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Oni O, El Barche A, Taddesse-Heath L. Unsuspected Malaria Diagnosed on a Routine Peripheral Smear Review. Cureus 2024; 16:e61077. [PMID: 38916004 PMCID: PMC11196128 DOI: 10.7759/cureus.61077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 06/26/2024] Open
Abstract
Prompt diagnosis of malaria infection is critical for effective management, yet it can be challenging due to varying incubation periods and the need for physician-initiated laboratory workups. We present a case of a 40-year-old male with fever and dark-colored urine, initially evaluated for sepsis. Plasmodium vivax was incidentally identified on a peripheral smear review after obtaining a remote travel history from a malaria-endemic area. Consultation with the Centers for Disease Control confirmed the diagnosis, emphasizing the importance of thorough travel history assessment and timely laboratory investigation in suspected cases of malaria. This case underscores the significance of early diagnosis in managing this potentially life-threatening infection.
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Affiliation(s)
- Olanrewaju Oni
- Pathology and Laboratory Medicine, Howard University Hospital, Washington, D.C., USA
| | - Alejandro El Barche
- Pathology and Laboratory Medicine, Howard University Hospital, Washington, D.C., USA
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Tripathi H, Bhalerao P, Singh S, Arya H, Alotaibi BS, Rashid S, Hasan MR, Bhatt TK. Malaria therapeutics: are we close enough? Parasit Vectors 2023; 16:130. [PMID: 37060004 PMCID: PMC10103679 DOI: 10.1186/s13071-023-05755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/22/2023] [Indexed: 04/16/2023] Open
Abstract
Malaria is a vector-borne parasitic disease caused by the apicomplexan protozoan parasite Plasmodium. Malaria is a significant health problem and the leading cause of socioeconomic losses in developing countries. WHO approved several antimalarials in the last 2 decades, but the growing resistance against the available drugs has worsened the scenario. Drug resistance and diversity among Plasmodium strains hinder the path of eradicating malaria leading to the use of new technologies and strategies to develop effective vaccines and drugs. A timely and accurate diagnosis is crucial for any disease, including malaria. The available diagnostic methods for malaria include microscopy, RDT, PCR, and non-invasive diagnosis. Recently, there have been several developments in detecting malaria, with improvements leading to achieving an accurate, quick, cost-effective, and non-invasive diagnostic tool for malaria. Several vaccine candidates with new methods and antigens are under investigation and moving forward to be considered for clinical trials. This article concisely reviews basic malaria biology, the parasite's life cycle, approved drugs, vaccine candidates, and available diagnostic approaches. It emphasizes new avenues of therapeutics for malaria.
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Affiliation(s)
- Himani Tripathi
- Department of Biotechnology, Central University of Rajasthan, NH-8, Bandarsindri, 305817, Rajasthan, India
| | - Preshita Bhalerao
- Department of Biotechnology, Central University of Rajasthan, NH-8, Bandarsindri, 305817, Rajasthan, India
| | - Sujeet Singh
- Department of Biotechnology, Central University of Rajasthan, NH-8, Bandarsindri, 305817, Rajasthan, India
| | - Hemant Arya
- Department of Biotechnology, Central University of Rajasthan, NH-8, Bandarsindri, 305817, Rajasthan, India.
| | - Bader Saud Alotaibi
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Alquwayiyah, Shaqra University, Riyadh, 11971, Saudi Arabia
| | - Summya Rashid
- Department of Pharmacology and Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, Al-Kharj, 11942, Saudi Arabia
| | - Mohammad Raghibul Hasan
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Alquwayiyah, Shaqra University, Riyadh, 11971, Saudi Arabia.
| | - Tarun Kumar Bhatt
- Department of Biotechnology, Central University of Rajasthan, NH-8, Bandarsindri, 305817, Rajasthan, India.
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Thorne N, Flores-Olazo L, Egoávil-Espejo R, Vela EA, Noel J, Valdivia-Silva J, van Noort D. Systematic Review: Microfluidics and Plasmodium. MICROMACHINES 2021; 12:mi12101245. [PMID: 34683295 PMCID: PMC8538353 DOI: 10.3390/mi12101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022]
Abstract
Malaria affects 228 million people worldwide each year, causing severe disease and worsening the conditions of already vulnerable populations. In this review, we explore how malaria has been detected in the past and how it can be detected in the future. Our primary focus is on finding new directions for low-cost diagnostic methods that unspecialized personnel can apply in situ. Through this review, we show that microfluidic devices can help pre-concentrate samples of blood infected with malaria to facilitate the diagnosis. Importantly, these devices can be made cheaply and be readily deployed in remote locations.
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Affiliation(s)
- Nicolas Thorne
- Centro de Investigación en Bioingeniería, Universidad de Ingenieria y Tecnologia (UTEC), 15063 Lima, Peru; (L.F.-O.); (R.E.-E.); (E.A.V.); (J.N.); (J.V.-S.)
- Correspondence: (N.T.); (D.v.N.)
| | - Luis Flores-Olazo
- Centro de Investigación en Bioingeniería, Universidad de Ingenieria y Tecnologia (UTEC), 15063 Lima, Peru; (L.F.-O.); (R.E.-E.); (E.A.V.); (J.N.); (J.V.-S.)
| | - Rocío Egoávil-Espejo
- Centro de Investigación en Bioingeniería, Universidad de Ingenieria y Tecnologia (UTEC), 15063 Lima, Peru; (L.F.-O.); (R.E.-E.); (E.A.V.); (J.N.); (J.V.-S.)
| | - Emir A. Vela
- Centro de Investigación en Bioingeniería, Universidad de Ingenieria y Tecnologia (UTEC), 15063 Lima, Peru; (L.F.-O.); (R.E.-E.); (E.A.V.); (J.N.); (J.V.-S.)
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia (UTEC), 15063 Lima, Peru
| | - Julien Noel
- Centro de Investigación en Bioingeniería, Universidad de Ingenieria y Tecnologia (UTEC), 15063 Lima, Peru; (L.F.-O.); (R.E.-E.); (E.A.V.); (J.N.); (J.V.-S.)
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia (UTEC), 15063 Lima, Peru
| | - Julio Valdivia-Silva
- Centro de Investigación en Bioingeniería, Universidad de Ingenieria y Tecnologia (UTEC), 15063 Lima, Peru; (L.F.-O.); (R.E.-E.); (E.A.V.); (J.N.); (J.V.-S.)
| | - Danny van Noort
- Centro de Investigación en Bioingeniería, Universidad de Ingenieria y Tecnologia (UTEC), 15063 Lima, Peru; (L.F.-O.); (R.E.-E.); (E.A.V.); (J.N.); (J.V.-S.)
- Biotechnology, Linköping University, 581 83 Linköping, Sweden
- Correspondence: (N.T.); (D.v.N.)
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Nishimura J, Dharap P, Raimbault S. The utility of basic blood counts, WBC histogram and C-reactive protein in detecting malaria. BMC Infect Dis 2021; 21:1006. [PMID: 34565334 PMCID: PMC8474782 DOI: 10.1186/s12879-021-06704-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hematology analyzers display abnormal parameters during malaria infection providing insightful information for suspecting and assessing malaria infection. The goal of this study is to demonstrate the potential of a three-part differential hematology analyzer to assess malaria, provide information about the parasitemia, and discuss the importance of combining C-reactive protein (CRP) with hematology parameters to obtain further information about the malaria infection. Methods The present study shows the results of a case–control study during the monsoon season of years 2018 and 2019 in Mumbai, India. The study considers 1008 non-malaria febrile cases, 209 P. vivax and 31 P. falciparum positive malaria samples, five cases of mixed P. vivax and P. falciparum infection, and three co-infection cases of P. vivax and dengue. Raw data from the three-part analyzer LC-667G CRP (HORIBA) and the corresponding microscopic findings (golden standard for diagnosis of malaria) were obtained for each sample. Results The medians of platelet counts (PLT) were 102.5, 109.0, and 223.0 × 103/µL, while CRP medians were 67.4, 81.4 and 10.4 mg/L in P. vivax, P. falciparum and control groups respectively (p < 0.001 in Mann–Whitney U tests between malaria and control groups). Compared with negative samples, platelets counting less than 161.5 × 103/µL were observed on malaria patients (OR 19.12, 95% CI 11.89–30.75). Especially in P. vivax cases, an abnormal peak was frequently observed in the white blood cells (WBC) histogram around the 37fL channel. The events counted around that channel showed a linear correlation with the counting of red blood cells infected predominantly with larger parasitic forms. Parameters like CRP (rs = 0.325, p < 0.001), WBC (rs = 0.285, p < 0.001) and PLT (rs = − 0.303, p < 0.001) were correlated with the parasitemia of P. vivax samples. Between the malaria and dengue groups, the highest area under the receiver operating characteristic curve was observed on CRP (0.867, CRP ≥ 26.85 mg/L). Conclusions A three-part differential hematology analyzer has the potential to not only trigger malaria diagnosis confirmation but also assess the severity of the infection when CRP is considered. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06704-5.
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Huh HJ, Chung JW, Park SY, Chae SL. Vivax malaria detection using a parasitic red blood cell flag generated by the Sysmex XN-9000 hematology analyzer. Int J Lab Hematol 2021; 43:1403-1407. [PMID: 34374207 DOI: 10.1111/ijlh.13672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/29/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A Sysmex XN-series hematology analyzer (Sysmex), the next generation up from the Sysmex XE-series, can provide information regarding malaria infection in the form of a parasitic red blood cell (pRBC) flag. This study aimed to determine the usefulness of the pRBC flag for early detection and follow-up in patients infected with Plasmodium vivax. METHODS A total of 221 patients with fever for whom CBC and malaria microscopy had been requested were analyzed. Sixty-seven individuals were diagnosed with P vivax infection, and 154 were diagnosed with other febrile diseases. The sensitivity and specificity of the pRBC flag for malaria parasite detection and the relationship between parasite density and presence of the pRBC flag were determined. The concordance rate between malaria microscopy and pRBC flag in 147 follow-up cases was calculated. RESULTS The pRBC flag was detected in 56 of 67 malaria patients (sensitivity, 83.6%; specificity, 100%). The patients with the pRBC flag at initial diagnosis revealed significantly higher parasite density than the patients without the pRBC flag (P < .05). The concordance rate between malaria microscopy and pRBC flag in the follow-up cases was 53.1%. CONCLUSION Considering its high sensitivity in malaria-suspicious patients, unexpected vivax malaria cases can be detected with the pRBC flag when CBC is done in a routine laboratory setting. The pRBC flag provided by the Sysmex XN series is a valuable tool for vivax malaria detection.
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Affiliation(s)
- Hee Jin Huh
- Departments of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jae-Woo Chung
- Departments of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Seong Yeon Park
- Department of Internal medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Seok-Lae Chae
- Departments of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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Dharap P, Raimbault S. Performance evaluation of machine learning-based infectious screening flags on the HORIBA Medical Yumizen H550 Haematology Analyzer for vivax malaria and dengue fever. Malar J 2020; 19:429. [PMID: 33228680 PMCID: PMC7684750 DOI: 10.1186/s12936-020-03502-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Automated detection of malaria and dengue infection has been actively researched for more than two decades. Although many improvements have been achieved, these solutions remain too expensive for most laboratories and clinics in developing countries. The low range HORIBA Medical Haematology Analyzer, Yumizen H550, now provides dedicated flags 'vivax malaria' and 'dengue fever' in routine blood testing, developed through machine learning methods, to be used as a screening tool for malaria and dengue fever in endemic areas. This study sought to evaluate the effectiveness of these flags under real clinical conditions. METHODS A total of 1420 samples were tested using the Yumizen H550 Haematology Analyzer, including 1339 samples from febrile patients among whom 202 were infected with malaria parasites (Plasmodium vivax only: 182, Plasmodium falciparum only: 18, both: 2), 210 were from febrile dengue infected patients, 3 were from afebrile dengue infected patients and 78 were samples from healthy controls, in an outpatient laboratory clinic in Mumbai, India. Microscopic examination was carried out as the confirmatory reference method for detection of malarial parasite, species identification and assessing parasitaemia based on different stages of parasite life cycle. Rapid diagnostic malarial antigen tests were used for additional confirmation. For dengue infection, NS1 antigen detection by ELISA was used as a diagnostic marker. RESULTS For the automated vivax malaria flag, the original manufacturer's cut off yielded a sensitivity and specificity of 65.2% and 98.9% respectively with the ROC AUC of 0.9. After optimization of cut-off value, flag performance improved to 72% for sensitivity and 97.9% specificity. Additionally it demonstrated a positive correlation with increasing levels of parasitaemia. For the automated dengue fever flag it yielded a ROC AUC of 0.82 with 79.3% sensitivity and 71.5% specificity. CONCLUSIONS The results demonstrate a possibility of the effective use of automated infectious flags for screening vivax malaria and dengue infection in a clinical setting.
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Post A, Kaboré B, Reuling IJ, Bognini J, van der Heijden W, Diallo S, Lompo P, Kam B, Herssens N, Lanke K, Bousema T, Sauerwein RW, Tinto H, Jacobs J, de Mast Q, van der Ven AJ. The XN-30 hematology analyzer for rapid sensitive detection of malaria: a diagnostic accuracy study. BMC Med 2019; 17:103. [PMID: 31146732 PMCID: PMC6543632 DOI: 10.1186/s12916-019-1334-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate and timely diagnosis of malaria is essential for disease management and surveillance. Thin and thick blood smear microscopy and malaria rapid diagnostic tests (RDTs) are standard malaria diagnostics, but both methods have limitations. The novel automated hematology analyzer XN-30 provides standard complete blood counts (CBC) as well as quantification of malaria parasitemia at the price of a CBC. This study assessed the accuracy of XN-30 for malaria detection in a controlled human malaria infection (CHMI) study and a phase 3 diagnostic accuracy study in Burkina Faso. METHODS Sixteen healthy, malaria-naive CHMI participants were challenged with five Plasmodium falciparum-infected mosquitoes. Blood was sampled daily for XN-30, blood smear microscopy, and malaria qPCR. The accuracy study included patients aged > 3 months presenting with acute febrile illness. XN-30, microscopy, and rapid diagnostic tests (HRP-2/pLDH) were performed on site; qPCR was done in retrospect. The malaria reference standard was microscopy, and results were corrected for sub-microscopic cases. RESULTS All CHMI participants became parasitemic by qPCR and XN-30 with a strong correlation for parasite density (R2 = 0.91; p < .0001). The XN-30 accurately monitored treatment and allowed detection of recrudescence. Out of 908 patients in the accuracy study, 241 had microscopic malaria (density 24-491,802 parasites/μL). The sensitivity and specificity of XN-30 compared to microscopy were 98.7% and 99.4% (PPV = 98.7%, NPV = 99.4%). Results were corrected for qPCR-confirmed sub-microscopic cases. Three microscopy-confirmed cases were not detected by XN-30. However, XN-30 detected 19/134 (14.2%) qPCR-confirmed cases missed by microscopy. Among qPCR-confirmed cases, XN-30 had a higher sensitivity (70.9% versus 66.4%; p = .0009) and similar specificity (99.6% versus 100%; p = .5) as microscopy. The accuracy of XN-30 for microscopic malaria was equal to or higher than HRP-2 and pLDH RDTs, respectively. CONCLUSIONS The XN-30 is a novel, automated hematology analyzer that combines standard hemocytometry with rapid, objective, and robust malaria detection and quantification, ensuring prompt treatment of malaria and malaria anemia and follow-up of treatment response. TRIAL REGISTRATION Both trials were registered on clinicaltrials.gov with respective identifiers NCT02836002 (CHMI trial) and NCT02669823 (diagnostic accuracy study).
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Affiliation(s)
- Annelies Post
- Nijmegen Institute of International Health, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Berenger Kaboré
- Nijmegen Institute of International Health, Radboud University Medical Centre, Nijmegen, the Netherlands.,IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Isaie J Reuling
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Joel Bognini
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Wouter van der Heijden
- Nijmegen Institute of International Health, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Salou Diallo
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | | | - Basile Kam
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Natacha Herssens
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Kjerstin Lanke
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Robert W Sauerwein
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Halidou Tinto
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.,Centre Muraz, Bobo-Dioulasso, Burkina Faso.,Institut Supérieur des Sciences de la Santé, Université Nazi Boni de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine (ITM), Antwerp, Belgium.,Department of Microbiology and Immunology, University of Leuven (KU Leuven), Leuven, Belgium
| | - Quirijn de Mast
- Nijmegen Institute of International Health, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Andre J van der Ven
- Nijmegen Institute of International Health, Radboud University Medical Centre, Nijmegen, the Netherlands.
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Roch A, Prodéo J, Pierart C, Muller RN, Duez P. The paramagnetic properties of malaria pigment, hemozoin, yield clues to a low-cost system for its trapping and determination. Talanta 2019; 197:553-557. [PMID: 30771975 DOI: 10.1016/j.talanta.2019.01.090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/27/2022]
Abstract
The binding of malaria pigment, hemozoin, by a gradient magnetic field has been investigated in a manual trapping column system. Two types of magnetic filling have been tested to produce field gradients: nickel-plated steel wires, wrapped around a steel core, and superparamagnetic microbeads. The latter system allows an efficient trapping (> 80%) of β-hematin (a synthetic pigment with physical and paramagnetic properties analogous to those of hemozoin). Tests with a Plasmodium falciparum 3D7 culture indicate that hemozoin is similarly trapped. Off-line optical spectroscopy measurements present limited sensitivity as the hemozoin we detected from in vitro cultured parasites would correspond to only a theoretical 0.02% parasitemia (1000 parasites/µL). Further work needs to be undertaken to reduce this threshold to a practical detectability level. Based on these data, a magneto-chromatographic on-line system with reduced dead volumes is proposed as a possible low-cost instrument to be tested as a malaria diagnosis system.
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Affiliation(s)
- A Roch
- Service de Chimie Générale, Organique et Biomédicale, Université de Mons (UMONS), Bât. Mendeleïev, Avenue Maistriau 19, 7000 Mons, Belgium
| | - J Prodéo
- Service de Chimie Générale, Organique et Biomédicale, Université de Mons (UMONS), Bât. Mendeleïev, Avenue Maistriau 19, 7000 Mons, Belgium
| | - C Pierart
- Service de Chimie Générale, Organique et Biomédicale, Université de Mons (UMONS), Bât. Mendeleïev, Avenue Maistriau 19, 7000 Mons, Belgium
| | - R N Muller
- Service de Chimie Générale, Organique et Biomédicale, Université de Mons (UMONS), Bât. Mendeleïev, Avenue Maistriau 19, 7000 Mons, Belgium
| | - P Duez
- Service de Chimie Thérapeutique et de Pharmacognosie, Université de Mons (UMONS), Bât. 6, Chemin du Champ de Mars 25, 7000 Mons, Belgium.
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Pillay E, Khodaiji S, Bezuidenhout BC, Litshie M, Coetzer TL. Evaluation of automated malaria diagnosis using the Sysmex XN-30 analyser in a clinical setting. Malar J 2019; 18:15. [PMID: 30670023 PMCID: PMC6341646 DOI: 10.1186/s12936-019-2655-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early and accurate diagnosis of malaria is a critical aspect of efforts to control the disease, and several diagnostic tools are available. Microscopic assessment of a peripheral blood smear enables direct visualization of parasites in infected red blood cells and is the clinical diagnostic gold standard. However, it is subjective and requires a high level of skill. Numerous indirect detection methods are in use, but are not ideal since surrogate markers of infection are measured. This study describes the first clinical performance evaluation of the automated Sysmex XN-30 analyser, which utilizes fluorescence flow cytometry to directly detect and quantitate parasite-infected red blood cells. RESULTS Residual EDTA blood samples from suspected malaria cases referred for routine diagnosis were analysed on the XN-30. Parasitaemia was reported as a percentage, as well as absolute numbers of infected red blood cells, and scattergrams provided a visual image of the parasitized red blood cell clusters. The results reported by the XN-30 correlated with microscopy and the analyser demonstrated 100% sensitivity and specificity. Measurements were reproducible and storage of samples at room temperature did not affect the parameters. Several Plasmodium species were detected, including Plasmodium falciparum, Plasmodium vivax and Plasmodium ovale. The XN-30 also identified the transmissible gametocytes as a separate cluster on the scattergrams. Abnormal red blood cell indices (low haemoglobin and raised reticulocyte counts), haemoglobinopathies and thrombocytopenia did not interfere with the detection of parasites. The XN-30 also generated a concurrent full blood count for each sample. CONCLUSIONS The novel technology of the Sysmex XN-30 provides a robust, rapid, automated and accurate platform for diagnosing malaria in a clinical setting. The objective enumeration of red blood cells infected with Plasmodium species makes it suitable for global use and allows monitoring of the parasite load once therapy has been initiated, thereby providing an early marker of drug resistance. The automated generation of a full blood count for each sample provides an opportunity for detecting unsuspected cases. Asymptomatic carriers can also be identified, which will be useful in blood transfusion centres, and will enable treatment of these individuals to prevent the spread of the disease.
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Affiliation(s)
- Evashin Pillay
- Wits Research Institute for Malaria, Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa.
| | - Shanaz Khodaiji
- Hematology Department, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | - Belinda C Bezuidenhout
- Wits Research Institute for Malaria, Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Monwabisi Litshie
- Department of Microbiology, Chris Hani Baragwanath Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - Thérèsa L Coetzer
- Wits Research Institute for Malaria, Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
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Dumas C, Bienvenu AL, Girard S, Picot S, Debize G, Durand B. AutomatedPlasmodiumdetection by the Sysmex XN hematology analyzer. J Clin Pathol 2018; 71:594-599. [DOI: 10.1136/jclinpath-2017-204878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/01/2017] [Accepted: 12/07/2017] [Indexed: 11/04/2022]
Abstract
BackgroundMalaria is a potentially severe disease affecting nearly 200 million people per year. Early detection of the parasite even in unsuspected patients remains the challenging aim for effective patient care. Automated complete blood counts that are usually performed for any febrile patient might represent a tool to ascertain malaria infection.AimsTo evaluate the ability of the new generation of the Sysmex hematology analyzer (XN-series) to detect malaria.MethodsWe retrospectively studied 100 blood samples performed with the recent Sysmex XN analyzer that were positive forPlasmodiumand explored its ability to detect the parasite. 100 samples from patients uninfected by malaria were used as control group.ResultsSpecific abnormalities such as additional events in the mature neutrophil/eosinophil area of the white blood cells differential (WDF) scattergram were noted for 1.1% ofPlasmodium falciparumsamples and 56.2% of otherPlasmodiumspecies samples. Mature parasite stages (schizonts or gametocytes) were observed on blood smears among those samples. WDF scattergrams were able to detect 80.0% (12/15) ofPlasmodiummature stages. Furthermore, the differential in white blood counts between WDF and white cell nucleated (WNR) channels was a predictive signal ofPlasmodiummature stages in 73.3% (11/15) of samples and may be explained by a differential destruction of particles with the analyzer reagent.ConclusionAssociated to thrombocytopaenia, a Sysmex XNPlasmodiumpattern may represent a useful warning forPlasmodiumdetection in unsuspected patients, particularly when mature parasite stages are present.
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Hemoglobin consumption by P. falciparum in individual erythrocytes imaged via quantitative phase spectroscopy. Sci Rep 2016; 6:24461. [PMID: 27087557 PMCID: PMC4834482 DOI: 10.1038/srep24461] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/22/2016] [Indexed: 12/21/2022] Open
Abstract
Plasmodium falciparum infection causes structural and biochemical changes in red blood cells (RBCs). To quantify these changes, we apply a novel optical technique, quantitative phase spectroscopy (QPS) to characterize individual red blood cells (RBCs) during the intraerythrocytic life cycle of P. falciparum. QPS captures hyperspectral holograms of individual RBCs to measure spectroscopic changes across the visible wavelength range (475-700 nm), providing complex information, i.e. amplitude and phase, about the light field which has interacted with the cell. The complex field provides complimentary information on hemoglobin content and cell mass, which are both found to dramatically change upon infection by P. falciparum. Hb content progressively decreases with parasite life cycle, with an average 72.2% reduction observed for RBCs infected by schizont-stage P. falciparum compared to uninfected cells. Infection also resulted in a 33.1% reduction in RBC's optical volume, a measure of the cells' non-aqueous components. Notably, optical volume is only partially correlated with hemoglobin content, suggesting that changes in other dry mass components such as parasite mass may also be assessed using this technique. The unique ability of QPS to discriminate individual healthy and infected cells using spectroscopic changes indicates that the approach can be used to detect disease.
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A diagnostic tool for malaria based on computer software. Sci Rep 2015; 5:16656. [PMID: 26559606 PMCID: PMC4642325 DOI: 10.1038/srep16656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/19/2015] [Indexed: 01/03/2023] Open
Abstract
Nowadays, the gold standard method for malaria diagnosis is a staining of thick and thin blood film examined by expert laboratorists. It requires well-trained laboratorists, which is a time consuming task, and is un-automated protocol. For this study, Maladiag Software was developed to predict malaria infection in suspected malaria patients. The demographic data of patients, examination for malaria parasites, and complete blood count (CBC) profiles were analyzed. Binary logistic regression was used to create the equation for the malaria diagnosis. The diagnostic parameters of the equation were tested on 4,985 samples (703 infected and 4,282 control samples). The equation indicated 81.2% sensitivity and 80.3% specificity for predicting infection of malaria. The positive likelihood and negative likelihood ratio were 4.12 (95% CI = 4.01–4.23) and 0.23 (95% CI = 0.22–0.25), respectively. This parameter also had odds ratios (P value < 0.0001, OR = 17.6, 95% CI = 16.0–19.3). The equation can predict malaria infection after adjust for age, gender, nationality, monocyte (%), platelet count, neutrophil (%), lymphocyte (%), and the RBC count of patients. The diagnostic accuracy was 0.877 (Area under curve, AUC) (95% CI = 0.871–0.883). The system, when used in combination with other clinical and microscopy methods, might improve malaria diagnoses and enhance prompt treatment.
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Singh A, Narang V, Sood N, Garg B, Gupta VK. Malaria Diagnosis Using Automated Analysers: A Boon for Hematopathologists in Endemic Areas. J Clin Diagn Res 2015; 9:EC05-8. [PMID: 26557525 DOI: 10.7860/jcdr/2015/15108.6696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/10/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Haematological abnormalities are common in acute febrile tropical illnesses. Malaria is a major health problem in tropics. In endemic areas especially in the post monsoon season, it is not practical to manually screen all peripheral blood films (PBF) for malarial parasite. Automated analysers offer rapid, sensitive and cost effective screening of all samples. AIM The study was done to evaluate the usefulness of automated cell counters analysing their histograms, scatter-grams and the flaggings generated in malaria positive and negative cases. The comparison of other haematological parameters were also studied which could help to identify malaria parasite in peripheral blood smear. MATERIALS AND METHODS The blood samples were analysed using Beckman coulter LH-750. The abnormal scatter grams and additional peaks in WBC histograms were observed diligently & compared with normal controls. Haematological abnormalities were also evaluated. STATISTICAL ANALYSIS Statistical analysis was done by using software Epi-Info version 7.1.4 freely available from CDC website. Fisher exact test was applied to calculate the p-value and value < 0.05 was considered as significant. Final identification of malarial parasite species was done independently by peripheral blood smear examination by two pathologists. RESULTS Of all the 200 cases evaluated abnormal scatter grams were observed in all the cases of malaria while abnormal WBC histogram peaks were noted in 96% cases demonstrating a peak at the threshold of the histogram. The difference between number of slides positive for abnormal WBC scatter gram and abnormal WBC histogram peaks were statistically highly significant (p=0.007). So abnormal WBC scatter gram can better give idea of malarial parasite presence. Of the haematological parameters thrombocytopenia (92% cases) emerged as the strongest predictor of malaria. CONCLUSION It is recommended for haematopathologists to review the haematological data and the scatter plots on the analyser along with peripheral blood smear examination.
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Affiliation(s)
- Aminder Singh
- Assistant Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Vikram Narang
- Assistant Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Neena Sood
- Professor and Head, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Bhavna Garg
- Professor, Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
| | - Vikram Kumar Gupta
- Assistant Professor, Department of SPM, Dayanand Medical College and Hospital , Ludhiana, Punjab, India
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Pirnstill CW, Coté GL. Malaria Diagnosis Using a Mobile Phone Polarized Microscope. Sci Rep 2015; 5:13368. [PMID: 26303238 PMCID: PMC4548194 DOI: 10.1038/srep13368] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/14/2015] [Indexed: 12/15/2022] Open
Abstract
Malaria remains a major global health burden, and new methods for low-cost, high-sensitivity, diagnosis are essential, particularly in remote areas with low-resource around the world. In this paper, a cost effective, optical cell-phone based transmission polarized light microscope system is presented for imaging the malaria pigment known as hemozoin. It can be difficult to determine the presence of the pigment from background and other artifacts, even for skilled microscopy technicians. The pigment is much easier to observe using polarized light microscopy. However, implementation of polarized light microscopy lacks widespread adoption because the existing commercial devices have complicated designs, require sophisticated maintenance, tend to be bulky, can be expensive, and would require re-training for existing microscopy technicians. To this end, a high fidelity and high optical resolution cell-phone based polarized light microscopy system is presented which is comparable to larger bench-top polarized microscopy systems but at much lower cost and complexity. The detection of malaria in fixed and stained blood smears is presented using both, a conventional polarized microscope and our cell-phone based system. The cell-phone based polarimetric microscopy design shows the potential to have both the resolution and specificity to detect malaria in a low-cost, easy-to-use, modular platform.
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Affiliation(s)
- Casey W Pirnstill
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Gerard L Coté
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843.,Center for Remote Health Technologies and Systems, Texas Engineering Experiment Station, College Station, TX 77843
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Rebelo M, Tempera C, Bispo C, Andrade C, Gardner R, Shapiro HM, Hänscheid T. Light depolarization measurements in malaria: A new job for an old friend. Cytometry A 2015; 87:437-45. [PMID: 25808846 DOI: 10.1002/cyto.a.22659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/28/2015] [Accepted: 02/27/2015] [Indexed: 12/15/2022]
Abstract
The use of flow cytometry in malaria research has increased over the last decade. Most approaches use nucleic acid stains to detect parasite DNA and RNA and require complex multi-color, multi-parameter analysis to reliably detect infected red blood cells (iRBCs). We recently described a novel and simpler approach to parasite detection based on flow cytometric measurement of scattered light depolarization caused by hemozoin (Hz), a pigment formed by parasite digestion of hemoglobin in iRBCs. Depolarization measurement by flow cytometry was described in 1987; however, patent issues restricted its use to a single manufacturer's hematology analyzers until 2009. Although we recently demonstrated that depolarization measurement of Hz, easily implemented on a bench top flow cytometer (Cyflow), provided useful information for malaria work, doubts regarding its application and utility remain in both the flow cytometry and malaria communities, at least in part because instrument manufacturers do not offer the option of measuring depolarized scatter. Under such circumstances, providing other researchers with guidance as to how to do this seemed to offer the most expeditious way to resolve the issue. We accordingly examined how several commercially available flow cytometers (CyFlow SL, MoFLo, Attune and Accuri C6) could be modified to detect depolarization due to the presence of free Hz on solution, or of Hz in leukocytes or erythrocytes from rodent or human blood. All were readily adapted, with substantially equivalent results obtained with lasers emitting over a wide wavelength range. Other instruments now available may also be modifiable for Hz measurement. Cytometric detection of Hz using depolarization is useful to study different aspects of malaria. Adding additional parameters, such as DNA content and base composition and RNA content, can demonstrably provide improved accuracy and sensitivity of parasite detection and characterization, allowing malaria researchers and eventually clinicians to benefit from cytometric technology.
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Affiliation(s)
- Maria Rebelo
- Molecular Microbiology and Infection Unit, Instituto De Medicina Molecular, Faculdade De Medicina, Lisbon, Portugal
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Detection of intracellular parasites by use of the CellaVision DM96 analyzer during routine screening of peripheral blood smears. J Clin Microbiol 2014; 53:167-71. [PMID: 25378575 DOI: 10.1128/jcm.01783-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Conventional microscopy is the gold standard for malaria diagnosis. The CellaVision DM96 is a digital hematology analyzer that utilizes neural networks to locate, digitize, and preclassify leukocytes and characterize red blood cell morphology. This study compared the detection rates of Plasmodium and Babesia species on peripheral blood smears utilizing the CellaVision DM96 with the rates for a routine red blood cell morphology scan. A total of 281 slides were analyzed, consisting of 130 slides positive for Plasmodium or Babesia species and 151 negative controls. Slides were blinded, randomized, and analyzed by CellaVision and microscopy for red cell morphology scans. The technologists were blinded to prior identification results. The parasite detection rate was 73% (95/130) for CellaVision and 81% (105/130) for microscopy for positive samples. The interobserver agreement between CellaVision and microscopy was fair, as Cohen's kappa coefficient equaled 0.36. Pathologist review of CellaVision images identified an additional 15 slides with parasites, bringing the total number of detectable positive slides to 110 of 130 (85%). Plasmodium ovale had the lowest rate of detection at 56% (5 of 9); Plasmodium malariae and Babesia spp. had the highest rate of detection at 100% (3/3 and 6/6, respectively). The detection rate by CellaVision was 100% (23/23) when the parasitemia was ≥2.5%. The detection rate for <0.1% parasitemia was 63% (15/24). Technologists appropriately classified all negative specimens. The percentage of positive specimens detectable by CellaVision (73%) approaches results for microscopy on routine scan of peripheral blood smears for red blood cell morphology.
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Shapiro HM, Apte SH, Chojnowski GM, Hänscheid T, Rebelo M, Grimberg BT. Cytometry in malaria--a practical replacement for microscopy? ACTA ACUST UNITED AC 2014; Chapter 11:11.20.1-11.20.23. [PMID: 23835802 DOI: 10.1002/0471142956.cy1120s65] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Malaria, caused by protozoan Plasmodium parasites, kills ~800,000 people each year. Exact figures are uncertain because presumptive diagnoses are often made without identifying parasites in patients' blood either by microscopy, using Giemsa's century-old stain, or by simpler tests that are ultimately dependent on microscopy for quality control. Microscopy itself relies on trained observers' ability to detect subtle morphological features of parasitized red blood cells, only a few of which may be present on a slide. Quantitative and objective flow cytometric measurements of cellular constituents such as DNA, RNA, and the malaria pigment hemozoin are now useful in research in malaria biology and pharmacology, and can provide more reliable identification of parasite species and developmental stages and better detection of low-density parasitemia than could microscopy. The same measurements can now be implemented in much smaller, simpler, cheaper imaging cytometers, potentially providing a more accurate and precise diagnostic modality.
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18
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Han ET. Loop-mediated isothermal amplification test for the molecular diagnosis of malaria. Expert Rev Mol Diagn 2014; 13:205-18. [DOI: 10.1586/erm.12.144] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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RAHARDJO TUR, NURHAYATI SITI, RAMADHANI DWI. Liver Histophatological Studies of Mice (Mus musculus sp.) Infected With Gamma Rays Irradiated Plasmodium berghei Strains Anka. HAYATI JOURNAL OF BIOSCIENCES 2013. [DOI: 10.4308/hjb.20.3.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Rebelo M, Sousa C, Shapiro HM, Mota MM, Grobusch MP, Hänscheid T. A novel flow cytometric hemozoin detection assay for real-time sensitivity testing of Plasmodium falciparum. PLoS One 2013; 8:e61606. [PMID: 23637865 PMCID: PMC3634823 DOI: 10.1371/journal.pone.0061606] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 03/11/2013] [Indexed: 11/23/2022] Open
Abstract
Resistance of Plasmodium falciparum to almost all antimalarial drugs, including the first-line treatment with artemisinins, has been described, representing an obvious threat to malaria control. In vitro antimalarial sensitivity testing is crucial to detect and monitor drug resistance. Current assays have been successfully used to detect drug effects on parasites. However, they have some limitations, such as the use of radioactive or expensive reagents or long incubation times. Here we describe a novel assay to detect antimalarial drug effects, based on flow cytometric detection of hemozoin (Hz), which is rapid and does not require any additional reagents. Hz is an optimal parasite maturation indicator since its amount increases as the parasite matures. Due to its physical property of birefringence, Hz depolarizes light, hence it can be detected using optical methods such as flow cytometry. A common flow cytometer was adapted to detect light depolarization caused by Hz. Synchronized in vitro cultures of P. falciparum were incubated for 48 hours with several antimalarial drugs. Analysis of depolarizing events, corresponding to parasitized red blood cells containing Hz, allowed the detection of parasite maturation. Moreover, chloroquine resistance and the inhibitory effect of all antimalarial drugs tested, except for pyrimethamine, could be determined as early as 18 to 24 hours of incubation. At 24 hours incubation, 50% inhibitory concentrations (IC50) were comparable to previously reported values. These results indicate that the reagent-free, real-time Hz detection assay could become a novel assay for the detection of drug effects on Plasmodium falciparum.
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Affiliation(s)
- Maria Rebelo
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisbon, Portugal
- Centre de Recherches Médicales de Lambaréné - CERMEL, Albert Schweitzer Hospital, Lambaréné, Gabon
| | - Claudia Sousa
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Howard M. Shapiro
- The Center for Microbial Cytometry, West Newton, Massachusetts, United States of America
| | - Maria M. Mota
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Martin P. Grobusch
- Centre de Recherches Médicales de Lambaréné - CERMEL, Albert Schweitzer Hospital, Lambaréné, Gabon
- Department of Infectious Diseases, Centre for Tropical and Travel Medicine, Amsterdam Medical Centre, Amsterdam, The Netherlands
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Thomas Hänscheid
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisbon, Portugal
- Centre de Recherches Médicales de Lambaréné - CERMEL, Albert Schweitzer Hospital, Lambaréné, Gabon
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Sharma S, Sethi N, Pujani M, Kushwaha S, Sehgal S. Abnormal WBC scattergram: a clue to the diagnosis of malaria. ACTA ACUST UNITED AC 2012; 18:101-5. [PMID: 22980408 DOI: 10.1179/1607845412y.0000000029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Malaria is highly prevalent and endemic in tropical countries and carries a significant health burden. The detection of malaria by light microscopy of Giemsa-stained smears is the gold standard. There are many hematological abnormalities associated with malaria like anemia, thrombocytopenia, and leucopenia; however, none of these abnormalities are specific. The present study was undertaken to assess the utility of WBC scattergram in predicting the diagnosis of malaria. METHODS In this study all cases diagnosed as Plasmodium vivax/Plasmodium falciparum infection on peripheral smear examination were included. Their complete blood counts and WBC scattergrams obtained from XT2000i were critically evaluated. Accordingly, sensitivity, specificity, positive predictive value (PPV), and negative predictive value of detection of malaria by abnormal WBC scattergram with and without abnormal blood counts were also calculated. RESULTS A total of 2251 ethylendiaminetetraacetic acid samples were run on XT2000i hematology autoanalyzer. Out of these 148 cases of malaria were diagnosed on peripheral smear (128 P. vivax and 20 P. falciparum). While analyzing the WBC scattergrams, 233 cases including 124 (83.8%) malaria cases showed different abnormalities. Sensitivity and PPV for the diagnosis of malaria by abnormal WBC scattergram were 83.78 and 53.20%, respectively. This had increased to 98.60 and 57.25%, respectively, when cytopenias were included. DISCUSSION Sysmex XT-2000i is capable of detecting specific abnormalities in WBC scattergram in patients with malaria. Therefore, the presence of an abnormal WBC scattergram with thrombocytopenia in a febrile patient helps the pathologist to clinch the diagnosis of malaria.
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22
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Cho S, Kim S, Kim Y, Park Y. Optical imaging techniques for the study of malaria. Trends Biotechnol 2011; 30:71-9. [PMID: 21930322 DOI: 10.1016/j.tibtech.2011.08.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 08/25/2011] [Accepted: 08/26/2011] [Indexed: 02/07/2023]
Abstract
Malarial infection needs to be imaged to reveal the mechanisms behind malaria pathophysiology and to provide insights to aid in the diagnosis of the disease. Recent advances in optical imaging methods are now being transferred from physics laboratories to the biological field, revolutionizing how we study malaria. To provide insight into how these imaging techniques can improve the study and treatment of malaria, we summarize recent progress on optical imaging techniques, ranging from in vitro visualization of the disease progression of malaria infected red blood cells (iRBCs) to in vivo imaging of malaria parasites in the liver.
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Affiliation(s)
- Sangyeon Cho
- Department of Chemistry, Korea Advanced Institute of Science and Technology, Daejeon, 305-701, Republic of Korea
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23
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Wilson BK, Behrend MR, Horning MP, Hegg MC. Detection of malarial byproduct hemozoin utilizing its unique scattering properties. OPTICS EXPRESS 2011; 19:12190-12196. [PMID: 21716456 DOI: 10.1364/oe.19.012190] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The scattering characteristics of the malaria byproduct hemozoin, including its scattering distribution and depolarization, are modeled using Discrete Dipole Approximation (DDA) and compared to those of healthy red blood cells. Scattering (or dark-field) spectroscopy and imaging are used to identify hemozoin in fresh rodent blood samples. A new detection method is proposed and demonstrated using dark-field in conjunction with cross-polarization imaging and spectroscopy. SNRs greater than 50:1 are achieved for hemozoin in fresh blood without the addition of stains or reagents. The potential of such a detection system is discussed.
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Affiliation(s)
- Benjamin K Wilson
- Intellectual Ventures Laboratories, 1600 132nd Avenue, NE, Bellevue, WA 98005, USA.
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Hänscheid T, Romão R, Grobusch MP, Amaral T, Melo-Cristino J. Limitation of malaria diagnosis with the Cell-Dyn® analyser: not all haemozoin-containing monocytes are detected or shown. Int J Lab Hematol 2011; 33:e14-6. [DOI: 10.1111/j.1751-553x.2011.01318.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Frita R, Rebelo M, Pamplona A, Vigario AM, Mota MM, Grobusch MP, Hänscheid T. Simple flow cytometric detection of haemozoin containing leukocytes and erythrocytes for research on diagnosis, immunology and drug sensitivity testing. Malar J 2011; 10:74. [PMID: 21453521 PMCID: PMC3078904 DOI: 10.1186/1475-2875-10-74] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 03/31/2011] [Indexed: 02/02/2023] Open
Abstract
Background Malaria pigment (haemozoin, Hz) has been the focus of diverse research efforts. However, identification of Hz-containing leukocytes or parasitized erythrocytes is usually based on microscopy, with inherent limitations. Flow cytometric detection of depolarized Side-Scatter is more accurate and its adaptation to common bench top flow cytometers might allow several applications. These can range from the ex-vivo and in-vitro detection and functional analysis of Hz-containing leukocytes to the detection of parasitized Red-Blood-Cells (pRBCs) to assess antimalarial activity. Methods A standard benchtop flow cytometer was adapted to detect depolarized Side-Scatter. Synthetic and Plasmodium falciparum Hz were incubated with whole blood and PBMCs to detect Hz-containing leukocytes and CD16 expression on monocytes. C5BL/6 mice were infected with Plasmodium berghei ANKA or P. berghei NK65 and Hz-containing leukocytes were analysed using CD11b and Gr1 expression. Parasitized RBC from infected mice were identified using anti-Ter119 and SYBR green I and were analysed for depolarized Side Scatter. A highly depolarizing RBC population was monitored in an in-vitro culture incubated with chloroquine or quinine. Results A flow cytometer can be easily adapted to detect depolarized Side-Scatter and thus, intracellular Hz. The detection and counting of Hz containing leukocytes in fresh human or mouse blood, as well as in leukocytes from in-vitro experiments was rapid and easy. Analysis of CD14/CD16 and CD11b/Gr1 monocyte expression in human or mouse blood, in a mixed populations of Hz-containing and non-containing monocytes, appears to show distinct patterns in both types of cells. Hz-containing pRBC and different maturation stages could be detected in blood from infected mice. The analysis of a highly depolarizing population that contained mature pRBC allowed to assess the effect of chloroquine and quinine after only 2 and 4 hours, respectively. Conclusions A simple modification of a flow cytometer allows for rapid and reliable detection and quantification of Hz-containing leukocytes and the analysis of differential surface marker expression in the same sample of Hz-containing versus non-Hz-containing leukocytes. Importantly, it distinguishes different maturation stages of parasitized RBC and may be the basis of a rapid no-added-reagent drug sensitivity assay.
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Affiliation(s)
- Rosangela Frita
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisbon, Hospital Universitário de Santa Maria, Av, Prof, Egas Moniz, P-1649-028 Lisboa, Portugal
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Abstract
For more than a decade, flow cytometry-based automated haematology analysers have been studied for malaria diagnosis. Although current haematology analysers are not specifically designed to detect malaria-related abnormalities, most studies have found sensitivities that comply with WHO malaria-diagnostic guidelines, i.e. ≥ 95% in samples with > 100 parasites/μl. Establishing a correct and early malaria diagnosis is a prerequisite for an adequate treatment and to minimizing adverse outcomes. Expert light microscopy remains the 'gold standard' for malaria diagnosis in most clinical settings. However, it requires an explicit request from clinicians and has variable accuracy. Malaria diagnosis with flow cytometry-based haematology analysers could become an important adjuvant diagnostic tool in the routine laboratory work-up of febrile patients in or returning from malaria-endemic regions. Haematology analysers so far studied for malaria diagnosis are the Cell-Dyn®, Coulter® GEN·S and LH 750, and the Sysmex XE-2100® analysers. For Cell-Dyn analysers, abnormal depolarization events mainly in the lobularity/granularity and other scatter-plots, and various reticulocyte abnormalities have shown overall sensitivities and specificities of 49% to 97% and 61% to 100%, respectively. For the Coulter analysers, a 'malaria factor' using the monocyte and lymphocyte size standard deviations obtained by impedance detection has shown overall sensitivities and specificities of 82% to 98% and 72% to 94%, respectively. For the XE-2100, abnormal patterns in the DIFF, WBC/BASO, and RET-EXT scatter-plots, and pseudoeosinophilia and other abnormal haematological variables have been described, and multivariate diagnostic models have been designed with overall sensitivities and specificities of 86% to 97% and 81% to 98%, respectively. The accuracy for malaria diagnosis may vary according to species, parasite load, immunity and clinical context where the method is applied. Future developments in new haematology analysers such as considerably simplified, robust and inexpensive devices for malaria detection fitted with an automatically generated alert could improve the detection capacity of these instruments and potentially expand their clinical utility in malaria diagnosis.
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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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Campuzano-Zuluaga G, Alvarez-Sánchez G, Escobar-Gallo GE, Valencia-Zuluaga LM, Ríos-Orrego AM, Pabón-Vidal A, Miranda-Arboleda AF, Blair-Trujillo S, Campuzano-Maya G. Design of malaria diagnostic criteria for the Sysmex XE-2100 hematology analyzer. Am J Trop Med Hyg 2010; 82:402-11. [PMID: 20207864 DOI: 10.4269/ajtmh.2010.09-0464] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Thick film, the standard diagnostic procedure for malaria, is not always ordered promptly. A failsafe diagnostic strategy using an XE-2100 analyzer is proposed, and for this strategy, malaria diagnostic models for the XE-2100 were developed and tested for accuracy. Two hundred eighty-one samples were distributed into Plasmodium vivax, P. falciparum, and acute febrile syndrome groups for model construction. Model validation was performed using 60% of malaria cases and a composite control group of samples from AFS and healthy participants from endemic and non-endemic regions. For P. vivax, two observer-dependent models (accuracy = 95.3-96.9%), one non-observer-dependent model using built-in variables (accuracy = 94.7%), and one non-observer-dependent model using new and built-in variables (accuracy = 96.8%) were developed. For P. falciparum, two non-observer-dependent models (accuracies = 85% and 89%) were developed. These models could be used by health personnel or be integrated as a malaria alarm for the XE-2100 to prompt early malaria microscopic diagnosis.
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Yoo JH, Song J, Lee KA, Sun YK, Kim YA, Park TS, Choi JR. Automated detection of malaria-associated pseudoeosinophilia and abnormal WBC scattergram by the Sysmex XE-2100 hematology analyzer: a clinical study with 1,801 patients and real-time quantitative PCR analysis in vivax malaria-endemic area. Am J Trop Med Hyg 2010; 82:412-4. [PMID: 20207865 DOI: 10.4269/ajtmh.2010.09-0560] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Recently, the XE-2100 hematology analyzer was investigated in a rather small patient group; pseudoeosinophilia or abnormal white blood cell (WBC) scattergrams reported by this instrument were considered as significantly valuable diagnostic parameters in detecting vivax malaria. This study was conducted not only to assess the usefulness of pseudoeosinophilia or abnormal WBC scattergram in vivax malaria-endemic areas with large patient groups (N = 1,801) but also to investigate the correlation of parasitemia and platelet count with pseudoeosinophilia and abnormal WBC scattergrams. Of the 1,801 analyzed patients, 413 (22.9%) were found to have malaria by Wright-Giemsa stained blood smears. Overall, either pseudoeosinophilia or abnormal WBC scattergram was detected in 191 of 413 malaria patients and 4 of 1,388 patients without malaria (sensitivity = 46.2%, specificity = 99.7%). We suggest that clinical hematology laboratories using the XE-2100 analyzer should be aware of such specific parameters, even with the absence of a clinical request.
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Affiliation(s)
- Jong-Ha Yoo
- Department of Laboratory Medicine, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea.
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Abstract
Malaria pigment is an intracellular inclusion body that appears in blood and tissue specimens on microscopic examination and can help in establishing the diagnosis of malaria. In simple light microscopy, it can be difficult to discern from cellular background and artifacts. It has long been known that if polarized light microscopy is used, malaria pigment can be much easier to distinguish. However, this technique is rarely used because of the need for a relatively costly polarization microscope. We describe a simple and economical technique to convert any standard light microscope suitable for examination of malaria films into a polarization microscope.
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Affiliation(s)
- Richard J Maude
- Centre for Tropical Diseases, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, United Kingdom.
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Tangpukdee N, Duangdee C, Wilairatana P, Krudsood S. Malaria diagnosis: a brief review. THE KOREAN JOURNAL OF PARASITOLOGY 2009; 47:93-102. [PMID: 19488414 PMCID: PMC2688806 DOI: 10.3347/kjp.2009.47.2.93] [Citation(s) in RCA: 234] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 04/01/2009] [Accepted: 04/09/2009] [Indexed: 11/23/2022]
Abstract
Malaria is a major cause of death in tropical and sub-tropical countries, killing each year over 1 million people globally; 90% of fatalities occur in African children. Although effective ways to manage malaria now exist, the number of malaria cases is still increasing, due to several factors. In this emergency situation, prompt and effective diagnostic methods are essential for the management and control of malaria. Traditional methods for diagnosing malaria remain problematic; therefore, new technologies have been developed and introduced to overcome the limitations. This review details the currently available diagnostic methods for malaria.
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Affiliation(s)
- Noppadon Tangpukdee
- Critical Care Research Unit, Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Hänscheid T, Längin M, Lell B, Pötschke M, Oyakhirome S, Kremsner PG, Grobusch MP. Full blood count and haemozoin-containing leukocytes in children with malaria: diagnostic value and association with disease severity. Malar J 2008; 7:109. [PMID: 18549498 PMCID: PMC2435542 DOI: 10.1186/1475-2875-7-109] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 06/12/2008] [Indexed: 11/23/2022] Open
Abstract
Background Diligent and correct laboratory diagnosis and up-front identification of risk factors for progression to severe disease are the basis for optimal management of malaria. Methods Febrile children presenting to the Medical Research Unit at the Albert Schweitzer Hospital (HAS) in Lambaréné, Gabon, were assessed for malaria. Giemsa-stained thick films for qualitative and quantitative diagnosis and enumeration of malaria pigment, or haemozoin (Hz)-containing leukocytes (PCL) were performed, and full blood counts (FBC) were generated with a Cell Dyn 3000® instrument. Results Compared to standard light microscopy of Giemsa-stained thick films, diagnosis by platelet count only, by malaria pigment-containing monocytes (PCM) only, or by pigment-containing granulocytes (PCN) only yielded sensitivities/specificities of 92%/93%; 96%/96%; and 85%/96%, respectively. The platelet count was significantly lower in children with malaria compared to those without (p < 0.001), and values showed little overlap between groups. Compared to microscopy, scatter flow cytometry as applied in the Cell-Dyn 3000® instrument detected significantly more patients with PCL (p < 0.01). Both PCM and PCN numbers were higher in severe versus non-severe malaria yet reached statistical significance only for PCN (p < 0.0001; PCM: p = 0.14). Of note was the presence of another, so far ill-defined pigment-containing group of phagocytic cells, identified by laser-flow cytometry as lymphocyte-like gated events, and predominantly found in children with malaria-associated anaemia. Conclusion In the age group examined in the Lambaréné area, platelets are an excellent adjuvant tool to diagnose malaria. Pigment-containing leukocytes (PCL) are more readily detected by automated scatter flow cytometry than by microscopy. Automated Hz detection by an instrument as used here is a reliable diagnostic tool and correlates with disease severity. However, clinical usefulness as a prognostic tool is limited due to an overlap of PCL numbers recorded in severe versus non-severe malaria. However, this is possibly because of the instrument detection algorithm was not geared towards this task, and data lost during processing; and thus adjusting the instrument's algorithm may allow to establish a meaningful cut-off value.
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Affiliation(s)
- Thomas Hänscheid
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
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Malaria detection with the Sysmex XE-2100 hematology analyzer using pseudoeosinophilia and abnormal WBC scattergram. Ann Hematol 2008; 87:755-9. [DOI: 10.1007/s00277-008-0486-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 03/08/2008] [Indexed: 10/22/2022]
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A magneto-optic route toward the in vivo diagnosis of malaria: preliminary results and preclinical trial data. Biophys J 2008; 95:994-1000. [PMID: 18390603 DOI: 10.1529/biophysj.107.128140] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report the development of magneto-optic technology for the rapid quantitative diagnosis of malaria that may also be realizable in a noninvasive format. Hemozoin, the waste product of malarial parasitic action on hemoglobin, is produced in a form that under the action of an applied magnetic field gives rise to an induced optical dichroism characteristic of the hemozoin concentration. Here we show that precise measurement of this induced dichroism may be used to determine the level of malarial infection because this correlates, albeit in a complex manner throughout the infection cycle, with the concentration of hemozoin in the blood and tissues of infected patients. Under conservative assumptions for the production of hemozoin as a function of parasitemia, initial results indicate that the technique can match or exceed other current diagnostic techniques. The validity of the approach is confirmed by a small preliminary clinical trial on 13 patients, and measurements on live parasitized cells obtained from in vitro culture verify the possibility of producing in vivo diagnostic instrumentation.
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Shapiro HM, Perlmutter NG. Killer applications: Toward affordable rapid cell-based diagnostics for malaria and tuberculosis. CYTOMETRY PART B-CLINICAL CYTOMETRY 2008; 74 Suppl 1:S152-64. [DOI: 10.1002/cyto.b.20401] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Affiliation(s)
- Howard M Shapiro
- The Center for Microbial Cytometry, West Newton, Massachusetts 02465-2513, USA.
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37
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Molecular diagnostic and surveillance tools for global malaria control. Travel Med Infect Dis 2007; 6:82-99. [PMID: 18342279 DOI: 10.1016/j.tmaid.2007.10.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 10/09/2007] [Indexed: 01/09/2023]
Abstract
Malaria is the most devastating parasitic infection in the world, annually causing over 1 million deaths and extensive morbidity. The global burden of malaria has increased over the last several decades, as have rates of imported malaria into non-endemic regions. Rapid and accurate diagnostics are a crucial component of malaria control strategies, and epidemiological surveillance is required to monitor trends in malaria prevalence and antimalarial drug resistance. Conventional malaria diagnostic and surveillance tools can be cumbersome and slow with limitations in both sensitivity and specificity. New molecular techniques have been developed in an attempt to overcome these restrictions. These molecular techniques are discussed with regard to their technical advantages and disadvantages, with an emphasis on the practicality of implementation in malaria-endemic and non-endemic regions.
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Hänscheid T, Egan TJ, Grobusch MP. Haemozoin: from melatonin pigment to drug target, diagnostic tool, and immune modulator. THE LANCET. INFECTIOUS DISEASES 2007; 7:675-85. [PMID: 17897610 DOI: 10.1016/s1473-3099(07)70238-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Plasmodium spp produce a pigment (haemozoin) to detoxify the free haem that is generated by haemoglobin degradation. Haemozoin was originally thought to be an inert waste byproduct of the parasite. However, recent research has led to the recognition that haemozoin is possibly of great importance in various aspects of malaria. Haemozoin is the target of many antimalarial drugs, and the unravelling of the exact modes of action may allow the design of novel antimalarial compounds. The detection of haemozoin in erythrocytes or leucocytes facilitates the diagnosis of malaria. The number of haemozoin-containing monocytes and granulocytes has been shown to correlate well with disease severity and may hold the potential for becoming a novel, automated laboratory marker in the assessment of patients. Finally, haemozoin has a substantial effect on the immune system. Further research is needed to clarify these aspects, many of which are important in clinical practice.
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Affiliation(s)
- Thomas Hänscheid
- Institute of Molecular Medicine, Lisbon Medical College, Lisbon, Portugal
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Ochola LB, Vounatsou P, Smith T, Mabaso MLH, Newton CRJC. The reliability of diagnostic techniques in the diagnosis and management of malaria in the absence of a gold standard. THE LANCET. INFECTIOUS DISEASES 2006; 6:582-8. [PMID: 16931409 DOI: 10.1016/s1473-3099(06)70579-5] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The accuracy of techniques for the diagnosis of malaria are usually compared with optical microscopy, which is considered to be a gold standard. However, microscopy is prone to error and therefore makes it difficult to assess the reliability of other diagnostic techniques. We did a systematic review to assess the specificity and sensitivity of diagnostic techniques in different settings, using a statistical method that avoided defining a gold standard. Performance varied depending on species of the malaria parasite, level of parasitaemia, and immunity. Overall, histidine-rich protein 2 (HRP2)-based dipsticks showed a high sensitivity (92.7%) and specificity (99.2%) for Plasmodium falciparum in endemic areas. The acridine orange test was more sensitive (97.1%) in detecting P falciparum in epidemiological studies, with a specificity of 97.9%. In the absence of a gold standard, HRP2 dipsticks and acridine orange could provide an alternative for detecting falciparum infections in endemic areas and epidemiological studies, respectively. Microscopy still remains more reliable in detecting non-falciparum infections.
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Affiliation(s)
- L B Ochola
- Centre for Geographic Medicine Research, KEMRI, Kilifi, Kenya.
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40
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de Langen AJ, van Dillen J, de Witte P, Mucheto S, Nagelkerke N, Kager P. Automated detection of malaria pigment: feasibility for malaria diagnosing in an area with seasonal malaria in northern Namibia. Trop Med Int Health 2006; 11:809-16. [PMID: 16772002 DOI: 10.1111/j.1365-3156.2006.01634.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the feasibility of automated malaria detection with the Cell-Dyn 3700 (Abbott Diagnostics, Santa Clara, CA, USA) haematology analyser for diagnosing malaria in northern Namibia. METHODS From April to June 2003, all patients with a positive blood smear result and a subset of patients with no suspicion of malaria were included. Blood smear and a venous blood sample (to determine haemoglobin, platelet and malaria pigment levels) were collected from each patient. Malaria pigment test characteristics, correlations with blood parameters and pigment clearance time were calculated. Finally, a subset of blood samples was run twice to evaluate the consistency of test outcome. RESULTS Two hundred and eight patients were included. Ninety had a positive blood smear result of which 84 tested positive for malaria pigment and 118 patients had a negative blood smear result of which four tested positive for malaria pigment. Test characteristics as compared with microscopy were as follows: sensitivity 0.93, specificity 0.97, positive predictive value 0.95, negative predictive value 0.95. Rerun of the blood samples resulted in a change of diagnosis in 14%. After 4 weeks, 33% of patients with an initially positive pigment result still tested positive. Malaria pigment was found to be negatively correlated with haemoglobin. CONCLUSIONS Automated detection of malaria pigment is a useful diagnostic tool in this semi-rural area. In low-risk malaria season, the test can be used for diagnosing malaria because of the high sensitivity. In high-risk malaria season, the test can be used for excluding malaria in case of a negative pigment result because of the high specificity.
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Affiliation(s)
- Adrianus J de Langen
- Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands
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Dromigny JA, Jambou R, Scott CS, Perrier-Gros-Claude JD. Performance evaluation of automated depolarization analysis for detecting clinically unsuspected malaria in endemic countries. Trans R Soc Trop Med Hyg 2005; 99:430-9. [PMID: 15837355 DOI: 10.1016/j.trstmh.2004.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Revised: 07/08/2004] [Accepted: 07/22/2004] [Indexed: 10/25/2022] Open
Abstract
This prospective study evaluated the efficiency of automated depolarization analysis for recognition of unsuspected malaria by haemozoin detection during routine full blood count (FBC) screening of 676 randomly selected out-patients in a malaria hypoendemic area of Senegal. An additional 123 patients with clinically suspected malaria were studied for comparison. Of the 799 samples, 648 (81.1%) were categorized as malaria-negative, 83 (10.4%) as malaria-positive, and 68 as treated (early convalescence) or subclinical malaria (indirect evidence of infection). At a discrimination level of one or more atypical pigment-containing monocytes (PCM), negative and positive agreement was found to be 95.6% and 91.6% respectively for all malaria-negative and parasite-positive samples combined. Increasing the discriminator to two or more PCM events improved the overall agreement to 97.5%. Multivariate analysis showed that the only significant risk factor for the presence of PCM (odds ratio>200) was malaria infection. In the randomly selected group of 676 patients, 41 unsuspected cases of malaria infection were detected using the panel of reference diagnostic tests, and 37 (90.2%) of these had atypical PCM. The detection of clinically unrecognized malaria infection as part of a routine FBC procedure is a potentially useful extended application for laboratories in countries with endemic malaria.
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Affiliation(s)
- Jacques-Albert Dromigny
- Laboratoire de Biologie, Institut Pasteur de Dakar, 36 Avenue Pasteur, B.P. 220, Dakar, Senegal
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42
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Padial MM, Subirats M, Puente S, Lago M, Crespo S, Palacios G, Baquero M. Sensitivity of laser light depolarization analysis for detection of malaria in blood samples. J Med Microbiol 2005; 54:449-452. [PMID: 15824421 DOI: 10.1099/jmm.0.45650-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Automated light depolarization analysis could be a useful tool for diagnosing malarial infections. This work discusses the results of a diagnostic efficacy study on 411 samples from patients with suspected malaria infection performed with a Cell-Dyn 4000 analyser. Light dispersed at 90° and depolarized can be used for identifying and counting eosinophils. However, other cell populations with depolarizing capacity occur in malarial samples; these result from leukocytes ingesting haemozoin that is derived from the degradation of the haem group of haemoglobin performed by the parasite. A sensitivity of 72 % and specificity of 98 % were recorded, with positive and negative predictive values of 78 % and 97 %, respectively. Although the sensitivity level of the automated light depolarization analysis is not adequate to replace the existing methods for the diagnosis of parasitic diseases, it could alert clinicians to unsuspected infections by parasites, particularly those from the genus Plasmodium.
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Affiliation(s)
- Manuel Martínez Padial
- Laboratory of Microbiology1 and Department of Infectious Diseases2, Hospital Carlos III, Madrid, Spain 3Megalab Laboratories, Madrid, Spain 4Abbott Diagnostics Division, Costa Brava 13, 28034 Madrid, Spain
| | - Mercedes Subirats
- Laboratory of Microbiology1 and Department of Infectious Diseases2, Hospital Carlos III, Madrid, Spain 3Megalab Laboratories, Madrid, Spain 4Abbott Diagnostics Division, Costa Brava 13, 28034 Madrid, Spain
| | - Sabino Puente
- Laboratory of Microbiology1 and Department of Infectious Diseases2, Hospital Carlos III, Madrid, Spain 3Megalab Laboratories, Madrid, Spain 4Abbott Diagnostics Division, Costa Brava 13, 28034 Madrid, Spain
| | - Mar Lago
- Laboratory of Microbiology1 and Department of Infectious Diseases2, Hospital Carlos III, Madrid, Spain 3Megalab Laboratories, Madrid, Spain 4Abbott Diagnostics Division, Costa Brava 13, 28034 Madrid, Spain
| | - Santiago Crespo
- Laboratory of Microbiology1 and Department of Infectious Diseases2, Hospital Carlos III, Madrid, Spain 3Megalab Laboratories, Madrid, Spain 4Abbott Diagnostics Division, Costa Brava 13, 28034 Madrid, Spain
| | - Gonzalo Palacios
- Laboratory of Microbiology1 and Department of Infectious Diseases2, Hospital Carlos III, Madrid, Spain 3Megalab Laboratories, Madrid, Spain 4Abbott Diagnostics Division, Costa Brava 13, 28034 Madrid, Spain
| | - Margarita Baquero
- Laboratory of Microbiology1 and Department of Infectious Diseases2, Hospital Carlos III, Madrid, Spain 3Megalab Laboratories, Madrid, Spain 4Abbott Diagnostics Division, Costa Brava 13, 28034 Madrid, Spain
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Huh J, Jung J, Yoon H, Chung W. Pseudoeosinophilia associated with malaria infection determined in the Sysmex XE-2100 hematology analyzer. Ann Hematol 2004; 84:400-2. [PMID: 15616813 DOI: 10.1007/s00277-004-0987-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Accepted: 11/16/2004] [Indexed: 11/26/2022]
Abstract
Hemozoin is known to be an end product of hemoglobin digestion by the malaria parasite. Hemozoin is a birefringent crystal, and thus hemozoin-containing white blood cells (WBCs) may show the atypical light scattering pattern. The purpose of this study was to investigate pseudoeosinophilia associated with malaria infection using a Sysmex XE-2100 hematology analyzer (Sysmex Corporation, Kobe, Japan). The study group included 16 patients with malaria infection. Of these, 38% showed erroneously high eosinophil counts and atypical eosinophil distributions in the WBCs scattergram, which was due to the presence of hemozoin-containing neutrophils. In two patients, their erroneously high eosinophil counts declined as the parasitemia decreased with treatment. In conclusion, hematologists should consider the possibility of pseudoeosinophilia as a result of hemozoin-containing WBCs and confirm the WBC differential count by microscopy in cases of malaria infection.
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Affiliation(s)
- Jungwon Huh
- Department of Laboratory Medicine, College of Medicine, Mokdong Hospital, Ewha Womans University, Mokdong 911-1, Yangcheon-Gu, Seoul, South Korea, 158-710.
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Fourcade C, Casbas MJC, Belaouni H, Gonzalez JJD, Garcia PJJ, Pepio MAE. Automated detection of malaria by means of the haematology analyser CoulterR GEN.STM. ACTA ACUST UNITED AC 2004; 26:367-72. [PMID: 15595992 DOI: 10.1111/j.1365-2257.2004.00648.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The haematology analysers Coulter(R) GEN.S(TM) and LH(TM) give a set of data--'positional parameters'--which define each WBC population by mean of index values, the mean and the standard deviation (SD) of volume, conductivity and scatter, used to identify the WBC populations. These parameters were analysed in patients investigated for suspicion of malaria, in order to show a difference between malaria negative and malaria positive patients and to use it for malaria detection. The six parameters exhibiting a significant difference between the two groups were submitted to a ROC analysis, which showed both sensitivity >90% and specificity >60% for two parameters, lymphocyte and monocyte SDs of volumes. A discriminator combining the two parameters showed a sensitivity of 96.9% and a specificity of 82.5%. The cut off of the discriminative value was calculated. Because of the good stability and reproducibility of the parameters selected, the test can be used in order to detect patients having a high probability to be malaria positive and to pay particular attention to these blood smears. For more extensive diagnostic use, a standard control procedure of the positional parameters should be introduced.
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Affiliation(s)
- C Fourcade
- Laboratoire de Biologie, Centre Hospitalier V. Dupouy, Argenteuil, France.
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45
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Suh IB, Kim HJ, Kim JY, Lee SW, An SSA, Kim WJ, Lim CS. Evaluation of the Abbott Cell-Dyn 4000 hematology analyzer for detection and therapeutic monitoring of Plasmodium vivax
in the Republic of Korea. Trop Med Int Health 2003; 8:1074-81. [PMID: 14641842 DOI: 10.1046/j.1360-2276.2003.01135.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Cell-Dyn 4000 automated hematology analyzer (CD4000) has the ability to detect malaria patients, but it remained unclear whether it could detect persistent malaria post-treatment. To investigate this, we used the CD4000 to evaluate 68 Korean patients with Plasmodium vivax malaria, and control groups of 50 patients with fever and 50 asymptomatic patients. The results from the instrument-generated scatter plot (derived by laser light depolarization) were compared with microscopy results. During the initial diagnosis, the sensitivity of the CD4000 in detecting malaria was 91.2%. On day 3 of follow-up, the CD4000 results matched those from microscopy by 96.7%. Malaria was not detected by either method beyond 14 days post-presentation. Interestingly, the atypical depolarizing events, which typify the presence of malaria in the analyzer, were highly correlated with the levels of parasitaemia in serially diluted samples of the leucocyte-depleted blood, and the CD4000 detected parasites down to the level of 288 +/- 17.7/microl. Our findings suggest that the phenomenon of atypical light depolarization could be influenced by parasitaemia levels, and be used as a screening method for P. vivax malaria patients, as well as for the therapeutic monitoring.
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Affiliation(s)
- In Bum Suh
- Department of Laboratory Medicine, Travel Medicine Clinic, College of Medicine, Korea University, South Korea.
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Grobusch MP, Hänscheid T, Krämer B, Neukammer J, May J, Seybold J, Kun JFJ, Suttorp N. Sensitivity of hemozoin detection by automated flow cytometry in non- and semi-immune malaria patients. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2003; 55:46-51. [PMID: 12949959 DOI: 10.1002/cyto.b.10039] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cell-Dyn automated blood cell analyzers use laser flow cytometry technology, allowing detection of malaria pigment (hemozoin) in monocytes. We evaluated the value of such an instrument to diagnose malaria in febrile travelers returning to Berlin, Germany, the relation between the instrument's performance and the patients' immune status, and the capacity to increase its sensitivity. METHODS Malaria diagnosis was routinely established by thick-film microscopy. The patients' immune status was determined by an indirect fluorescent antibody test. Hemozoin detection was performed with a Cell-Dyn 3000. To assess the capacity for sensitivity increase, the relative frequencies of pigment-containing monocytes were determined for a subgroup of patients with the Cell-Dyn 3000 in comparison with a flow cytometer specifically adapted to rare-event analysis. RESULTS Of 403 patients screened microscopically, 107 had malaria. Overall sensitivity with the Cell-Dyn 3000 reached 48.6% (73.7% in semi-immune and 28.6% in nonimmune individuals; P < 0.0001). Specificity was 96.2%. The detection limit was at a relative concentration of 2 x 10(-4) pigment-containing monocytes (PCMs). By employing rare-event flow cytometry, the detection limit decreased to 3.25 x 10(-5), thus yielding a considerably increased sensitivity for the subgroup studied. CONCLUSIONS The correlation between immune status and relative concentration of PCMs explains the failure of the routine instrument for nonimmune patients and its significantly higher sensitivity for semi-immune individuals. The technique can be significantly improved by rare-event flow cytometry.
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Affiliation(s)
- Martin P Grobusch
- Medizinische Klinik (Infektiologie), Charité/Campus Virchow-Klinikum, Humboldt-Universität, Berlin, Germany.
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Abstract
Malaria remains the most important parasitic disease, and tens of thousands of cases are imported into non-endemic countries annually. However, any single institution may see only a very few cases-this is probably the reason why laboratory and clinical misdiagnosis may not be uncommon. In the laboratory, unfamiliarity with microscopic diagnosis may be the main reason, considering the large number of laboratory staff who provide on-call services, often without expert help at hand, as well as the difficulty in detecting cases with low-level parasitemia. Staff should therefore be provided with continuing microscopic training to maintain proficiency. The complementary use of immunochromatographic rapid detection tests (RDTs) may be useful, especially during on-call hours, although, in order to ensure correct interpretation, their inherent limitations have to be well known. Diagnosis based on the polymerase chain reaction is still unsuitable for routine use, due to its long turnaround time, its cost, and its unavailability outside regular hours, although it may be helpful in selected cases. Once the alert clinician has considered the possibility of malaria, and suspicion continues to be high, malaria can be excluded by repeat smears or RDTs. However, the absence of clinical suspicion may not be infrequent, and may have more serious consequences. Depending on the local number of malaria cases seen, laboratory staff should have a low threshold for the decision to perform unsolicited malaria diagnostic tests on suspicious samples, especially if other laboratory tests are abnormal (e.g. thrombocytopenia, presence of atypical lymphocytes, or raised lactate dehydrogenase). The detection of intraleukocytic hemozoin during automated full blood counts is a promising new way to avoid misdiagnosis of clinically unsuspected malaria.
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Affiliation(s)
- T Hänscheid
- Laboratório de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Hospital de Santa Maria, Lisboa, Portugal.
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48
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Scott CS, van Zyl D, Ho E, Meyersfeld D, Ruivo L, Mendelow BV, Coetzer TL. Automated detection of malaria-associated intraleucocytic haemozoin by Cell-Dyn CD4000 depolarization analysis. CLINICAL AND LABORATORY HAEMATOLOGY 2003; 25:77-86. [PMID: 12641610 DOI: 10.1046/j.1365-2257.2003.00496.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Laboratory tests for malaria are only performed if there is clinical suspicion of the disease, and a missed diagnosis contributes substantially to morbidity and mortality. Malaria parasites produce haemozoin, which is able to depolarize light and this allows the automated detection of malaria during routine complete blood count analysis (CBC) with some Abbott Cell-Dyn instruments. In this study, we evaluated the Cell-Dyn CD4000 with 831 blood samples submitted for malaria investigations. Samples were categorized as malaria negative (n = 417), convalescent malaria (n = 64) or malaria positive (n = 350) by reference to thin/thick film microscopy, 'rapid test' procedures, polymerase chain reaction analysis and clinical history. With regard to CD4000 depolarization analysis, a malaria positive CD4000 pattern was ascribed to samples that showed one or more abnormal depolarizing purple events, which corresponded to monocytes containing ingested malaria pigment (haemozoin). Positive CD4000 patterns were observed in 11 of 417, 50 of 64 and 281 of 350 of malaria negative, convalescent malaria and malaria positive samples respectively. The specificity and positive predictive values for malaria (active and convalescent) were very high (97.4 and 96.8%, respectively), while sensitivity and negative predictive values were 80.0 and 83.0% respectively. Depolarization analysis was particularly effective for Plasmodium falciparum malaria but there was lower detection sensitivity for White compared with Black African patients. CD4000 90 degrees depolarization vs 0 degrees analysis revealed a proportion of samples with small nonleucocyte-associated depolarizing particles. Appearance of such events in the form of a discrete cluster was associated with P. vivax rather than P. falciparum infection.
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Affiliation(s)
- C S Scott
- Abbott Diagnostics, Wiesbaden-Delkenheim, Germany.
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Fawzi ZO, Fakhro NA, Nabhan RA, Alloueche A, Scott CS. Differences in automated depolarization patterns of Plasmodium falciparum and P. vivax malaria infections defined by the Cell-Dyn CD4000 haematology analyser. Trans R Soc Trop Med Hyg 2003; 97:71-9. [PMID: 12886809 DOI: 10.1016/s0035-9203(03)90029-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Of 1014 samples submitted for full blood count analysis and malaria screening, 854 were designated malaria-negative by blood film microscopy, 79 were unequivocally identified as Plasmodium vivax and 81 as P. falciparum. All samples were additionally analysed with the Abbott Cell-Dyn CD4000 haematology instrument, and leucocyte differential plots of 90 degrees polarized vs. 90 degrees depolarized (NEU-EOS plot) and 90 degrees depolarized vs. 0 degree light (EOS I plot) scatter were specifically examined for abnormal depolarization patterns. Depolarization pattern types were correlated with microscopy (species) results, and these correlations were consolidated by polymerase chain reaction analysis. All 854 microscopically-designated malaria-negative samples showed a type 1 (normal) CD4000 depolarization pattern. Abnormal pattern types 2, 3a and 3b were entirely restricted to one of the two malaria categories. Plasmodium falciparum malaria showed two CD4000 pattern types only; a 'normal' type 1 pattern was seen in 36/75 (48%) cases and the remaining 39 cases were all abnormal pattern type 3a. In contrast, most (79/85) P. vivax malaria cases showed a distinctive clustered EOS I population (types 2 and 3b patterns) that was not seen with P. falciparum. Automated depolarization analysis provides an effective means of detecting malaria-associated haemozoin, and the patterns of intracellular haemozoin further appear to provide species differentiation between P. falciparum and P. vivax.
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Affiliation(s)
- Zainab O Fawzi
- Haematology Section, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
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Wever PC, Henskens YMC, Kager PA, Dankert J, van Gool T. Detection of imported malaria with the Cell-Dyn 4000 hematology analyzer. J Clin Microbiol 2002; 40:4729-31. [PMID: 12454179 PMCID: PMC154588 DOI: 10.1128/jcm.40.12.4729-4731.2002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The sensitivity and specificity of the Cell-Dyn 4000 hematology analyzer in the diagnosis of imported malaria were studied with samples from patients in an academic hospital setting. The performance of the Cell-Dyn 4000 hematology analyzer was compared with that of conventional diagnostic methods for malaria. The Cell-Dyn 4000 hematology analyzer detected hemozoin-containing depolarizing monocytes in 29 of 58 patients with malaria and 2 of 55 patients without malaria. The presence or absence of depolarizing monocytes in patients with malaria was related to duration of symptoms before presentation for malaria analysis. A second parameter, pseudoreticulocytosis due to nuclear material of intraerythrocytic malaria parasites, was detected by the Cell-Dyn 4000 hematology analyzer almost exclusively in Plasmodium falciparum malaria patients with parasitemia levels of >/=0.5%. Attention to these abnormalities in medical centers without tropical disease expertise may decrease a delay in the diagnosis of malaria.
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Affiliation(s)
- Peter C Wever
- Section of Parasitology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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