1
|
Kabalu Tshiongo J, Luzolo F, Kabena M, Kuseke L, Djimde M, Mitashi P, Lumbala C, Kayentao K, Menting S, Mens PF, Schallig HDFH, Lutumba P, Tinto H, Muhindo Mavoko H, Maketa V. Performance of ultra-sensitive malaria rapid diagnostic test to detect Plasmodium falciparum infection in pregnant women in Kinshasa, the Democratic Republic of the Congo. Malar J 2023; 22:322. [PMID: 37872634 PMCID: PMC10594769 DOI: 10.1186/s12936-023-04749-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Low peripheral parasitaemia caused by sequestration of Plasmodium falciparum in the placenta hampers the diagnosis of malaria in pregnant women, leading to microscopy or conventional rapid diagnostic tests (RDTs) false-negative results. Although mainly asymptomatic, maternal malaria remains harmful to pregnant women and their offspring in endemic settings and must be adequately diagnosed. Ultra-sensitive RDTs (uRDTs) are thought to be more sensitive than RDTs, and their diagnostic performance was assessed in the current study in pregnant women living in Kinshasa, a stable malaria transmission area in the Democratic Republic of the Congo. METHODS To assess and compare the diagnostic performances of both RDTs and uRDTs, 497 peripheral blood samples were tested using microscopy and quantitative polymerase chain reaction (qPCR) as the index and the reference tests, respectively. The agreement between the different diagnostic tests assessed was estimated by Cohen's Kappa test. RESULTS The median parasite density by qPCR was 292 p/μL of blood [IQR (49.7-1137)]. Using qPCR as the reference diagnostic test, the sensitivities of microscopy, RDT and uRDT were respectively [55.7% (95% CI 47.6-63.6)], [81.7% (95%CI 74.7-87.3)] and [88% (95% CI 81.9-92.6)]. The specificities of the tests were calculated at 98.5% (95% CI 96.6-99.5), 95.2% (95% CI 92.5-97.2) and 94.4% (95% CI 91.4-96.6) for microscopy, RDT and uRDT, respectively. The agreement between qPCR and uRDT was almost perfect (Kappa = 0.82). For parasite density (qPCR) below 100 p/µL, the sensitivity of RDT was 62% (95% CI 47.1-75.3) compared to 68% (95% CI 53.3-80.4) for uRDT. Between 100 and 200 p/µL, the sensitivity of RDT was higher, but still lower compared to uRDT: 89.4% (95% CI 66.8-98.7) for RDT versus 100% (95% CI 82.3-100) for uRDT. In both cases, microscopy was lower, with 20% (95% CI 10-33.7) and 47.3% (95% CI 24.4-71.1) respectively. CONCLUSIONS uRDT has the potential to improve malaria management in pregnant women as it has been found to be slightly more sensitive than RDT in the detection of malaria in pregnant women but the difference was not significant. Microscopy has a more limited value for the diagnosis of malaria during the pregnancy, because of its lower sensitivity.
Collapse
Affiliation(s)
- Japhet Kabalu Tshiongo
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo.
- Amsterdam University Medical Centres, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Academic Medical Centres at the University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, The Netherlands.
| | - Flory Luzolo
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| | - Melissa Kabena
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| | - Lise Kuseke
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| | - Moussa Djimde
- Amsterdam University Medical Centres, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Academic Medical Centres at the University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, The Netherlands
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Patrick Mitashi
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| | - Crispin Lumbala
- Clinton Health Access Initiative, Kinshasa, Democratic Republic of the Congo
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kassoum Kayentao
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Sandra Menting
- Amsterdam University Medical Centres, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Academic Medical Centres at the University of Amsterdam, Amsterdam, The Netherlands
| | - Petra F Mens
- Amsterdam University Medical Centres, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Academic Medical Centres at the University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Amsterdam University Medical Centres, Department of Medical Microbiology and Infection Prevention, Laboratory for Experimental Parasitology, Academic Medical Centres at the University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases Programme, Amsterdam, The Netherlands
| | - Pascal Lutumba
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
- Institut Supérieur Des Techniques Médicales de Kinshasa (ISTM-Kinshasa), Kinshasa, Democratic Republic of the Congo
| | - Halidou Tinto
- Institut de Recherche en Sciences de La Santé - Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Hypolite Muhindo Mavoko
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| | - Vivi Maketa
- Department of Tropical Medicine, University of Kinshasa (UNIKIN), Kinshasa, Democratic Republic of the Congo
| |
Collapse
|
2
|
Ding XC, Incardona S, Serra-Casas E, Charnaud SC, Slater HC, Domingo GJ, Adams ER, ter Kuile FO, Samuels AM, Kariuki S, Dittrich S. Malaria in pregnancy (MiP) studies assessing the clinical performance of highly sensitive rapid diagnostic tests (HS-RDT) for Plasmodium falciparum detection. Malar J 2023; 22:60. [PMID: 36803858 PMCID: PMC9942317 DOI: 10.1186/s12936-023-04445-1] [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] [Received: 07/12/2022] [Accepted: 01/06/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDTs) are effective tools to diagnose and inform the treatment of malaria in adults and children. The recent development of a highly sensitive rapid diagnostic test (HS-RDT) for Plasmodium falciparum has prompted questions over whether it could improve the diagnosis of malaria in pregnancy and pregnancy outcomes in malaria endemic areas. METHODS This landscape review collates studies addressing the clinical performance of the HS-RDT. Thirteen studies were identified comparing the HS-RDT and conventional RDT (co-RDT) to molecular methods to detect malaria in pregnancy. Using data from five completed studies, the association of epidemiological and pregnancy-related factors on the sensitivity of HS-RDT, and comparisons with co-RDT were investigated. The studies were conducted in 4 countries over a range of transmission intensities in largely asymptomatic women. RESULTS Sensitivity of both RDTs varied widely (HS-RDT range 19.6 to 85.7%, co-RDT range 22.8 to 82.8% compared to molecular testing) yet HS-RDT detected individuals with similar parasite densities across all the studies including different geographies and transmission areas [geometric mean parasitaemia around 100 parasites per µL (p/µL)]. HS-RDTs were capable of detecting low-density parasitaemias and in one study detected around 30% of infections with parasite densities of 0-2 p/µL compared to the co-RDT in the same study which detected around 15%. CONCLUSION The HS-RDT has a slightly higher analytical sensitivity to detect malaria infections in pregnancy than co-RDT but this mostly translates to only fractional and not statistically significant improvement in clinical performance by gravidity, trimester, geography or transmission intensity. The analysis presented here highlights the need for larger and more studies to evaluate incremental improvements in RDTs. The HS-RDT could be used in any situation where co-RDT are currently used for P. falciparum diagnosis, if storage conditions can be adhered to.
Collapse
Affiliation(s)
- Xavier C. Ding
- grid.452485.a0000 0001 1507 3147FIND, Geneva, Switzerland
| | | | | | | | - Hannah C. Slater
- grid.415269.d0000 0000 8940 7771Diagnostics Program, PATH, Seattle, USA
| | | | - Emily R. Adams
- grid.48004.380000 0004 1936 9764Department of Tropical Disease Biology and Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA UK
| | - Feiko O. ter Kuile
- grid.48004.380000 0004 1936 9764Department of Tropical Disease Biology and Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA UK
| | - Aaron M. Samuels
- grid.512515.7Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Kisumu, Kenya ,grid.467642.50000 0004 0540 3132Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia USA
| | - Simon Kariuki
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute-Centre for Global Health Research, Kisumu, Kenya
| | | |
Collapse
|
3
|
Esitgen Germaner ET, Wassill L, Dichtl K, Roider J, Seybold U. Rapid point of care testing for four bacterial sexually transmitted infections using the portable isothermal loop-mediated nucleic acid amplification eazyplex platform. Infection 2023:10.1007/s15010-023-01981-5. [PMID: 36641506 PMCID: PMC9840521 DOI: 10.1007/s15010-023-01981-5] [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] [Received: 11/28/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
PURPOSE To analyze sensitivity and specificity of the rapid point-of-care (POC) eazyplex testing platform for bacterial sexually transmitted infections (STI) among men who have sex with men (MSM). METHODS 272 anal, urethral, and pharyngeal swabs collected from 153 MSM were tested by both the eazyplex platform and an in-house PCR or culture in the university microbiology reference laboratory. RESULTS Compared to the reference diagnostic method, the overall sensitivity/specificity of eazyplex was 88%/98% for N. gonorrhoeae, 82%/100% for C. trachomatis, 70%/ > 99% for U. urealyticum, and 85%/98% for M. hominis, respectively. Sensitivity for N. gonorrhoeae and U. urealyticum in urethral samples was 100%. CONCLUSION With good to very good sensitivity depending on the sampling site and pathogen as well as very good specificity overall the eazyplex platform is a useful rapid diagnostic method for POC bacterial STI-testing especially for N. gonorrhoeae and C. trachomatis, allowing for almost immediate treatment initiation.
Collapse
Affiliation(s)
- Ece T. Esitgen Germaner
- grid.5252.00000 0004 1936 973XSektion Klinische Infektiologie, Med. Klinik und Poliklinik IV, LMU Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336 Munich, Germany
| | - Lars Wassill
- AmplexDiagnostics GmbH, Werkstr. 2, 83555 Gars-Bahnhof, Germany
| | - Karl Dichtl
- grid.5252.00000 0004 1936 973XMax von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, Ludwig-Maximilians-Universität München, Pettenkoferstraße 9a, 80336 Munich, Germany ,grid.11598.340000 0000 8988 2476Diagnostik & Forschungsinstitut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Neue Stiftingtalstraße 6/III, 8010 Graz, Austria
| | - Julia Roider
- grid.5252.00000 0004 1936 973XSektion Klinische Infektiologie, Med. Klinik und Poliklinik IV, LMU Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336 Munich, Germany ,grid.452463.2German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Ulrich Seybold
- grid.5252.00000 0004 1936 973XSektion Klinische Infektiologie, Med. Klinik und Poliklinik IV, LMU Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336 Munich, Germany
| |
Collapse
|
4
|
Yon JLT, Htet NH, Naing C, Tung WS, Aung HH, Mak JW. Loop-mediated isothermal amplification (LAMP) test in the detection of uncomplicated malaria in pregnancy: a meta-analysis of diagnostic accuracy. Malar J 2022; 21:391. [PMID: 36550507 PMCID: PMC9783437 DOI: 10.1186/s12936-022-04419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Due to relatively low malaria parasitaemia in pregnancy, an appropriate field test that can adequately detect infections in pregnant women presenting with illness or for malaria screening during antenatal care is crucially important. The objective was to evaluate the diagnostic accuracy of loop-mediated isothermal amplification (LAMP) for the detection of uncomplicated malaria in pregnancy. METHODS This was a meta-analysis of diagnostic accuracy. Relevant studies that assessed the diagnostic performance of LAMP for the detection of malaria in pregnancy were searched in health-related electronic databases including PubMed, Ovid, and Google Scholar. The methodological quality of the studies included was evaluated using the QUADAS-2 tool. RESULTS Of the 372 studies identified, eight studies involving 2999 pregnant women in five endemic countries that assessed the accuracy of LAMP were identified. With three types of PCR as reference tests, the pooled sensitivity of LAMP was 91% (95%CI 67-98%) and pooled specificity was 99% (95%CI 83-100%, 4 studies), and the negative likelihood ratio was 9% (2-40%). Caution is needed in the interpretation as there was substantial between-study heterogeneity (I2: 80%), and a low probability that a person without infection is tested negative. With microscopy as a reference, the pooled sensitivity of LAMP was 95% (95%CI 26-100%) and pooled specificity was 100% (95%CI 94-100%, 4 studies). There was a wide range of sensitivity and substantial between-study heterogeneity (I2: 83.5-98.4%). To investigate the source of heterogeneity, a meta-regression analysis was performed with covariates. Of these potential confounding factors, reference test (p: 0.03) and study design (p:0.03) had affected the diagnostic accuracy of LAMP in malaria in pregnancy. Overall, there was a low certainty of the evidence in accuracy estimates. CONCLUSION The findings suggest that LAMP is more sensitive than traditional tests used at facilities, but the utility of detecting and treating these low-density infections is not well understood. Due to the limited number of studies with bias in their methodological quality, variation in the study design, and different types of reference tests further research is likely to change the estimate. Well-conceived large prospective studies with blinding of the index test results are recommenced.
Collapse
Affiliation(s)
- Joseph Lee Teck Yon
- grid.411729.80000 0000 8946 5787School of Medicine, International Medical University, Kuala Lumpur, Malaysia ,grid.4305.20000 0004 1936 7988University of Edinburgh, Old College, Edinburgh, EH8 9YL UK
| | - Norah Htet Htet
- grid.411729.80000 0000 8946 5787School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Cho Naing
- grid.1011.10000 0004 0474 1797Division of Tropical Health and Medicine, James Cook University, Townsville, QLD Australia
| | - Wong Siew Tung
- grid.411729.80000 0000 8946 5787School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Htar Htar Aung
- grid.411729.80000 0000 8946 5787School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Joon Wah Mak
- grid.411729.80000 0000 8946 5787Institute of Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur, Malaysia
| |
Collapse
|