learning and deep learning in medical diagnosis, it is quite possible to minimize diagnosis costs and improve overall detection accuracy compared with the traditional microscopy method. This paper proposes a multiheaded attention-based transformer model to diagnose the malaria parasite from blood cell images. To demonstrate the effectiveness of the proposed model, the gradient-weighted class activation map (Grad-CAM) technique was implemented to identify which parts of an image the proposed model paid much more attention to compared with the remaining parts by generating a heatmap image. The proposed model achieved a testing accuracy, precision, recall, f1-score, and AUC score of 96.41%, 96.99%, 95.88%, 96.44%, and 99.11%, respectively, for the original malaria parasite dataset and 99.25%, 99.08%, 99.42%, 99.25%, and 99.99%, respectively, for the modified dataset. Various hyperparameters were also finetuned to obtain optimum results, which were also compared with state-of-the-art (SOTA) methods for malaria parasite detection, and the proposed method outperformed the existing methods.

Barnacles Mating Optimizer with Deep Transfer Learning Enabled Biomedical Malaria Parasite Detection and Classification

Biomedical engineering involves ideologies and problem-solving methods of engineering to biology and medicine. Malaria is a life-threatening illness, which has gained significant attention among researchers. Since the manual diagnosis of malaria in a clinical setting is tedious, automated tools based on computational intelligence (CI) tools have gained considerable interest. Though earlier studies were focused on the handcrafted features, the diagnostic accuracy can be boosted through deep learning (DL) methods. This study introduces a new Barnacles Mating Optimizer with Deep Transfer Learning Enabled Biomedical Malaria Parasite Detection and Classification (BMODTL-BMPC) model. The presented BMODTL-BMPC model involves the design of intelligent models for the recognition and classification of malaria parasites. Initially, the Gaussian filtering (GF) approach is employed to eradicate noise in blood smear images. Then, Graph cuts (GC) segmentation technique is applied to determine the affected regions in the blood smear images. Moreover, the barnacles mating optimizer (BMO) algorithm with the NasNetLarge model is employed for the feature extraction process. Furthermore, the extreme learning machine (ELM) classification model is employed for the identification and classification of malaria parasites. To assure the enhanced outcomes of the BMODTL-BMPC technique, a wide-ranging experimentation analysis is performed using a benchmark dataset. The experimental results show that the BMODTL-BMPC technique outperforms other recent approaches.

IMNets: Deep Learning Using an Incremental Modular Network Synthesis Approach for Medical Imaging Applications

Deep learning approaches play a crucial role in computer-aided diagnosis systems to support clinical decision-making. However, developing such automated solutions is challenging due to the limited availability of annotated medical data. In this study, we proposed a novel and computationally efficient deep learning approach to leverage small data for learning generalizable and domain invariant representations in different medical imaging applications such as malaria, diabetic retinopathy, and tuberculosis. We refer to our approach as Incremental Modular Network Synthesis (IMNS), and the resulting CNNs as Incremental Modular Networks (IMNets). Our IMNS approach is to use small network modules that we call SubNets which are capable of generating salient features for a particular problem. Then, we build up ever larger and more powerful networks by combining these SubNets in different configurations. At each stage, only one new SubNet module undergoes learning updates. This reduces the computational resource requirements for training and aids in network optimization. We compare IMNets against classic and state-of-the-art deep learning architectures such as AlexNet, ResNet-50, Inception v3, DenseNet-201, and NasNet for the various experiments conducted in this study. Our proposed IMNS design leads to high average classification accuracies of 97.0%, 97.9%, and 88.6% for malaria, diabetic retinopathy, and tuberculosis, respectively. Our modular design for deep learning achieves the state-of-the-art performance in the scenarios tested. The IMNets produced here have a relatively low computational complexity compared to traditional deep learning architectures. The largest IMNet tested here has 0.95 M of the learnable parameters and 0.08 G of the floating-point multiply–add (MAdd) operations. The simpler IMNets train faster, have lower memory requirements, and process images faster than the benchmark methods tested.

Detection of Peripheral Malarial Parasites in Blood Smears Using Deep Learning Models

Due to the plasmodium parasite, malaria is transmitted mostly through red blood cells. Manually counting blood cells is extremely time consuming and tedious. In a recommendation for the advanced technology stage and analysis of malarial disease, the performance of the XG-Boost, SVM, and neural networks is compared. In comparison to machine learning models, convolutional neural networks provide reliable results when analyzing and recognizing the same datasets. To reduce discrepancies and improve robustness and generalization, we developed a model that analyzes blood samples to determine whether the cells are parasitized or not. Experiments were conducted on 13,750 parasitized and 13,750 parasitic samples. Support vector machines achieved 94% accuracy, XG-Boost models achieved 90% accuracy, and neural networks achieved 80% accuracy. Among these three models, the support vector machine was the most accurate at distinguishing parasitized cells from uninfected ones. An accuracy rate of 97% was achieved by the convolution neural network in recognizing the samples. The deep learning model is useful for decision making because of its better accuracy.

Machine Learning and Its Applications for Protozoal Pathogens and Protozoal Infectious Diseases

In recent years, massive attention has been attracted to the development and application of machine learning (ML) in the field of infectious diseases, not only serving as a catalyst for academic studies but also as a key means of detecting pathogenic microorganisms, implementing public health surveillance, exploring host-pathogen interactions, discovering drug and vaccine candidates, and so forth. These applications also include the management of infectious diseases caused by protozoal pathogens, such as Plasmodium, Trypanosoma, Toxoplasma, Cryptosporidium, and Giardia, a class of fatal or life-threatening causative agents capable of infecting humans and a wide range of animals. With the reduction of computational cost, availability of effective ML algorithms, popularization of ML tools, and accumulation of high-throughput data, it is possible to implement the integration of ML applications into increasing scientific research related to protozoal infection. Here, we will present a brief overview of important concepts in ML serving as background knowledge, with a focus on basic workflows, popular algorithms (e.g., support vector machine, random forest, and neural networks), feature extraction and selection, and model evaluation metrics. We will then review current ML applications and major advances concerning protozoal pathogens and protozoal infectious diseases through combination with correlative biology expertise and provide forward-looking insights for perspectives and opportunities in future advances in ML techniques in this field.

Computational Methods for Automated Analysis of Malaria Parasite Using Blood Smear Images: Recent Advances

Malaria comes under one of the dangerous diseases in many countries. It is the primary reason for most of the causalities across the world. It is presently rated as a significant cause of the high mortality rate worldwide compared with other diseases that can be reduced significantly by its earlier detection. Therefore, to facilitate the early detection/diagnosis of malaria to reduce the mortality rate, an automated computational method is required with a high accuracy rate. This study is a solid starting point for researchers who want to look into automated blood smear analysis to detect malaria. In this paper, a comprehensive review of different computer-assisted techniques has been outlined as follows: (i) acquisition of image dataset, (ii) preprocessing, (iii) segmentation of RBC, and (iv) feature extraction and selection, and (v) classification for the detection of malaria parasites using blood smear images. This study will be helpful for: (i) researchers can inspect and improve the existing computational methods for early diagnosis of malaria with a high accuracy rate that may further reduce the interobserver and intra-observer variations; (ii) microbiologists to take the second opinion from the automated computational methods for effective diagnosis of malaria; and (iii) finally, several issues remain addressed, and future work has also been discussed in this work.

Field evaluation of the diagnostic performance of EasyScan GO: a digital malaria microscopy device based on machine-learning

BACKGROUND

Microscopic examination of Giemsa-stained blood films remains the reference standard for malaria parasite detection and quantification, but is undermined by difficulties in ensuring high-quality manual reading and inter-reader reliability. Automated parasite detection and quantification may address this issue.

METHODS

A multi-centre, observational study was conducted during 2018 and 2019 at 11 sites to assess the performance of the EasyScan Go, a microscopy device employing machine-learning-based image analysis. Sensitivity, specificity, accuracy of species detection and parasite density estimation were assessed with expert microscopy as the reference. Intra- and inter-device reliability of the device was also evaluated by comparing results from repeat reads on the same and two different devices. This study has been reported in accordance with the Standards for Reporting Diagnostic accuracy studies (STARD) checklist.

RESULTS

In total, 2250 Giemsa-stained blood films were prepared and read independently by expert microscopists and the EasyScan Go device. The diagnostic sensitivity of EasyScan Go was 91.1% (95% CI 88.9-92.7), and specificity 75.6% (95% CI 73.1-78.0). With good quality slides sensitivity was similar (89.1%, 95%CI 86.2-91.5), but specificity increased to 85.1% (95%CI 82.6-87.4). Sensitivity increased with parasitaemia rising from 57% at < 200 parasite/µL, to ≥ 90% at > 200-200,000 parasite/µL. Species were identified accurately in 93% of Plasmodium falciparum samples (kappa = 0.76, 95% CI 0.69-0.83), and in 92% of Plasmodium vivax samples (kappa = 0.73, 95% CI 0.66-0.80). Parasite density estimates by the EasyScan Go were within ± 25% of the microscopic reference counts in 23% of slides.

CONCLUSIONS

The performance of the EasyScan Go in parasite detection and species identification accuracy fulfil WHO-TDR Research Malaria Microscopy competence level 2 criteria. In terms of parasite quantification and false positive rate, it meets the level 4 WHO-TDR Research Malaria Microscopy criteria. All performance parameters were significantly affected by slide quality. Further software improvement is required to improve sensitivity at low parasitaemia and parasite density estimations. Trial registration ClinicalTrials.gov number NCT03512678.

Teleclinical Microbiology: An Innovative Approach to Providing Web-Enabled Diagnostic Laboratory Services in Syria

OBJECTIVES

Telemedicine can compensate for the lack of health care specialists in response to protracted humanitarian crises. We sought to assess the usability of a teleclinical microbiology (TCM) program to provide diagnostic services in a hard-to-reach region of Syria.

METHODS

A semimobile station was equipped with conventional micrograph and macrograph digital imaging systems. An electronic platform (Telemicrobiology in Humanitarian Crises, TmHC) was created to facilitate sharing, interpreting, and storing the results. A pilot study was conducted to identify the bacterial species and antimicrobial susceptibility pattern of 74 urinary clinical isolates. An experience survey was conducted to capture the feedback of 8 participants in the program.

RESULTS

The TmHC platform (https://sdh.ngo/tmhc/) enabled systematic transmission of the laboratory records and co-interpretation of the results. The isolates were identified as Escherichia coli (n = 61), Klebsiella pneumoniae (n = 12), and Proteus mirabilis(n = 1). All the isolates were multidrug resistant. The performance of our TCM module was rated 4 (satisfying) and 5 (very satisfying) by 6 and 2 users, respectively. Data security of and cost-effectiveness were the main perceived concerns.

CONCLUSIONS

Although we encountered several context-related obstacles, our TCM program managed to reach a highly vulnerable population of 4 million people confined in the northwest region of Syria.

Automatic Recognition of Ragged Red Fibers in Muscle Biopsy from Patients with Mitochondrial Disorders

Mitochondrial dysfunction is considered to be a major cause of primary mitochondrial myopathy in children and adults, as reduced mitochondrial respiration and morphological changes such as ragged red fibers (RRFs) are observed in muscle biopsies. However, it is also possible to hypothesize the role of mitochondrial dysfunction in aging muscle or in secondary mitochondrial dysfunctions. The recognition of true histological patterns of mitochondrial myopathy can avoid unnecessary genetic investigations. The aim of our study was to develop and validate machine-learning methods for RRF detection in light microscopy images of skeletal muscle tissue. We used image sets of 489 color images captured from representative areas of Gomori’s trichrome-stained tissue retrieved from light microscopy images at a 20× magnification. We compared the performance of random forest, gradient boosting machine, and support vector machine classifiers. Our results suggested that the advent of scanning technologies, combined with the development of machine-learning models for image classification, make neuromuscular disorders’ automated diagnostic systems a concrete possibility.

An Empirical Evaluation of Convolutional Networks for Malaria Diagnosis

Malaria is a globally widespread disease caused by parasitic protozoa transmitted to humans by infected female mosquitoes of Anopheles. It is caused in humans only by the parasite Plasmodium, further classified into four different species. Identifying malaria parasites is possible by analysing digital microscopic blood smears, which is tedious, time-consuming and error prone. So, automation of the process has assumed great importance as it helps the laborious manual process of review and diagnosis. This work focuses on deep learning-based models, by comparing off-the-shelf architectures for classifying healthy and parasite-affected cells, by investigating the four-class classification on the Plasmodium falciparum stages of life and, finally, by evaluating the robustness of the models with cross-dataset experiments on two different datasets. The main contributions to the research in this field can be resumed as follows: (i) comparing off-the-shelf architectures in the task of classifying healthy and parasite-affected cells, (ii) investigating the four-class classification on the P. falciparum stages of life and (iii) evaluating the robustness of the models with cross-dataset experiments. Eleven well-known convolutional neural networks on two public datasets have been exploited. The results show that the networks have great accuracy in binary classification, even though they lack few samples per class. Moreover, the cross-dataset experiments exhibit the need for some further regulations. In particular, ResNet-18 achieved up to 97.68% accuracy in the binary classification, while DenseNet-201 reached 99.40% accuracy on the multiclass classification. The cross-dataset experiments exhibit the limitations of deep learning approaches in such a scenario, even though combining the two datasets permitted DenseNet-201 to reach 97.45% accuracy. Naturally, this needs further investigation to improve the robustness. In general, DenseNet-201 seems to offer the most stable and robust performance, offering as a crucial candidate to further developments and modifications. Moreover, the mobile-oriented architectures showed promising and satisfactory performance in the classification of malaria parasites. The obtained results enable extensive improvements, specifically oriented to the application of object detectors for type and stage of life recognition, even in mobile environments.

Deep Learning for Microscopic Examination of Protozoan Parasites

The infectious and parasitic diseases represent a major threat to public health and are among the main causes of morbidity and mortality. The complex and divergent life cycles of parasites present major difficulties associated with the diagnosis of these organisms by microscopic examination. Deep learning has shown extraordinary performance in biomedical image analysis including various parasites diagnosis in the past few years. Here we summarize advances of deep learning in the field of protozoan parasites microscopic examination, focusing on publicly available microscopic image datasets of protozoan parasites. In the end, we summarize the challenges and future trends, which deep learning faces in protozoan parasite diagnosis.

Automated detection and staging of malaria parasites from cytological smears using convolutional neural networks

Microscopic examination of blood smears remains the gold standard for laboratory inspection and diagnosis of malaria. Smear inspection is, however, time-consuming and dependent on trained microscopists with results varying in accuracy. We sought to develop an automated image analysis method to improve accuracy and standardization of smear inspection that retains capacity for expert confirmation and image archiving. Here, we present a machine learning method that achieves red blood cell (RBC) detection, differentiation between infected/uninfected cells, and parasite life stage categorization from unprocessed, heterogeneous smear images. Based on a pretrained Faster Region-Based Convolutional Neural Networks (R-CNN) model for RBC detection, our model performs accurately, with an average precision of 0.99 at an intersection-over-union threshold of 0.5. Application of a residual neural network-50 model to infected cells also performs accurately, with an area under the receiver operating characteristic curve of 0.98. Finally, combining our method with a regression model successfully recapitulates intraerythrocytic developmental cycle with accurate lifecycle stage categorization. Combined with a mobile-friendly web-based interface, called PlasmoCount, our method permits rapid navigation through and review of results for quality assurance. By standardizing assessment of Giemsa smears, our method markedly improves inspection reproducibility and presents a realistic route to both routine lab and future field-based automated malaria diagnosis.

An Automatic Procedure for Overheated Idler Detection in Belt Conveyors Using Fusion of Infrared and RGB Images Acquired during UGV Robot Inspection

Complex mechanical systems used in the mining industry for efficient raw materials extraction require proper maintenance. Especially in a deep underground mine, the regular inspection of machines operating in extremely harsh conditions is challenging, thus, monitoring systems and autonomous inspection robots are becoming more and more popular. In the paper, it is proposed to use a mobile unmanned ground vehicle (UGV) platform equipped with various data acquisition systems for supporting inspection procedures. Although maintenance staff with appropriate experience are able to identify problems almost immediately, due to mentioned harsh conditions such as temperature, humidity, poisonous gas risk, etc., their presence in dangerous areas is limited. Thus, it is recommended to use inspection robots collecting data and appropriate algorithms for their processing. In this paper, the authors propose red-green-blue (RGB) and infrared (IR) image fusion to detect overheated idlers. An original procedure for image processing is proposed, that exploits some characteristic features of conveyors to pre-process the RGB image to minimize non-informative components in the pictures collected by the robot. Then, the authors use this result for IR image processing to improve SNR and finally detect hot spots in IR image. The experiments have been performed on real conveyors operating in industrial conditions.

An ensemble-based approach for automated medical diagnosis of malaria using EfficientNet

Each year, more than 400,000 people die of malaria. Malaria is a mosquito-borne transmissible infection that affects humans and other animals. According to World Health Organization (WHO), 1.5 billion malaria cases and 7.6 million related deaths have been prevented from 2000 to 2019. Malaria is a disease that can be treated if early detected. We propose a support decision system for detecting malaria from microscopic peripheral blood cells images through convolutional neural networks (CNN). The proposed model is based on EfficientNetB0 architecture. The results are validated with 10-fold stratified cross-validation. This paper presents the classification findings using images from malaria patients and normal patients. The proposed approach is compared and outperforms the related work. Furthermore, the proposed ensemble method shows a recall value of 98.82%, a precision value of 97.74%, an F1-score of 98.28% and a ROC value of 99.76%. This work suggests that EfficientNet is a reliable architecture for automatic medical diagnostics of malaria.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11042-022-12624-6.

Erythrocyte morphological symmetry analysis to detect sublethal trauma in shear flow

The viscoelastic properties of red blood cells (RBC) facilitate flexible shape change in response to extrinsic forces. Their viscoelasticity is intrinsically linked to physical properties of the cytosol, cytoskeleton, and membrane-all of which are highly sensitive to supraphysiological shear exposure. Given the need to minimise blood trauma within artificial organs, we observed RBC in supraphysiological shear through direct visualisation to gain understanding of processes leading to blood damage. Using a custom-built counter-rotating shear generator fit to a microscope, healthy red blood cells (RBC) were directly visualised during exposure to different levels of shear (10-60 Pa). To investigate RBC morphology in shear flow, we developed an image analysis method to quantify (a)symmetry of deforming ellipsoidal cells-following RBC identification and centroid detection, cell radius was determined for each angle around the circumference of the cell, and the resultant bimodal distribution (and thus RBC) was symmetrically compared. While traditional indices of RBC deformability (elongation index) remained unaltered in all shear conditions, following ~100 s of exposure to 60 Pa, the frequency of asymmetrical ellipses and RBC fragments/extracellular vesicles significantly increased. These findings indicate RBC structure is sensitive to shear history, where asymmetrical morphology may indicate sublethal blood damage in real-time shear flow.