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Sandoval MN, McClellan SP, Pont SJ, Ross JA, Swartz MD, Silberman MA, Boerwinkle E. Prozone masks elevated SARS-CoV-2 antibody level measurements. PLoS One 2024; 19:e0301232. [PMID: 38547209 PMCID: PMC10977713 DOI: 10.1371/journal.pone.0301232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
We report a prozone effect in measurement of SARS-CoV-2 spike protein antibody levels from an antibody surveillance program. Briefly, the prozone effect occurs in immunoassays when excessively high antibody concentration disrupts the immune complex formation, resulting in a spuriously low reported result. Following participant inquiries, we observed anomalously low measurement of SARS-CoV-2 spike protein antibody levels using the Roche Elecsys® Anti-SARS-CoV-2 S immunoassay from participants in the Texas Coronavirus Antibody Research survey (Texas CARES), an ongoing prospective, longitudinal antibody surveillance program. In July, 2022, samples were collected from ten participants with anomalously low results for serial dilution studies, and a prozone effect was confirmed. From October, 2022 to March, 2023, serial dilution of samples detected 74 additional cases of prozone out of 1,720 participants' samples. Prozone effect may affect clinical management of at-risk populations repeatedly exposed to SARS-CoV-2 spike protein through multiple immunizations or serial infections, making awareness and mitigation of this issue paramount.
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Affiliation(s)
- Micaela N. Sandoval
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | | | - Stephen J. Pont
- Center for Public Health Policy and Practice at Texas Department of State Health Services, Austin, Texas, United States of America
| | - Jessica A. Ross
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
| | - Mark A. Silberman
- Clinical Pathology Laboratories, Austin, Texas, United States of America
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States of America
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Ryan ET, Succi MD, Paras ML, Klontz EH. Case 4-2024: A 39-Year-Old Man with Fever and Headache after International Travel. N Engl J Med 2024; 390:549-556. [PMID: 38324489 DOI: 10.1056/nejmcpc2309382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Edward T Ryan
- From the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Massachusetts General Hospital, and the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Harvard Medical School - both in Boston
| | - Marc D Succi
- From the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Massachusetts General Hospital, and the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Harvard Medical School - both in Boston
| | - Molly L Paras
- From the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Massachusetts General Hospital, and the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Harvard Medical School - both in Boston
| | - Erik H Klontz
- From the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Massachusetts General Hospital, and the Departments of Medicine (E.T.R., M.L.P.), Radiology (M.D.S.), and Pathology (E.H.K.), Harvard Medical School - both in Boston
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3
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Yadav V, Rafiqi SI, Yadav A, Kushwaha A, Godara R, Katoch R, Panadero-Fontán R. Dot-ELISA based on recombinant Hypodermin C of Przhevalskiana silenus for field diagnosis of goat warble fly infestation. Parasite Immunol 2023; 45:e13007. [PMID: 37524537 DOI: 10.1111/pim.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
Goat warble fly infestation (GWFI) is an economically important myiasis caused by larvae of Przhevalskiana silenus (Diptera, Oestridae), prevalent in countries of the Mediterranean Basin and Indian subcontinent. GWFI is characterized by the presence of subcutaneous warbles at the lumbar and sacral region of dorsum in the infested animal. The early larval instars (L1 and L2) remain inaccessible to physical detection due to their small size and subcutaneous presence thus causing hindrance in the diagnosis. The objective of present study was to develop a field applicable early diagnostic intervention for GWFI monitoring and prophylactic management for effective control of the disease. Recombinant Hypodermin C (rHyC) antigen of P. silenus was expressed in Escherichia coli. The purified protein was used for optimizing dot-ELISA in a checkerboard titration using goat warble fly infested serum as known positive. The optimized assay was further tested for lower temperature (18°C) and incubation time (30 min). The optimized assay was assessed for inter-rater reliability and field samples. The optimized conditions require 188 ng of protein/dot, 1:800 dilution of serum sample, 1:4000 dilution of anti-goat IgG conjugate and 5% skim milk powder in phosphate buffer saline as blocking buffer. The assay was found to have a diagnostic sensitivity and specificity of 97.3% and 95.8%, respectively. The inter-rater reliability of dot ELISA with rHyC indirect ELISA was found to be almost perfect with a Cohen's kappa index of 0.973. Further testing at ambient temperature (18°C) and shorter incubation steps (30 min) supported suitability of the assay for field diagnosis of GWFI. The present study provides the first report of a sensitive and specific dot-ELISA for early diagnosis of GWFI which is rapid and cost effective. The test may provide an effective field applicable tool for sustainable control of GWFI.
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Affiliation(s)
- Vikas Yadav
- Division of Veterinary Parasitology, Faculty of Veterinary Sciences and Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Jammu, R. S. Pura, UT of Jammu and Kashmir, India
| | - Shafiya Imtiaz Rafiqi
- Division of Veterinary Parasitology, Faculty of Veterinary Sciences and Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Jammu, R. S. Pura, UT of Jammu and Kashmir, India
| | - Anish Yadav
- Division of Veterinary Parasitology, Faculty of Veterinary Sciences and Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Jammu, R. S. Pura, UT of Jammu and Kashmir, India
| | - Anand Kushwaha
- Division of Veterinary Parasitology, Faculty of Veterinary Sciences and Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Jammu, R. S. Pura, UT of Jammu and Kashmir, India
| | - Rajesh Godara
- Division of Veterinary Parasitology, Faculty of Veterinary Sciences and Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Jammu, R. S. Pura, UT of Jammu and Kashmir, India
| | - Rajesh Katoch
- Division of Veterinary Parasitology, Faculty of Veterinary Sciences and Animal Husbandry, Sher-e-Kashmir University of Agricultural Sciences and Technology of Jammu, R. S. Pura, UT of Jammu and Kashmir, India
| | - Rosario Panadero-Fontán
- INVESAGA Group, Department of Animal Pathology, Universidade de Santiago de Compostela, Lugo, Spain
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Biruksew A, Demeke A, Birhanu Z, Kebede E, Golassa L, Mathebula EM, Yewhalaw D. Diagnostic performance of NxTek™ Eliminate Malaria-Pf test for the detection of Plasmodium falciparum in school children with asymptomatic malaria. Malar J 2023; 22:112. [PMID: 36991438 DOI: 10.1186/s12936-023-04529-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
One of the major roadblocks to the falciparum malaria elimination programme is the presence of a portion of the population, such as school children, with asymptomatic malaria infection. Targeting such reservoirs of infections is critical to interrupting transmission and enhancing elimination efforts. The NxTek™ Eliminate Malaria Pf test is a highly sensitive rapid diagnostic test (hsRDT) for the detection of HRP-2. However, knowledge gaps exist in Ethiopia on the diagnostic performance of hsRDT for the detection of Plasmodium falciparum in school children with asymptomatic malaria.
Methods
A school-based cross-sectional study was conducted from September 2021 to January 2022 on 994 healthy school children (aged 6–15 years). Finger-pricked whole blood samples were collected for microscopy, hsRDT, conventional RDT (cRDT or SD Bioline Malaria Ag Pf/P.v), and QuantStudio™ 3 Real—Time PCR system (qPCR). The hsRDT was compared to cRDT and microscopy. qPCR and microscopy were used as reference methods.
Results
The prevalence of Plasmodium falciparum was 1.51%, 2.2%. 2.2% and 4.52%, by microscopy, hsRDT, cRDT and qPCR, respectively. Using qPCR as reference, the sensitivity of hsRDT was higher (48.89%) than the microscopy (33.3%), and showed 100% specificity and a positive predictive value (PPV). Microscopy showed similar specificity and PPV as hsRDT. Using microscopy as a reference, the diagnostic perforrmances of both hsRDT and cRDT were similar. Both RDTs demonstrated identical diagnostic performances in both comparison methods.
Conclusions
hsRDT has the same diagnostic performance as cRDT but improved diagnostic characteristics than microscopy for detection of P. falciparum in school children with asymptomatic malaria. It can be a useful tool for the national malaria elimination plan of Ethiopia.
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Perez-Ugarte A, Rubio Maturana C, Silgado A, Zarzuela Serrat F, Goterris L, Paredes-Carmona F, Sulleiro E. Unexpected false-negative result in a traveller's malaria diagnosis. J Travel Med 2023; 30:6775350. [PMID: 36300508 DOI: 10.1093/jtm/taac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022]
Abstract
A 4-year-old traveller returned from Senegal with symptoms compatible with malaria. Plasmodium falciparum HRP-2 antigen detection was negative, whereas panmalarial aldolase was positive. Microscopy confirmed the presence of P. falciparum trophozoites with parasitaemia of 16%. Discarding other causes of false-negative antigen detection, this is a rare case of prozone effect.
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Affiliation(s)
- Arantxa Perez-Ugarte
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona 08035, España
| | - Carles Rubio Maturana
- Microbiology Department, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona 08035, España
| | - Aroa Silgado
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona 08035, España
- CIBERINFEC, ISCIII- CIBER Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Francesc Zarzuela Serrat
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona 08035, España
| | - Lidia Goterris
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona 08035, España
| | | | - Elena Sulleiro
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona 08035, España
- CIBERINFEC, ISCIII- CIBER Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
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Egwu CO, Aloke C, Chukwu J, Agwu A, Alum E, Tsamesidis I, Aja PM, Offor CE, Obasi NA. A world free of malaria: It is time for Africa to actively champion and take leadership of elimination and eradication strategies. Afr Health Sci 2022; 22:627-640. [PMID: 37092107 PMCID: PMC10117514 DOI: 10.4314/ahs.v22i4.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
The global burden of malaria seems unabated. Africa carries the greatest burden accounting for over 95% of the annual cases of malaria. For the vision of a world free of malaria by Global Technical Strategy to be achieved, Africa must take up the stakeholder's role. It is therefore imperative that Africa rises up to the challenge of malaria and champion the fight against it. The fight against malaria may just be a futile or mere academic venture if Africans are not directly and fully involved. This work reviews the roles playable by Africans in order to curb the malaria in Africa and the world at large.
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Affiliation(s)
- Chinedu Ogbonnia Egwu
- Medical Biochemistry Department, College of Medicine, Alex-Ekwueme Federal University Ndufu-Alike Ikwo, P.M.B. 1010 Ebonyi State, Nigeria
| | - Chinyere Aloke
- Medical Biochemistry Department, College of Medicine, Alex-Ekwueme Federal University Ndufu-Alike Ikwo, P.M.B. 1010 Ebonyi State, Nigeria
- Protein Structure-Function and Research Unit, School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Braamfontein, Johannesburg 2050, South Africa
| | - Jennifer Chukwu
- World Health Organization, United Nations House Plot 617/618 Central Area District PMB 2861 Abuja, Nigeria
| | - Anthony Agwu
- Biochemistry Department, Ebonyi State University Abakaliki, P.M.B. 053 Ebonyi State Nigeria
| | - Esther Alum
- Biochemistry Department, Ebonyi State University Abakaliki, P.M.B. 053 Ebonyi State Nigeria
| | - Ioannis Tsamesidis
- Department of Prosthodontics, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki 54124 Greece
| | - Patrick M Aja
- Biochemistry Department, Ebonyi State University Abakaliki, P.M.B. 053 Ebonyi State Nigeria
| | - Christian E Offor
- Biochemistry Department, Ebonyi State University Abakaliki, P.M.B. 053 Ebonyi State Nigeria
| | - Nwogo Ajuka Obasi
- Medical Biochemistry Department, College of Medicine, Alex-Ekwueme Federal University Ndufu-Alike Ikwo, P.M.B. 1010 Ebonyi State, Nigeria
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7
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Beck HP. Digital microscopy and artificial intelligence could profoundly contribute to malaria diagnosis in elimination settings. Front Artif Intell 2022; 5:510483. [DOI: 10.3389/frai.2022.510483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
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8
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Tan AF, Sakam SSB, Rajahram G, William T, Abd Rachman Isnadi M, Daim S, Barber B, Kho S, Sutherland CJ, Anstey NM, Yerlikaya S, van Schalkwyk DA, Grigg MJ. Diagnostic accuracy and limit of detection of ten malaria parasite lactate dehydrogenase-based rapid tests for Plasmodium knowlesi and P. falciparum. Front Cell Infect Microbiol 2022; 12:1023219. [PMID: 36325471 PMCID: PMC9618705 DOI: 10.3389/fcimb.2022.1023219] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Plasmodium knowlesi causes zoonotic malaria across Southeast Asia. First-line diagnostic microscopy cannot reliably differentiate P. knowlesi from other human malaria species. Rapid diagnostic tests (RDTs) designed for P. falciparum and P. vivax are used routinely in P. knowlesi co-endemic areas despite potential cross-reactivity for species-specific antibody targets. Methods Ten RDTs were evaluated: nine to detect clinical P. knowlesi infections from Malaysia, and nine assessing limit of detection (LoD) for P. knowlesi (PkA1-H.1) and P. falciparum (Pf3D7) cultures. Targets included Plasmodium-genus parasite lactate dehydrogenase (pan-pLDH) and P. vivax (Pv)-pLDH. Results Samples were collected prior to antimalarial treatment from 127 patients with microscopy-positive PCR-confirmed P. knowlesi mono-infections. Median parasitaemia was 788/µL (IQR 247-5,565/µL). Pan-pLDH sensitivities ranged from 50.6% (95% CI 39.6–61.5) (SD BIOLINE) to 87.0% (95% CI 75.1–94.6) (First Response® and CareStart™ PAN) compared to reference PCR. Pv-pLDH RDTs detected P. knowlesi with up to 92.0% (95% CI 84.3-96.7%) sensitivity (Biocredit™). For parasite counts ≥200/µL, pan-pLDH (Standard Q) and Pv-pLDH RDTs exceeded 95% sensitivity. Specificity of RDTs against 26 PCR-confirmed negative controls was 100%. Sensitivity of six highest performing RDTs were not significantly different when comparing samples taken before and after (median 3 hours) antimalarial treatment. Parasite ring stages were present in 30% of pre-treatment samples, with ring stage proportions (mean 1.9%) demonstrating inverse correlation with test positivity of Biocredit™ and two CareStart™ RDTs. For cultured P. knowlesi, CareStart™ PAN demonstrated the lowest LoD at 25 parasites/µL; LoDs of other pan-pLDH ranged from 98 to >2000 parasites/µL. Pv-pLDH LoD for P. knowlesi was 49 parasites/µL. No false-positive results were observed in either P. falciparum-pLDH or histidine-rich-protein-2 channels. Conclusion Selected RDTs demonstrate sufficient performance for detection of major human malaria species including P. knowlesi in co-endemic areas where microscopy is not available, particularly for higher parasite counts, although cannot reliably differentiate among non-falciparum malaria.
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Affiliation(s)
- Angelica F. Tan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, N T, Australia
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- *Correspondence: Angelica F. Tan, ; Matthew J. Grigg,
| | - Sitti Saimah binti Sakam
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Giri S. Rajahram
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
- Department of Medicine, Queen Elizabeth Hospital II, Kota Kinabalu, Sabah, Malaysia
| | - Timothy William
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | | | - Sylvia Daim
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Bridget E. Barber
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, N T, Australia
- Clinical Malaria, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Steven Kho
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, N T, Australia
| | - Colin J. Sutherland
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicholas M. Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, N T, Australia
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Seda Yerlikaya
- Malaria and Fever, Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Donelly A. van Schalkwyk
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew J. Grigg
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, N T, Australia
- Infectious Diseases Society Kota Kinabalu Sabah – Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- *Correspondence: Angelica F. Tan, ; Matthew J. Grigg,
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Martiáñez-Vendrell X, Skjefte M, Sikka R, Gupta H. Factors Affecting the Performance of HRP2-Based Malaria Rapid Diagnostic Tests. Trop Med Infect Dis 2022; 7:tropicalmed7100265. [PMID: 36288006 PMCID: PMC9611031 DOI: 10.3390/tropicalmed7100265] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
The recent COVID-19 pandemic has profoundly impacted global malaria elimination programs, resulting in a sharp increase in malaria morbidity and mortality. To reduce this impact, unmet needs in malaria diagnostics must be addressed while resuming malaria elimination activities. Rapid diagnostic tests (RDTs), the unsung hero in malaria diagnosis, work to eliminate the prevalence of Plasmodium falciparum malaria through their efficient, cost-effective, and user-friendly qualities in detecting the antigen HRP2 (histidine-rich protein 2), among other proteins. However, the testing mechanism and management of malaria with RDTs presents a variety of limitations. This paper discusses the numerous factors (including parasitic, host, and environmental) that limit the performance of RDTs. Additionally, the paper explores outside factors that can hinder RDT performance. By understanding these factors that affect the performance of HRP2-based RDTs in the field, researchers can work toward creating and implementing more effective and accurate HRP2-based diagnostic tools. Further research is required to understand the extent of these factors, as the rapidly changing interplay between parasite and host directly hinders the effectiveness of the tool.
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Affiliation(s)
- Xavier Martiáñez-Vendrell
- Molecular Virology Laboratory, Department of Medical Microbiology, LUMC Center for Infectious Diseases (LU-CID), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands or
| | - Malia Skjefte
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Ruhi Sikka
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, Mathura 281406, UP, India
| | - Himanshu Gupta
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, Mathura 281406, UP, India
- Correspondence: or
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Eyong EM, Etutu SJM, Jerome FC, Nyasa RB, Kwenti TE, Moyeh MN. Plasmodium falciparum histidine-rich protein 2 and 3 gene deletion in the Mount Cameroon region. IJID REGIONS (ONLINE) 2022; 3:300-307. [PMID: 35755467 PMCID: PMC9216387 DOI: 10.1016/j.ijregi.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022]
Abstract
pfhrp2/3 gene deletions occur in parasite populations in the Mount Cameroon region pfhrp2-negative parasites are the more common in the Mount Cameroon region pfhrp2/3-negative parasites negatively impact malaria rapid diagnostic test success
Objective Plasmodium falciparum produces histidine-rich protein 2/3 (Pfhrp2/3) genes that accumulate to high levels in the bloodstream and serve as a diagnostic and prognostic marker for falciparum malaria. Pfhrp2/3 gene deletions may lead to false-negative rapid diagnostic test (RDT) results. We aimed to determine the prevalence of pfhrp2/3 gene deletions in P. falciparum isolates and the implications for RDT use in the Mount Cameroon region. Methods A cross-sectional hospital-based study with malaria diagnosis performed using microscopy, RDT and nested polymerase chain reaction (nPCR). In total, 324 P. falciparum microscopy positive individuals were enrolled and their samples confirmed positive for P. falciparum using 18SrRNA PCR. Samples that gave false-negative RDT results were analyzed to detect pfhrp2/3 exon 2 deletions. Results Of 324 positive microscopic and nPCR samples, 16 gave RDT false-negative results. Among the 324 P. falciparum positive isolates, exon 2 deletions were observed in 2.2% (7 of 324); 3 were negative for pfhrp2 gene, 2 for pfhrp3, and 2 for both pfhrp2 and pfhrp3 (double deletions). Conclusion P. falciparum isolates with pfhrp2/3 gene deletion were present in the parasite populations and may contribute to the RDT false-negative results in the Mount Cameroon region.
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Affiliation(s)
- Esum Mathias Eyong
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, P.O. Box 63, Buea, South West Region, Cameroon
| | - Sophie Jose Molua Etutu
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, P.O. Box 63, Buea, South West Region, Cameroon
| | - Fru-Cho Jerome
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, P.O. Box 63, Buea, South West Region, Cameroon
| | - Raymond Babila Nyasa
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, P.O. Box 63, Buea, South West Region, Cameroon
| | - Tebit Emmanuel Kwenti
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, South West Region, Cameroon
| | - Marcel N Moyeh
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P.O. Box 63, Buea, South West Region of Cameroon
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Plasmodium falciparum histidine-rich protein 2 and 3 genes deletion in global settings (2010–2021): a systematic review and meta-analysis. Malar J 2022; 21:26. [PMID: 35093092 PMCID: PMC8800273 DOI: 10.1186/s12936-022-04051-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/17/2022] [Indexed: 01/10/2023] Open
Abstract
Background The usefulness of histidine-rich protein-2/3 (HRP2/3)-based rapid diagnostic tests of malaria due to Plasmodium falciparum has been threatened by the appearance of mutant PfHRP2/3 genes. This study was undertaken to determine the global pooled estimates of PfHRP2/3gene deletions. Methods Relevant publications were identified from electronic databases such as; PubMed, EMBASE, and MEDLINE online. Besides, all the relevant literatures were retrieved through Google and Google Scholar. STATA software was used for data analysis. The pooled estimates were calculated using random effect model. The summary estimates were presented using forest plots and tables. Results A total of 27 studies were included in the systematic review. However, only 24 and 17 studies were included for PfHRP2 and 3 gene deletion meta-analysis, respectively. The prevalence of PfHRP2 gene deletion across the individual studies ranged from the highest 100% to the lowest 0%. However, the meta-analysis result showed that the global pooled prevalence of PfHRP2 and PfHRP3 gene deletions were 21.30% and 34.50%, respectively. The pooled proportion of PfHRP2 gene deletion among false negative PfHRP2-based RDTs results was found to be 41.10%. The gene deletion status was higher in South America and followed by Africa. The pooled estimate of PfHRP2 gene deletion among studies, which did not follow the WHO PfHRP2/3 gene deletion analysis protocol was higher than their counter parts (21.3% vs 10.5%). Conclusions This review showed that there is a high pooled prevalence of PfHRP2/3 gene deletions in Plasmodium falciparum confirmed isolates and also a high proportion of their deletions among false-negative malaria cases using PfHRP2-based RDT results. Hence, malaria diagnosis based on PfHRP2-based rapid tests seems to be less sensitive and warrants further evaluation of PfHRP2/3 gene deletions.
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Adjei GO, Sulley AM, Goka BQ, Enweronu-Laryea C, Renner L, Alifrangis M, Kurtzhals JAL. Performance of an HRP-2 based (First Response®) and p-LDH-based (Optimal®) rapid diagnostic tests for diagnosis of malaria in paediatric sickle cell disease patients. Clin Infect Dis 2021; 75:435-441. [PMID: 34849647 DOI: 10.1093/cid/ciab977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDTs) have been extensively evaluated and play an important role in malaria diagnosis. However, the accuracy of RDT for malaria diagnosis in patients with sickle cell disease (SCD) is unknown. METHODS We compared the performance of a histidine rich protein 2 (HRP-2) - based RDT (First Response®), and a lactate dehydrogenase (LDH) - based RDT (Optimal®) with routine microscopy as reference standard in 445 SCD children with an acute febrile illness in Accra, Ghana. RESULTS The overall sensitivity, specificity, positive and negative predictive values of the HRP-2 based RDT were, 100%, 95.7%, 73.8% and 100%, respectively. Comparable values for the LDH based RDT were, 91.7%, 99.5%, 95.7% and 99.0% respectively. A total of 423 results were true in both tests, one result was false in both tests, 16 results were false in the HRP-2 test only and 5 were false in the LDH test only (McNemar's test, p=0.03). At follow up, 73.7 % (28/38), 52.6 % (20/38), 48.6 % (17/35), and 13.2 % (5/38) of study participants were HRP-2 positive on days 14, 28, 35 and 42, respectively, compared to 0, 2.6 % (1/38), 2.9 % (1/35), and 2.6 % (1/38) for LDH. CONCLUSION The HRP2 based RDT fulfilled WHO criteria for malaria diagnosis in SCD patients and may provide diagnostic evidence for treatment to begin in cases where treatment would otherwise have begun presumptively based on symptoms, while LDH based RDT may be more suitable as a confirmatory test in low-parasitaemic sub-groups, such as SCD patients.
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Affiliation(s)
- George O Adjei
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, University of Ghana
| | - A M Sulley
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, University of Ghana
| | - B Q Goka
- Department of Child Health, University of Ghana Medical School, University of Ghana
| | - C Enweronu-Laryea
- Department of Child Health, University of Ghana Medical School, University of Ghana
| | - L Renner
- Department of Child Health, University of Ghana Medical School, University of Ghana
| | - M Alifrangis
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - J A L Kurtzhals
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen and Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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The Brief Case: A 6-Year-Old with Fever, Abdominal Pain, and Recent Travel to Sierra Leone. J Clin Microbiol 2021; 59:e0053421. [PMID: 34664995 DOI: 10.1128/jcm.00534-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Comparison of conventional and non-invasive diagnostic tools for detecting Plasmodium falciparum infection in southwestern Cameroon: a cross-sectional study. Infect Dis Poverty 2021; 10:75. [PMID: 34022958 PMCID: PMC8140564 DOI: 10.1186/s40249-021-00859-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background Malaria remains a significant health challenge in sub-Saharan Africa, with early diagnosis critical to reducing its morbidity and mortality. Despite the increasing Plasmodium spp. diagnostic capabilities, access to testing is limited in some cases by the almost absolute requirement for blood from potentially infected subjects as the only sample source for all conventional methods. A rapid test on non-invasive specimen with comparable performance to microscopy for the screening or diagnosis of all participants is invaluable. This study sought to compare conventional and non-invasive diagnostic tools for detecting Plasmodium falciparum. Methods This was a cross-sectional study, carried out between March and August 2019 to evaluate and compare the diagnostic performance of a PfHRP2/pLDH-based malaria rapid diagnostic test (mRDT) on patients’ blood, saliva and urine relative to conventional light microscopy and nested PCR at outpatient clinics in the Buea and Tiko health districts of Southwestern Cameroon. The significance of differences in proportions was explored using the Pearson’s χ2 test whereas differences in group means were assessed using analyses of variance. Results A total of 359 individuals of both sexes, aged 1–92 years, were enrolled into the study. Of the 301 individuals tested by light microscopy and mRDTs on blood, saliva and urine, 84 (27.9%), 81 (26.9%), 87 (28.9%) and 107 (35.5%) respectively were positive. However, only 34.3%, 90.5%, 91.4%, 83.9% and 65.4% febrile, light microscopy and mRDT positives on blood, saliva and urine respectively had P. falciparum infection as confirmed by PCR. The sensitivity and specificity of presumptive diagnosis, light microscopy and mRDT on blood, saliva and urine were 86.9% and 19.7%, 77.8% and 96.1%, 75.8% and 96.6%, 74.5% and 93.1%, and 70.7% and 81.8%, respectively. The agreement between mRDT on saliva (k = 0.696) and microscopy (k = 0.766) compared to PCR was good. Conclusion The study highlighted the low performance of presumptive diagnosis, reinforcing the need for parasitological tests prior to antimalarial therapy. The higher PfHRP2/pLDH mRDT parasite detection rates and sensitivity in saliva compared to urine suggests that the former is a practical adjunct to or alternative worth optimising for the routine diagnosis of malaria. Graphic Abstract Flow chart for diagnosis of P. falciparum infection by light microscopy, rapid diagnostic tests and nested PCR.![]()
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Kojom Foko LP, Pande V, Singh V. Field Performances of Rapid Diagnostic Tests Detecting Human Plasmodium Species: A Systematic Review and Meta-Analysis in India, 1990-2020. Diagnostics (Basel) 2021; 11:590. [PMID: 33806066 PMCID: PMC8064471 DOI: 10.3390/diagnostics11040590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 11/29/2022] Open
Abstract
Rapid diagnostic tests (RDTs) have become a mainstay of malaria diagnosis in endemic countries since their implementation in the 1990s. We conducted a 30-year systematic review and meta-analysis on malaria RDTs performance in India. Outcomes of interest were sensitivity (Se), specificity (Sp), positive/negative likelihood ratio (PLR/NLR), and diagnostic odd ratio (DOR). Among the 75 studies included, most of the studies were cross-sectional (65.3%), hospital-based (77.3%), and targeted febrile patients (90.6%). Nearly half of RDTs were designed for detecting Plasmodium falciparum only (47.5%) while the rest were for P. falciparum and P. vivax (11.9%), and P. falciparum/Pan-Plasmodium except for P. knowlesi (32.3%). When compared to light microscopy (gold standard), pooled estimates of performances were: Se = 97.0%, Sp = 96.0%, PLR = 22.4, NLR = 0.02 and DOR = 1080. In comparison to polymerase chain reaction, the RDTs showed Se = 89.0% and Sp = 99.0%. Performance outcomes (Se and Sp) were similar for RDT targeting P. falciparum only, but decreased for mixed and non-falciparum infections. Performances of malaria RDTs are still high India. However, there is a need for developing RDTs with regard to targeting minor malarial species, individuals carrying only mature gametocytes, and pfhrp2-deleted parasites.
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Affiliation(s)
- Loick Pradel Kojom Foko
- Cell Biology Laboratory and Malaria Parasite Bank, ICMR-National Institute of Malaria Research, Sector 8, Dwarka, New Delhi 110077, India;
- Department of Biotechnology, Kumaun University, Bhimtal, Uttarakhand 263001, India;
| | - Veena Pande
- Department of Biotechnology, Kumaun University, Bhimtal, Uttarakhand 263001, India;
| | - Vineeta Singh
- Cell Biology Laboratory and Malaria Parasite Bank, ICMR-National Institute of Malaria Research, Sector 8, Dwarka, New Delhi 110077, India;
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Manjurano A, Omolo JJ, Lyimo E, Miyaye D, Kishamawe C, Matemba LE, Massaga JJ, Changalucha J, Kazyoba PE. Performance evaluation of the highly sensitive histidine-rich protein 2 rapid test for plasmodium falciparum malaria in North-West Tanzania. Malar J 2021; 20:58. [PMID: 33482835 PMCID: PMC7821515 DOI: 10.1186/s12936-020-03568-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background Precise detection of Plasmodium infections in community surveys is essential for effective malaria control. Microscopy and rapid diagnostic tests (RDTs) are the major techniques used to identify malaria infections in the field-based surveys. Although microscopy is still considered as the gold standard, RDTs are increasingly becoming versatile due to their rapid and adequate performance characteristics. Methods A malaria prevalence cross-sectional survey was carried out in north-western Tanzania in 2016, aimed at appraising the performance of high sensitivity Plasmodium falciparum (HSPf) tests compared to SD Bioline Pf and microscopy in detecting P. falciparum infections. A total of 397 individuals aged five years and above were tested for P. falciparum infections. The sensitivity, specificity, positive, and negative predictive values (PPV and NPV) of microscopy, Pf RDT and HSPf RDT was determined using PCR as the gold standard method. Results The prevalence of P. falciparum infections determined by microscopy, SD Bioline Pf, HSPf and PCR was 21.9, 27.7, 33.3 and 43.2%, respectively. The new HSPf RDT had significantly higher sensitivity (98.2%) and specificity (91.6%) compared to the routinely used SD Bioline Pf RDT(P < 0.001). The positive predictive value (PPV) was 81.8% and the negative predictive value (NPV) was 99.2% for the routinely used SD Bioline Pf RDT. Moreover, HSPf RDT had sensitivity of 69% and specificity of 76.8% compared to microscopy. The PPV was 45.5% and the NPV was 89.8% for microscopy. Furthermore, the analytical sensitivity test indicated that the newly developed HSPf RDT had lower detection limits compared to routinely used SD Bioline RDT. Conclusions HSPf RDT had better performance when compared to both microscopy and the currently used malaria RDTs. The false negativity could be associated with the low parasite density of the samples. False positivity may be related to the limitations of the expertise of microscopists or persistent antigenicity from previous infections in the case of RDTs. Nevertheless, HS PfRDT performed better compared to routinely used Pf RDT, and microscopy in detecting malaria infections. Therefore, HS Pf RDT presents the best alternative to the existing commercial/regularly available RDTs due to its sensitivity and specificity, and reliability in diagnosing malaria infections.
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Affiliation(s)
- Alphaxard Manjurano
- Mwanza Medical Research Center, National Institute for Medical Research, Mwanza, Tanzania.
| | - Justin J Omolo
- National Institute of Medical Research, Head Quarters, P.O. Box 9653, Dar es Salaam, Tanzania
| | - Eric Lyimo
- Mwanza Medical Research Center, National Institute for Medical Research, Mwanza, Tanzania
| | - Donald Miyaye
- Mwanza Medical Research Center, National Institute for Medical Research, Mwanza, Tanzania
| | - Coleman Kishamawe
- Mwanza Medical Research Center, National Institute for Medical Research, Mwanza, Tanzania
| | - Lucas E Matemba
- Dodoma Medical Research Center, National Institute for Medical Research, Dodoma, Tanzania
| | - Julius J Massaga
- National Institute of Medical Research, Head Quarters, P.O. Box 9653, Dar es Salaam, Tanzania
| | - John Changalucha
- Mwanza Medical Research Center, National Institute for Medical Research, Mwanza, Tanzania
| | - Paul E Kazyoba
- National Institute of Medical Research, Head Quarters, P.O. Box 9653, Dar es Salaam, Tanzania
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Sensitivity and specificity of rapid hepatitis C antibody assays in freshly collected whole blood, plasma and serum samples: A multicentre prospective study. PLoS One 2020; 15:e0243040. [PMID: 33270716 PMCID: PMC7714359 DOI: 10.1371/journal.pone.0243040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/15/2020] [Indexed: 11/19/2022] Open
Abstract
Background This study evaluated performance of two hepatitis C virus (HCV) rapid diagnostic tests (RDTs) performed by intended users in resource-limited settings. Methods Testing was conducted at three facilities in two countries (Georgia, Cambodia) using matched fingerstick whole blood, plasma and serum samples. Investigational RDTs were compared with a composite reference standard (CRS) comprised of three laboratory tests, and a reference RDT. Results In matched samples from 489 HCV positive and 967 HCV negative participants, specificity with both investigational RDTs was high using either reference method (≥98.4% in all sample types). Sensitivity was lower in whole blood versus plasma and serum for both RDTs compared with the CRS (86.5–91.4% vs 97.5–98.0% and 97.3–97.1%) and reference RDT (93.6–97.8% vs 100% and 99.4%). Sensitivity improved when considering only samples with detectable HCV viral load. Conclusion Sensitivity was highest in serum and plasma versus whole blood. The World Health Organization prequalification criterion (≥98%) was narrowly missed by both RDTs in serum, and one in plasma, possibly due to the intended user factor. Performance in whole blood was considered adequate, given potential roles of HCV infection history, improved sensitivity with detectable viral load and performance similarities to the reference RDT.
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Morang'a CM, Amenga-Etego L, Bah SY, Appiah V, Amuzu DSY, Amoako N, Abugri J, Oduro AR, Cunnington AJ, Awandare GA, Otto TD. Machine learning approaches classify clinical malaria outcomes based on haematological parameters. BMC Med 2020; 18:375. [PMID: 33250058 PMCID: PMC7702702 DOI: 10.1186/s12916-020-01823-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Malaria is still a major global health burden, with more than 3.2 billion people in 91 countries remaining at risk of the disease. Accurately distinguishing malaria from other diseases, especially uncomplicated malaria (UM) from non-malarial infections (nMI), remains a challenge. Furthermore, the success of rapid diagnostic tests (RDTs) is threatened by Pfhrp2/3 deletions and decreased sensitivity at low parasitaemia. Analysis of haematological indices can be used to support the identification of possible malaria cases for further diagnosis, especially in travellers returning from endemic areas. As a new application for precision medicine, we aimed to evaluate machine learning (ML) approaches that can accurately classify nMI, UM, and severe malaria (SM) using haematological parameters. METHODS We obtained haematological data from 2,207 participants collected in Ghana: nMI (n = 978), SM (n = 526), and UM (n = 703). Six different ML approaches were tested, to select the best approach. An artificial neural network (ANN) with three hidden layers was used for multi-classification of UM, SM, and uMI. Binary classifiers were developed to further identify the parameters that can distinguish UM or SM from nMI. Local interpretable model-agnostic explanations (LIME) were used to explain the binary classifiers. RESULTS The multi-classification model had greater than 85% training and testing accuracy to distinguish clinical malaria from nMI. To distinguish UM from nMI, our approach identified platelet counts, red blood cell (RBC) counts, lymphocyte counts, and percentages as the top classifiers of UM with 0.801 test accuracy (AUC = 0.866 and F1 score = 0.747). To distinguish SM from nMI, the classifier had a test accuracy of 0.96 (AUC = 0.983 and F1 score = 0.944) with mean platelet volume and mean cell volume being the unique classifiers of SM. Random forest was used to confirm the classifications, and it showed that platelet and RBC counts were the major classifiers of UM, regardless of possible confounders such as patient age and sampling location. CONCLUSION The study provides proof of concept methods that classify UM and SM from nMI, showing that the ML approach is a feasible tool for clinical decision support. In the future, ML approaches could be incorporated into clinical decision-support algorithms for the diagnosis of acute febrile illness and monitoring response to acute SM treatment particularly in endemic settings.
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Affiliation(s)
- Collins M Morang'a
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Lucas Amenga-Etego
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana.
| | - Saikou Y Bah
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana.,Florey Institute, Molecular Biology and Biotechnology, University of Sheffield, Sheffield, UK
| | - Vincent Appiah
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Dominic S Y Amuzu
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Nicholas Amoako
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - James Abugri
- Department of Applied Chemistry and Biochemistry, C. K Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Abraham R Oduro
- Ministry of Health, Navrongo Health Research Centre (NHRC), Navrongo, Ghana
| | - Aubrey J Cunnington
- Section of Pediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
| | - Gordon A Awandare
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Thomas D Otto
- Institute of Infection, Immunity & Inflammation, MVLS, University of Glasgow, Glasgow, UK.
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Alemayehu GS, Lopez K, Dieng CC, Lo E, Janies D, Golassa L. Evaluation of PfHRP2 and PfLDH Malaria Rapid Diagnostic Test Performance in Assosa Zone, Ethiopia. Am J Trop Med Hyg 2020; 103:1902-1909. [PMID: 32840197 DOI: 10.4269/ajtmh.20-0485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In malaria-endemic countries, rapid diagnostic tests (RDTs) targeting Plasmodium falciparum histidine-rich protein 2 (PfHRP2) and lactate dehydrogenase (PfLDH) have been widely used. However, little is known regarding the diagnostic performances of these RDTs in the Assosa zone of northwest Ethiopia. The objective of this study was to determine the diagnostic performances of PfHRP2 and PfLDH RDTs using microscopy and quantitative PCR (qPCR) as a reference test. A health facility-based cross-sectional study design was conducted from malaria-suspected study participants at selected health centers from November to December 2018. Finger-prick blood samples were collected for microscopy, RDTs, and qPCR method. The prevalence of P. falciparum was 26.4%, 30.3%, and 24.1% as determined by microscopy, PfHRP2 RDT, and PfLDH RDT, respectively. Compared with microscopy, the sensitivity and specificity of the PfHRP2 RDT were 96% and 93%, respectively, and those of the PfLDH RDT were 89% and 99%, respectively. Compared with qPCR, the specificity of the PfHRP2 RDT (93%) and PfLDH RDT (98%) was high, but the sensitivity of the PfHRP2 RDT (77%) and PfLDH RDT (70%) was relatively low. These malaria RDTs and reference microscopy methods showed reasonable agreement with a kappa value above 0.85 and provided accurate diagnosis of P. falciparum malaria. Thus, the current malaria RDT in the Ministry of Health program can be used in the Assosa zone of Ethiopia. However, continuous monitoring of the performance of PfHRP2 RDT is important to support control and elimination of malaria in Ethiopia.
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Affiliation(s)
| | - Karen Lopez
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Cheikh Cambel Dieng
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Eugenia Lo
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Daniel Janies
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Plewes K, Leopold SJ, Kingston HWF, Dondorp AM. Malaria: What's New in the Management of Malaria? Infect Dis Clin North Am 2019; 33:39-60. [PMID: 30712767 DOI: 10.1016/j.idc.2018.10.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The global burden of malaria remains high, with 216 million cases causing 445,000 deaths in 2016 despite first-line treatment with artemisinin-based combination therapy. Decreasing transmission in Africa shifts the risk for severe malaria to older age groups as premunition wanes. Prompt diagnosis and treatment with intravenous artesunate in addition to appropriate supportive management are critical to reduce deaths from severe malaria. Effective individual management is challenging in settings with limited resources for higher-level care. Adjunctive therapies targeting the underlying pathophysiological pathways have the potential to reduce mortality. Resistance to artemisinin derivatives and their partner drugs threaten malaria management and control.
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Affiliation(s)
- Katherine Plewes
- Malaria Department, Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 3/F 60th, Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand; Department of Medicine, University of British Columbia, Vancouver General Hospital, 452D Heather Pavilion East, 2733 Heather Street, Vancouver, British Columbia V5Z 3J5, Canada
| | - Stije J Leopold
- Malaria Department, Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 3/F 60th, Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Hugh W F Kingston
- Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK; Malaria Department, Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 3/F 60th, Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Arjen M Dondorp
- Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, 3/F 60th, Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand.
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Jacobs J, Hardy L, Semret M, Lunguya O, Phe T, Affolabi D, Yansouni C, Vandenberg O. Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance. Front Med (Lausanne) 2019; 6:205. [PMID: 31608280 PMCID: PMC6771306 DOI: 10.3389/fmed.2019.00205] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 09/03/2019] [Indexed: 12/28/2022] Open
Abstract
This review provides an update on the factors fuelling antimicrobial resistance and shows the impact of these factors in low-resource settings. We detail the challenges and barriers to integrating clinical bacteriology in hospitals in low-resource settings, as well as the opportunities provided by the recent capacity building efforts of national laboratory networks focused on vertical single-disease programmes. The programmes for HIV, tuberculosis and malaria have considerably improved laboratory medicine in Sub-Saharan Africa, paving the way for clinical bacteriology. Furthermore, special attention is paid to topics that are less familiar to the general medical community, such as the crucial role of regulatory frameworks for diagnostics and the educational profile required for a productive laboratory workforce in low-resource settings. Traditionally, clinical bacteriology laboratories have been a part of higher levels of care, and, as a result, they were poorly linked to clinical practices and thus underused. By establishing and consolidating clinical bacteriology laboratories at the hospital referral level in low-resource settings, routine patient care data can be collected for surveillance, antibiotic stewardship and infection prevention and control. Together, these activities form a synergistic tripartite effort at the frontline of the emergence and spread of multi-drug resistant bacteria. If challenges related to staff, funding, scale, and the specific nature of clinical bacteriology are prioritized, a major leap forward in the containment of antimicrobial resistance can be achieved. The mobilization of resources coordinated by national laboratory plans and interventions tailored by a good understanding of the hospital microcosm will be crucial to success, and further contributions will be made by market interventions and business models for diagnostic laboratories. The future clinical bacteriology laboratory in a low-resource setting will not be an "entry-level version" of its counterparts in high-resource settings, but a purpose-built, well-conceived, cost-effective and efficient diagnostic facility at the forefront of antimicrobial resistance containment.
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Affiliation(s)
- Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Makeda Semret
- JD MacLean Centre for Tropical Diseases, McGill University, Montreal, QC, Canada
| | - Octavie Lunguya
- Department of Clinical Microbiology, National Institute of Biomedical Research, Kinshasa, Democratic Republic of Congo
- Service of Microbiology, Kinshasa General Hospital, Kinshasa, Democratic Republic of Congo
| | - Thong Phe
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Dissou Affolabi
- Clinical Microbiology, Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | - Cedric Yansouni
- JD MacLean Centre for Tropical Diseases, McGill University, Montreal, QC, Canada
| | - Olivier Vandenberg
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Innovation and Business Development Unit, LHUB - ULB, Pôle Hospitalier Universitaire de Bruxelles (PHUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
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Talapko J, Škrlec I, Alebić T, Jukić M, Včev A. Malaria: The Past and the Present. Microorganisms 2019; 7:microorganisms7060179. [PMID: 31234443 PMCID: PMC6617065 DOI: 10.3390/microorganisms7060179] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/28/2019] [Accepted: 06/19/2019] [Indexed: 02/07/2023] Open
Abstract
Malaria is a severe disease caused by parasites of the genus Plasmodium, which is transmitted to humans by a bite of an infected female mosquito of the species Anopheles. Malaria remains the leading cause of mortality around the world, and early diagnosis and fast-acting treatment prevent unwanted outcomes. It is the most common disease in Africa and some countries of Asia, while in the developed world malaria occurs as imported from endemic areas. The sweet sagewort plant was used as early as the second century BC to treat malaria fever in China. Much later, quinine started being used as an antimalaria drug. A global battle against malaria started in 1955, and Croatia declared 1964 to be the year of eradication of malaria. The World Health Organization carries out a malaria control program on a global scale, focusing on local strengthening of primary health care, early diagnosis of the disease, timely treatment, and disease prevention. Globally, the burden of malaria is lower than ten years ago. However, in the last few years, there has been an increase in the number of malaria cases around the world. It is moving towards targets established by the WHO, but that progress has slowed down.
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Affiliation(s)
- Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, HR-31000 Osijek, Croatia.
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, HR-31000 Osijek, Croatia.
| | - Tamara Alebić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
| | - Melita Jukić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
- General Hospital Vukovar, Županijska 35, HR-32000 Vukovar, Croatia.
| | - Aleksandar Včev
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, HR-31000 Osijek, Croatia.
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
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Simultaneous Quantification of Plasmodium Antigens and Host Factor C-Reactive Protein in Asymptomatic Individuals with Confirmed Malaria by Use of a Novel Multiplex Immunoassay. J Clin Microbiol 2019; 57:JCM.00948-18. [PMID: 30404944 PMCID: PMC6322473 DOI: 10.1128/jcm.00948-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022] Open
Abstract
Malaria rapid diagnostic tests (RDTs) primarily detect Plasmodium falciparum antigen histidine-rich protein 2 (HRP2) and the malaria-conserved antigen lactate dehydrogenase (LDH) for P. vivax and other malaria species. The performance of RDTs and their utility is dependent on circulating antigen concentration distributions in infected individuals in a population in which malaria is endemic and on the limit of detection of the RDT for the antigens. Malaria rapid diagnostic tests (RDTs) primarily detect Plasmodium falciparum antigen histidine-rich protein 2 (HRP2) and the malaria-conserved antigen lactate dehydrogenase (LDH) for P. vivax and other malaria species. The performance of RDTs and their utility is dependent on circulating antigen concentration distributions in infected individuals in a population in which malaria is endemic and on the limit of detection of the RDT for the antigens. A multiplexed immunoassay for the quantification of HRP2, P. vivax LDH, and all-malaria LDH (pan LDH) was developed to accurately measure circulating antigen concentration and antigen distribution in a population with endemic malaria. The assay also measures C-reactive protein (CRP) levels as an indicator of inflammation. Validation was conducted with clinical specimens from 397 asymptomatic donors from Myanmar and Uganda, confirmed by PCR for infection, and from participants in induced blood-stage malaria challenge studies. The assay lower limits of detection for HRP2, pan LDH, P. vivax LDH, and CRP were 0.2 pg/ml, 9.3 pg/ml, 1.5 pg/ml, and 26.6 ng/ml, respectively. At thresholds for HRP2, pan LDH, and P. vivax LDH of 2.3 pg/ml, 47.8 pg/ml, and 75.1 pg/ml, respectively, and a specificity ≥98.5%, the sensitivities for ultrasensitive PCR-confirmed infections were 93.4%, 84.9%, and 48.9%, respectively. Plasmodium LDH (pLDH) concentration, in contrast to that of HRP2, correlated closely with parasite density. CRP levels were moderately higher in P. falciparum infections with confirmed antigenemia versus those in clinical specimens with no antigen. The 4-plex array is a sensitive tool for quantifying diagnostic antigens in malaria infections and supporting the evaluation of new ultrasensitive RDTs.
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Pati P, Dhangadamajhi G, Bal M, Ranjit M. High proportions of pfhrp2 gene deletion and performance of HRP2-based rapid diagnostic test in Plasmodium falciparum field isolates of Odisha. Malar J 2018; 17:394. [PMID: 30373573 PMCID: PMC6206925 DOI: 10.1186/s12936-018-2502-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/03/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND With the documentation of cases of falciparum malaria negative by rapid diagnostic tests (RDT), though at low frequency from natural isolates in a small pocket of Odisha, it became absolutely necessary to investigate the status of HRP-2 based RDT throughout the state and in different seasons of the year. METHODS Suspected individuals were screened for malaria infection by microscopy and RDT in 25/30 districts of Odisha, India. Discrepancies in results were confirmed by PCR. False negative RDT samples for Plasmodium falciparum mono-infection were evaluated for detection of HRP2 antigen in ELISA and genotyped for pfhrp2, pfhrp3 and their flanking genes. Multiplicity of infection was ascertained based on msp1 and msp2 genotyping and parasitaemia level was determined by microscopy. RESULTS Of the total 1058 patients suspected for malaria, 384 were microscopically confirmed for P. falciparum mono-infection and RDT failure was observed in 58 samples at varying proportion in different regions of the state. The failure in detection was due to undetectable level of HRP-2. Although most of these samples were screened during rainy season (45/345), significantly high proportion (9/17) of RDT negative samples were obtained during the summer compared to rainy season (P = 0.0002; OR = 7.5). PCR genotyping of pfhrp2 and pfhrp3 in RDT negative samples showed 38/58 (65.5) samples to be pfhrp2 negative and 24/58 (41.4) to be pfhrp3 negative including dual negative in 17/58 (29.3). Most of the RDT negative samples (39/58) were with single genotype infection and high proportions of pfhrp2 deletion (7/9) was observed in summer. No difference in parasitaemia level was observed between RDT positive and RDT negative patients. CONCLUSION High prevalence of parasites with pfhrp2 deletion including dual deletions (pfhrp2 and pfhrp3) is a serious cause of concern, as these patients could not be given a correct diagnosis and treatment. Therefore, HRP2-based RDT for diagnosing P. falciparum infection in Odisha is non-reliable and must be performed in addition to or replaced by other appropriate diagnostic tools for clinical management of the disease.
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Affiliation(s)
- Pallabi Pati
- Molecular Epidemiology Laboratory, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India
| | | | - Madhusmita Bal
- Immunology Laboratory, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India
| | - Manoranjan Ranjit
- Molecular Epidemiology Laboratory, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India.
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25
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Gunasekera WDAW, Premaratne R, Weerasena O, Premawansa W, Handunnetti S, Fernando S. Utility of pf/pan RDT for diagnosis in the prevention of re-establishment of malaria in Sri Lanka. Pathog Glob Health 2018; 112:360-367. [PMID: 30355068 PMCID: PMC6300746 DOI: 10.1080/20477724.2018.1536855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The utility of CareStartTM Malaria Pf/PAN (HRP2/pLDH) Ag Combo Test, in detecting non-endemic clinical malaria cases was evaluated in Sri Lanka, a country in prevention of re-establishment of malaria following elimination. RDT, microscopy and nested PCR were performed for 350 suspected malaria patients recruited prospectively. There were 173 PCR confirmed malaria patients and 177 PCR negative subjects. Plasmodium falciparum amounted to 48% of infections with 44% P. vivax, 6% P. ovale and 2% P. malariae. Performance characteristics of RDTs and microscopy were compared with nested PCR. Sensitivity and specificity of RDT with 95% confidence intervals (CI) were as follows: any malaria infection 95.95% (CI = 91.84-98.36) and 94.92% (CI = 90.57-97.65); P. falciparum 100% (CI = 95.65-100) and 97.00% (CI = 94.18-98.70) and other species 92.22% (CI = 84.63-96.82) and 99.62% (97.88-99.99) respectively. A significant difference between sensitivities of HRP2 (100%, CI = 95.65-100) and pan pLDH line (68.67%, CI = 57.56-78.41) was seen for P. falciparum, parasite densities less than 1000 parasites/microliter being detected only by HRP2. Sensitivity and specificity of microscopy with 95% CI were as follows: any malaria infection, 94.22% (CI = 89.63-97.19) and 99.44% (CI = 96.89-99.99); P. falciparum 89.16% (CI = 80.40-94.90) and 99.63% (CI = 97.94-99.99); other species 98.89% (CI = 93.96-99.97) and 100% (CI = 98.59-100) respectively. The low sensitivity of pan specific pLDH for P. falciparum, P. ovale and P. malariae should be taken in to consideration when using this RDT as a point of care test when and wherever microscopy facilities are not readily available. Considering the low sensitivity of microscopy for P. falciparum, it is preferable to perform both tests, when malaria is highly suspected.
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Affiliation(s)
| | - R.G. Premaratne
- World Health Organization –Regional Office for South East Asia, New Delhi, India
| | - O.V.D.S.J. Weerasena
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | - W.S. Premawansa
- Department of Zoology and Environmental Science, Faculty of Science, University of Colombo, Colombo, Sri Lanka
| | - S.M. Handunnetti
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | - S.D. Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Gendrot M, Fawaz R, Dormoi J, Madamet M, Pradines B. Genetic diversity and deletion of Plasmodium falciparum histidine-rich protein 2 and 3: a threat to diagnosis of P. falciparum malaria. Clin Microbiol Infect 2018; 25:580-585. [PMID: 30267926 DOI: 10.1016/j.cmi.2018.09.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 08/31/2018] [Accepted: 09/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND PfHRP2-based rapid diagnostic tests (RDTs), based on the recognition of the Plasmodium falciparum histidine-rich protein 2, are currently the most used tests in malaria detection. Most of the antibodies used in RDTs also detect PfHRP3. However, false-negative results were reported. Significant variation in the pfhrp2 gene could lead to the expression of a modified protein that would no longer be recognized by the antibodies used in PfHRP2-based RDTs. Additionally, parasites lacking the PfHRP2 do not express the protein and are, therefore, not identifiable. AIMS This review aims to assess the pfhrp2 and pfhrp3 genetic variation or the prevalence of gene deletion in areas where malaria is endemic and describe its implications on RDT use. SOURCES Publications of interest were identified using PubMed, Google Scholar and Google. CONTENT More than 18 types of amino acid repeats were identified from the PfHRP2 sequences. Sequencing analysis revealed high-level genetic variation in the pfhrp2 and pfhrp3 genes (>90% of variation in Madagascar, Nigeria or Senegal) both within and between countries. However, genetic variation of PfHRP2 and PfHRP3 does not seem to be a major cause of false-negative results. The countries that showed the highest proportions of pfhrp2-negative parasites were Peru (20%-100%) and Guyana (41%) in South America, Ghana (36%) and Rwanda (23%) in Africa. High prevalence of pfhrp2 deletion causes a high rate of false-negatives results. IMPLICATIONS Presence of parasites lacking the pfhrp2 gene may pose a major threat to malaria control programmes because P. falciparum-infected individuals are not diagnosed and properly treated.
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Affiliation(s)
- M Gendrot
- Unité Parasitologie et entomologie, Département de biologie des agents transmissibles, Institut de recherche biomédicale des armées, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France
| | - R Fawaz
- Ecole de santé des armées, Bron, France
| | - J Dormoi
- Unité Parasitologie et entomologie, Département de biologie des agents transmissibles, Institut de recherche biomédicale des armées, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France
| | - M Madamet
- Unité Parasitologie et entomologie, Département de biologie des agents transmissibles, Institut de recherche biomédicale des armées, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France; Centre national de référence du paludisme, Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France
| | - B Pradines
- Unité Parasitologie et entomologie, Département de biologie des agents transmissibles, Institut de recherche biomédicale des armées, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France; Centre national de référence du paludisme, Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France.
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Vernelen K, Barbé B, Gillet P, Van Esbroeck M, China B, Jacobs J. Photo-based External Quality Assessment of Malaria rapid diagnostic tests in a non-endemic setting. PLoS One 2018; 13:e0201622. [PMID: 30169508 PMCID: PMC6118386 DOI: 10.1371/journal.pone.0201622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction In non-endemic settings, expertise in malaria microscopy is limited and rapid diagnostic tests (RDTs) are an adjunct to malaria diagnosis. Aim We performed an External Quality Assessment (EQA) on reading and interpretation of malaria RDTs in a non-endemic setting. Methods Participants were medical laboratories in Belgium and the Grand Duchy of Luxembourg using malaria RDTs; they received (i) 10 high-resolution photographs presenting test line combinations of RDTs with interpretations listed in a multiple choice format and (ii) a questionnaire about their practices of malaria diagnosis. Results Among 135 subscribing laboratories, 134 (99.3%) used 139 RDT products (11 different products from 8 brands). After exclusion of the results of one laboratory, analysis was done for 133 laboratories using 137 RDT products. Scores of 10/10, 9/10 and 8/10 were achieved for 58.4%, 13.1% and 8.0% of 137 RDT products respectively. For three-band P. falciparum–pan-Plasmodium RDTs (113 (82.5%) products, 6 brands), most frequent errors were (1) disregarding faint test lines (18.6%), (2) reporting invalid instead of P. falciparum (16.8%) and (3) reporting “Plasmodium spp., no further differentiation possible” without mentioning the presence or absence of P. falciparum (11.5%). For four-band RDTs (21 (15.3%) products, 1 brand), errors were (4) disregarding faint P. vivax test lines (47.6%) and (5) reporting “Plasmodium spp., no further differentiation possible” without mentioning the presence of P. falciparum and P. vivax (28.6%). Instructions for use (IFU) of only 4 out of 10 RDT products mentioned to interpret faint-intensity test lines as positive (conducive to errors 1 and 4) and IFU of 2 products displayed incorrect information (conducive to errors 2 and 5). Outside of office hours, 36.1% of participants relied on RDTs as the initial diagnostic test; 13.9% did not perform microscopic confirmation. Conclusion Reading and interpretation of malaria RDTs was satisfactory, but errors were embedded in the instructions for use of the products. Relying on RDTs alone for malaria diagnosis (about one third of participants) is not a recommended practice.
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Affiliation(s)
- Kris Vernelen
- Quality of Medical Laboratories, Institute of Public Health, Sciensano, Brussels, Belgium
- * E-mail:
| | | | | | | | - Bernard China
- Quality of Medical Laboratories, Institute of Public Health, Sciensano, Brussels, Belgium
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
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Pham NM, Karlen W, Beck HP, Delamarche E. Malaria and the 'last' parasite: how can technology help? Malar J 2018; 17:260. [PMID: 29996831 PMCID: PMC6042346 DOI: 10.1186/s12936-018-2408-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/03/2018] [Indexed: 01/09/2023] Open
Abstract
Malaria, together with HIV/AIDS, tuberculosis and hepatitis are the four most deadly infectious diseases globally. Progress in eliminating malaria has saved millions of lives, but also creates new challenges in detecting the 'last parasite'. Effective and accurate detection of malaria infections, both in symptomatic and asymptomatic individuals are needed. In this review, the current progress in developing new diagnostic tools to fight malaria is presented. An ideal rapid test for malaria elimination is envisioned with examples to demonstrate how innovative technologies can assist the global defeat against this disease. Diagnostic gaps where technology can bring an impact to the elimination campaign for malaria are identified. Finally, how a combination of microfluidic-based technologies and smartphone-based read-outs could potentially represent the next generation of rapid diagnostic tests is discussed.
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Affiliation(s)
- Ngoc Minh Pham
- Department of Health Sciences and Technology, ETH Zürich, Lengghalde 5, 8092, Zurich, Switzerland
| | - Walter Karlen
- Department of Health Sciences and Technology, ETH Zürich, Lengghalde 5, 8092, Zurich, Switzerland
| | - Hans-Peter Beck
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.
- University of Basel, Petersgraben 1, 4001, Basel, Switzerland.
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Swana EK, Yav TI, Ngwej LM, Mupemba BN, Suprianto, Mukeng CK, Hattingh I, Luboya ON, Kakoma JBS, Bangs MJ. School-based malaria prevalence: informative systematic surveillance measure to assess epidemiological impact of malaria control interventions in the Democratic Republic of the Congo. Malar J 2018; 17:141. [PMID: 29615041 PMCID: PMC5883584 DOI: 10.1186/s12936-018-2297-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 03/24/2018] [Indexed: 11/28/2022] Open
Abstract
Background In southern Democratic Republic of the Congo, malaria transmission is stable with seasonal fluctuations. Different measurements can be used to monitor disease burden and estimate the performance of control programmes. Repeated school-based malaria prevalence surveys (SMPS) were conducted from 2007 to 2014 to generate up-to-date surveillance data and evaluate the impact of an integrated vector control programme. Methods Biannual SMPS used a stratified, randomized and proportional sampling method. Schools were randomly selected from the entire pool of facilities within each Health Area (HA). Subsequently, school-children from 6 to 12 years of age were randomly selected in a proportional manner. Initial point-of-care malaria diagnosis was made using a rapid detection test. A matching stained blood film was later examined by expert microscopy and used in the final analysis. Data was stratified and analysed based on age, survey time and location. Results The baseline SMPS (pre-control in 2007) prevalence was approximately 77%. From 2009 to 2014, 11,628 school-children were randomly screened. The mean age was 8.7 years with a near equal sex ratio. After exclusion, analysis of 10,493 students showed an overall malaria prevalence ratio of 1.92 in rural compared to urbanized areas. The distribution of Plasmodium falciparum malaria was significantly different between rural and urban HAs and between end of wet season and end of dry season surveys. The combined prevalence of single P. falciparum, Plasmodium malariae and Plasmodium ovale infections were 29.9, 1.8 and 0.3% of those examined, respectively. Only 1.8% were mixed Plasmodium species infections. From all microscopically detected infections (3545 of 10,493 samples examined), P. falciparum represented 88.5%, followed by P. malariae (5.4%) and P. ovale (0.8%). Cases with multiple species represented 5.3% of patent infections. Malaria prevalence was independent of age and gender. Control programme performance contributed to a significant decrease in mean P. falciparum infection density in urban compared to rural locations. Some rural areas remained highly refractory to control measures (insecticide-treated bed nets, periodic indoor residual spraying). Conclusion The SMPS is a useful longitudinal measurement for estimating population malaria prevalence and demonstrating disease burden and impact of control interventions. SMPS can identify refractory areas of transmission and thus prioritize control strategies accordingly.
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Affiliation(s)
- Edouard K Swana
- China Molybdenum Company International, Ltd/International SOS, Public Health Programme, Tenke Fungurume Mining Project, Lualaba, Democratic Republic of the Congo. .,Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo. .,School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
| | - Thierry I Yav
- China Molybdenum Company International, Ltd/International SOS, Public Health Programme, Tenke Fungurume Mining Project, Lualaba, Democratic Republic of the Congo.,Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.,School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Leonard M Ngwej
- China Molybdenum Company International, Ltd/International SOS, Public Health Programme, Tenke Fungurume Mining Project, Lualaba, Democratic Republic of the Congo.,School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Betty N Mupemba
- Public Health Referral Laboratory, Lubumbashi, Haut Katanga Province, Democratic Republic of the Congo
| | - Suprianto
- Public Health & Malaria Control, International SOS, P.T. Freeport Indonesia, Kuala Kencana, Papua, 99920, Indonesia
| | - Clarence K Mukeng
- School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Izak Hattingh
- China Molybdenum Company International, Ltd/International SOS, Public Health Programme, Tenke Fungurume Mining Project, Lualaba, Democratic Republic of the Congo
| | - Oscar N Luboya
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.,School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Jean-Baptiste S Kakoma
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.,School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Michael J Bangs
- School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.,Public Health & Malaria Control, International SOS, P.T. Freeport Indonesia, Kuala Kencana, Papua, 99920, Indonesia
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30
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Peeters M, Chung P, Lin H, Mortelmans K, Phe C, San C, Kuijpers LMF, Teav S, Phe T, Jacobs J. Diagnostic accuracy of the InBiOS AMD rapid diagnostic test for the detection of Burkholderia pseudomallei antigen in grown blood culture broth. Eur J Clin Microbiol Infect Dis 2018; 37:1169-1177. [PMID: 29594800 PMCID: PMC5948296 DOI: 10.1007/s10096-018-3237-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/19/2018] [Indexed: 01/18/2023]
Abstract
To assess the diagnostic and operational performance of the InBiOS AMD rapid diagnostic test (RDT) (Seattle, USA) for the detection of B. pseudomallei in grown blood culture broth. The InBiOS RDT is a lateral flow immunoassay in a strip format detecting B. pseudomallei capsular polysaccharide in culture fluids, marketed for research only. Broth of blood culture bottles (BacT/Alert, bioMérieux, Marcy L’Etoile, France) sampled in adult patients at the Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia, during 2010–2017 and stored at − 80 °C was tested. They included samples grown with B. pseudomallei (n = 114), samples with no growth (n = 12), and samples with growth of other pathogens (n = 139, among which Burkholderia cepacia (n = 5)). Diagnostic sensitivity and specificity were 96.5% [95% confidence interval (CI): 91.3–98.6%] and 100% [CI: 97.5–100%] respectively. Background clearance and line intensities were good and very good. The RDT’s test strip, not housed in a cassette, caused difficulties in manipulation and biosafety. The centrifugation step prescribed by the procedure challenged biosafety, but processing of 19 B. pseudomallei samples without centrifugation showed similar results for line intensity and background clearance, compared to centrifugation. The InBiOS RDT showed excellent accuracy for detection of B. pseudomallei in grown blood culture broth. Provided operational adaptations such as cassette housing, it has the potential to reduce time to diagnosis of melioidosis.
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Affiliation(s)
- Marjan Peeters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Panha Chung
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Hua Lin
- SRI International, Menlo Park, CA, USA
| | | | - Chhundy Phe
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Chentha San
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Laura Maria Francisca Kuijpers
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Syna Teav
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Thong Phe
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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31
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Fraser LA, Kinghorn AB, Dirkzwager RM, Liang S, Cheung YW, Lim B, Shiu SCC, Tang MSL, Andrew D, Manitta J, Richards JS, Tanner JA. A portable microfluidic Aptamer-Tethered Enzyme Capture (APTEC) biosensor for malaria diagnosis. Biosens Bioelectron 2017; 100:591-596. [PMID: 29032164 DOI: 10.1016/j.bios.2017.10.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 01/04/2023]
Abstract
There is a critical need for better biosensors for the detection and diagnosis of malaria. We previously developed a DNA aptamer that recognises the Plasmodium falciparum lactate dehydrogenase (PfLDH) enzyme with high sensitivity and specificity. The aptamer was integrated into an Aptamer-Tethered Enzyme Capture (APTEC) assay as a laboratory-based diagnostic approach. However, a portable equipment-free point-of-care aptamer-mediated biosensor could have a significant impact on malaria diagnosis in endemic regions. Here, we present a new concept for a malaria biosensor whereby aptamers are coated onto magnetic microbeads for magnet-guided capture, wash and detection of the biomarker. A biosensor incorporating three separate microfluidic chambers was designed to enable such magnet-guided equipment-free colorimetric detection of PfLDH. A series of microfluidic biosensor prototypes were optimised to lower rates of inter-chamber diffusion, increase sensitivity, and provide a method for point-of-care sample testing. The biosensor showed high sensitivity and specificity when detecting PfLDH using both in vitro cultured parasite samples and using clinical samples from malaria patients. The high performance of the biosensor provides a proof-of-principle for a portable biosensor that could be adaptable for a variety of aptamer-mediated diagnostic scenarios.
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Affiliation(s)
- Lewis A Fraser
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Andrew B Kinghorn
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Roderick M Dirkzwager
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Shaolin Liang
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Yee-Wai Cheung
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Bryce Lim
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Simon Chi-Chin Shiu
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Marco S L Tang
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Dean Andrew
- Centre for Biomedical Research, The Burnet Institute of Medical Research and Public Health, Melbourne, Victoria, Australia
| | - Joseph Manitta
- Department of Haematology, Victorian Infectious Diseases Reference Laboratory, Melbourne, Victoria, Australia
| | - Jack S Richards
- Centre for Biomedical Research, The Burnet Institute of Medical Research and Public Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Julian A Tanner
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
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Knight L, Makusha T, Lim J, Peck R, Taegtmeyer M, van Rooyen H. "I think it is right": a qualitative exploration of the acceptability and desired future use of oral swab and finger-prick HIV self-tests by lay users in KwaZulu-Natal, South Africa. BMC Res Notes 2017; 10:486. [PMID: 28923121 PMCID: PMC5604290 DOI: 10.1186/s13104-017-2810-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/12/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The uptake of HIV testing has increased in sub-Saharan Africa over the past three decades. However, the proportion of people aware of their HIV status remains lower than required to change the pandemic. HIV self-testing (HIVST) may meet this gap. Assessment of readiness for and the acceptability of HIVST by lay users in South Africa is limited. This paper presents results from a formative study designed to assess the perceived usability and acceptability of HIVST among lay users using several self-test prototypes. Fifty lay users were purposively selected from rural and peri-urban KwaZulu-Natal, South Africa. Acceptability of HIVST was assessed using a simple post-test quantitative assessment tool addressing confidence, ease-of-use, intended future use and willingness to pay. In-depth qualitative interviews explored what participants felt about the HIVST and why, their willingness to recommend and how much they would pay for a test. RESULTS The key finding is that there is high acceptability regardless of self-test prototype. Acceptability is framed by two domains: usability and perceived need. Perceived usability was explored through perceived ease of use, which, regardless of actual correct usage, was reported by many of the respondents. Acceptability is influenced by perceived need, expressed by many who felt that the need for the self-test to protect privacy and autonomy. Ease of access and widespread availability of the test, not at a significant cost, were also important factors. Many participants would recommend self-test use to others and also indicated that they would choose to conduct the test again if it was free while some also indicated being willing to buy a test. CONCLUSIONS The positive response and readiness amongst lay users for an HIVST in this context prototype suggests that there would be a ready and willing market for HIVST. For scalability and sustainability usability, including access and availability that are here independent indications of acceptability, should be considered. So too should the desire for future use, as an additional factor pointing to acceptability. The results show high acceptability in all of these areas domains and a general interest in HIVST amongst lay users in a community in KwaZulu-Natal.
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Affiliation(s)
- Lucia Knight
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535 South Africa
| | - Tawanda Makusha
- Human and Social Development Programme, Human Sciences Research Council, 5th Floor, The Atrium, 430 Peter Mokaba Ridge, Berea, Durban,
4001 South Africa
| | - Jeanette Lim
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, USA
| | - Roger Peck
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, USA
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Heidi van Rooyen
- Human and Social Development Programme, Human Sciences Research Council, 5th Floor, The Atrium, 430 Peter Mokaba Ridge, Berea, Durban,
4001 South Africa
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Kozycki CT, Umulisa N, Rulisa S, Mwikarago EI, Musabyimana JP, Habimana JP, Karema C, Krogstad DJ. False-negative malaria rapid diagnostic tests in Rwanda: impact of Plasmodium falciparum isolates lacking hrp2 and declining malaria transmission. Malar J 2017; 16:123. [PMID: 28320390 PMCID: PMC5359811 DOI: 10.1186/s12936-017-1768-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Rapid diagnostic tests (RDTs) for histidine rich protein 2 (HRP2) are often used to determine whether persons with fever should be treated with anti-malarials. However, Plasmodium falciparum parasites with a deletion of the hrp2 gene yield false-negative RDTs and there are concerns the sensitivity of HRP2-based RDTs may fall when the intensity of transmission decreases. Methods This observational study enrolled 9226 patients at three health centres in Rwanda from April 2014 to April 2015. It then compared the sensitivity of RDTs based on HRP2 and the Plasmodium lactate dehydrogenase (pLDH) to microscopy (thick smears) for the diagnosis of malaria. PCR was used to determine whether deletions of the histidine-rich central repeat region of the hrp2 gene (exon 2) were associated with false-negative HRP2-based RDTs. Results In comparison to microscopy, the sensitivity and specificity of HRP2- and pLDH-based RDTs were 89.5 and 86.2% and 80.2 and 94.3%, respectively. When the results for both RDTs were combined, sensitivity rose to 91.8% and specificity was 85.7%. Additionally, when smear positivity fell from 46 to 3%, the sensitivity of the HRP2-based RDT fell from 88 to 67%. Of 370 samples with false-negative HRP2 RDT results for which PCR was performed, 140 (38%) were identified as P. falciparum by PCR. Of the isolates identified as P. falciparum by PCR, 32 (23%) were negative for the hrp2 gene based on PCR. Of the 32 P. falciparum isolates negative for hrp2 by PCR, 17 (53%) were positive based on the pLDH RDT. Conclusion This prospective study of RDT performance coincided with a decline in the intensity of malaria transmission in Kibirizi (fall in slide positivity from 46 to 3%). This decline was associated with a decrease in HRP2 RDT sensitivity (from 88 to 67%). While P. falciparum isolates without the hrp2 gene were an important cause of false-negative HRP2-based RDTs, most were identified by the pLDH-based RDT. Although WHO does not recommend the use of combined HRP2/pLDH testing in sub-Saharan Africa, these results suggest that combination HRP2/pLDH-based RDTs could reduce the impact of false-negative HRP2-based RDTs for detection of symptomatic P. falciparum malaria. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1768-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Noella Umulisa
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda.,Maternal and Child Survival Programme, Jhpiego, Kigali, Rwanda
| | - Stephen Rulisa
- School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Emil I Mwikarago
- National Reference Laboratory, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | | | - Jean Pierre Habimana
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Corine Karema
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Quality and Equity Healthcare, Kigali, Rwanda
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34
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Houzé S. [Rapid diagnostic test for malaria]. BULLETIN DE LA SOCIETE DE PATHOLOGIE EXOTIQUE (1990) 2017; 110:49-54. [PMID: 28176239 DOI: 10.1007/s13149-017-0549-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/14/2017] [Indexed: 01/24/2023]
Abstract
The rapid diagnostic tests (RDTs) whose main interest lies in their implementation without special equipment by unskilled personnel have grown significantly over the past fifteen years to diagnose malaria. They rely on the detection of specific Plasmodium proteins, PfHRP2, pLDH and aldolase. If the detection of PfHRP2 has very good sensitivity for the diagnosis of Plasmodium falciparum malaria, the detection of pLDH or aldolase is less efficient for other species, leaving its place to the reference microscopic diagnosis. RDT could not generally be used to monitor therapeutic efficacy because they can remain positive after clinical and parasitological cure. Furthermore, the development of the use of these tests has highlighted the need for quality assurance programs to monitor their production as their use.
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Affiliation(s)
- S Houzé
- Laboratoire de parasitologie-mycologie, CNR du paludisme, AP-HP, CHU Bichat-C Bernard, 46 rue Henri Huchard, 75018, Paris, France.
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Kabaghe AN, Visser BJ, Spijker R, Phiri KS, Grobusch MP, van Vugt M. Health workers' compliance to rapid diagnostic tests (RDTs) to guide malaria treatment: a systematic review and meta-analysis. Malar J 2016; 15:163. [PMID: 26979286 PMCID: PMC4791859 DOI: 10.1186/s12936-016-1218-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/05/2016] [Indexed: 11/23/2022] Open
Abstract
Background The World Health Organization recommends malaria to be confirmed by either microscopy or a rapid diagnostic test (RDT) before treatment. The correct use of RDTs in resource-limited settings facilitates basing treatment onto a confirmed diagnosis; contributes to speeding up considering a correct alternative diagnosis, and prevents overprescription of anti-malarial drugs, reduces costs and avoids unnecessary exposure to adverse drug effects. This review aims to evaluate health workers’ compliance to RDT results and factors contributing to compliance. Methods A PROSPERO-registered systematic review was conducted to evaluate health workers’ compliance to RDTs in sub-Saharan Africa, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published up to November 2015 were searched without language restrictions in Medline/Ovid, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, Biosis Previews and the African Index Medicus. The primary outcome was health workers treating patients according to the RDT results obtained. Results The literature search identified 474 reports; 14 studies were eligible and included in the quantitative analysis. From the meta-analysis, health workers’ overall compliance in terms of initiating treatment or not in accordance with the respective RDT results was 83 % (95 % CI 80–86 %). Compliance to positive and negative results was 97 % (95 % CI 94–99 %) and 78 % (95 % CI 66–89 %), respectively. Community health workers had higher compliance rates to negative test results than clinicians. Patient expectations, work experience, scepticism of results, health workers’ cadres and perceived effectiveness of the test, influenced compliance. Conclusions With regard to published data, compliance to RDT appears to be generally fair in sub-Saharan Africa; compliance to negative results will need to improve to prevent mismanagement of patients and overprescribing of anti-malarial drugs. Improving diagnostic capacity for other febrile illnesses and developing local evidence-based guidelines may help improve compliance and management of negative RDT results. Trial registration: CRD42015016151 (PROSPERO) Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1218-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alinune N Kabaghe
- Public Health Department, College of Medicine, Private Bag 360, Blantyre, Malawi.,Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Benjamin J Visser
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE, Amsterdam, The Netherlands. .,Centre de Recherches de Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon.
| | - Rene Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kamija S Phiri
- Public Health Department, College of Medicine, Private Bag 360, Blantyre, Malawi
| | - Martin P Grobusch
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.,Centre de Recherches de Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
| | - Michèle van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
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36
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Tarimo DS, Jani B, Killewo JZ. Management of fever among under-fives and utility of malaria rapid diagnostic test under reduced malaria burden in Rufiji District, Southeastern Tanzania. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60946-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miller E, Sikes HD. Addressing Barriers to the Development and Adoption of Rapid Diagnostic Tests in Global Health. Nanobiomedicine (Rij) 2015; 2. [PMID: 26594252 PMCID: PMC4652944 DOI: 10.5772/61114] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Immunochromatographic rapid diagnostic tests (RDTs) have demonstrated significant potential for use as point-of-care diagnostic tests in resource-limited settings. Most notably, RDTs for malaria have reached an unparalleled level of technological maturity and market penetration, and are now considered an important complement to standard microscopic methods of malaria diagnosis. However, the technical development of RDTs for other infectious diseases, and their uptake within the global health community as a core diagnostic modality, has been hindered by a number of extant challenges. These range from technical and biological issues, such as the need for better affinity agents and biomarkers of disease, to social, infrastructural, regulatory and economic barriers, which have all served to slow their adoption and diminish their impact. In order for the immunochromatographic RDT format to be successfully adapted to other disease targets, to see widespread distribution, and to improve clinical outcomes for patients on a global scale, these challenges must be identified and addressed, and the global health community must be engaged in championing the broader use of RDTs.
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Affiliation(s)
- Eric Miller
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, USA
| | - Hadley D Sikes
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, USA
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38
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Hagen RM, Hinz R, Tannich E, Frickmann H. Comparison of two real-time PCR assays for the detection of malaria parasites from hemolytic blood samples - Short communication. Eur J Microbiol Immunol (Bp) 2015; 5:159-63. [PMID: 26185684 PMCID: PMC4500067 DOI: 10.1556/1886.2015.00006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 02/28/2015] [Indexed: 12/27/2022] Open
Abstract
We compared the performance of an in-house and a commercial malaria polymerase chain reaction (PCR) assay using freeze-thawed hemolytic blood samples. A total of 116 freeze-thawed ethylenediamine tetraacetic acid (EDTA) blood samples of patients with suspicion of malaria were analyzed by an in-house as well as by a commercially available real-time PCR. Concordant malaria negative PCR results were reported for 39 samples and malaria-positive PCR results for 67 samples. The in-house assay further detected one case of Plasmodium falciparum infection, which was negative in the commercial assay as well as five cases of P. falciparum malaria and three cases of Plasmodium vivax malaria, which showed sample inhibition in the commercial assay. The commercial malaria assay was positive in spite of a negative in-house PCR result in one case. In all concordant results, cycle threshold values of P. falciparum-positive samples were lower in the commercial PCR than in the in-house assay. Although Ct values of the commercial PCR kit suggest higher sensitivity in case of concordant results, it is prone to inhibition if it is applied to hemolytic freeze-thawed blood samples. The number of misidentifications was, however, identical for both real-time PCR assays.
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Affiliation(s)
- Ralf Matthias Hagen
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg , Germany
| | - Rebecca Hinz
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg , Germany
| | - Egbert Tannich
- Bernhard Nocht Institute for Tropical Medicine Hamburg , Germany
| | - Hagen Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg , Germany ; Institute for Microbiology, Virology and Hygiene, University Medicine Rostock , Germany
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39
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Michael OS. Malaria RDT diagnosis: Magnifying a curious point. Travel Med Infect Dis 2015; 13:267-8. [DOI: 10.1016/j.tmaid.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
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Fransisca L, Kusnanto JH, Satoto TBT, Sebayang B, Supriyanto, Andriyan E, Bangs MJ. Comparison of rapid diagnostic test Plasmotec Malaria-3, microscopy, and quantitative real-time PCR for diagnoses of Plasmodium falciparum and Plasmodium vivax infections in Mimika Regency, Papua, Indonesia. Malar J 2015; 14:103. [PMID: 25890368 PMCID: PMC4356117 DOI: 10.1186/s12936-015-0615-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization recommends malaria be diagnosed by standard microscopy or rapid diagnostic test (RDT) before treatment. RDTs have been used with greater frequency in the absence of matching blood slide confirmation in the majority of RDT reported cases in Mimika Regency, Papua Province, Indonesia. Given the importance of RDT in current health system as point-of-care tool, careful validation of RDT product performance for providing accurate malaria diagnosis is critical. METHODS Plasmotec Malaria-3 (XW-P07) performance was evaluated by comparing it with paired blood film microscopy and quantitative real-time PCR (qPCR). Consecutive whole blood samples were derived from one clinic in Mimika as part of routine passive malaria case detection. RDT results were read by two trained technicians and interpreted by consensus. Expert microscopic examination of blood slides was cross-checked by observer-blinded second reader and a third examiner if discordant between examinations. qPCR was used as the 'gold standard', followed by microscopy for the outcome/disease variable. Comparison analysis included sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV & NPV), and other diagnostic screening performance measures for detecting Plasmodium falciparum and Plasmodium vivax infections. RESULTS Overall malaria positive samples from qPCR was 42.2% (175/415 samples); and from matching blood slides 40.5% (168/415) of which those infections with relatively low parasite densities ≤100/μl blood was 5.7% of P. falciparum and 16.5% of P. vivax samples examined. Overall RDT performance when compared with microscopy for detecting P. falciparum was Sn:92%, Sp:96.6%, PPV:88%, NPV:97.8%, Kappa:0.87; and for P. vivax Sn:72.9%, Sp:99.1%, PPV:95.4%, NPV:93.4%, Kappa:0.79. Overall RDT performance when compared with qPCR for detecting P. falciparum was Sn:92%, Sp:96.6%, PPV:88%, NPV:97.8%, Kappa:0.87; and for P. vivax Sn:66%, Sp:99.1%, PPV:95.4%, NPV:90.9%, Kappa:0.73. CONCLUSIONS Plasmotec Malaria-3 test showed good overall performance scores in precision for detecting P. falciparum, but lower values regarding sensitivity and negative likelihood ratio for detecting P. vivax, a finding partly associated with greater frequency of lower density P. vivax infections compared to P. falciparum in this study. In particular, the negative likelihood ratio (>0.1) for P. vivax detection indicates RDT lacked sufficient discriminating exclusion power falling below general acceptance criteria.
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Affiliation(s)
- Liony Fransisca
- Public Health & Malaria Control, International SOS, PT. Freeport Indonesia, Kuala Kencana, Papua, Indonesia.
| | - Josef Hari Kusnanto
- Center for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
| | - Tri Baskoro T Satoto
- Public Health Department, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
| | - Boni Sebayang
- Public Health & Malaria Control, International SOS, PT. Freeport Indonesia, Kuala Kencana, Papua, Indonesia.
| | - Supriyanto
- Public Health & Malaria Control, International SOS, PT. Freeport Indonesia, Kuala Kencana, Papua, Indonesia.
| | - Eko Andriyan
- Public Health & Malaria Control, International SOS, PT. Freeport Indonesia, Kuala Kencana, Papua, Indonesia.
| | - Michael J Bangs
- Public Health & Malaria Control, International SOS, PT. Freeport Indonesia, Kuala Kencana, Papua, Indonesia.
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Masanja IM, McMorrow ML, Maganga MB, Sumari D, Udhayakumar V, McElroy PD, Kachur SP, Lucchi NW. Quality assurance of malaria rapid diagnostic tests used for routine patient care in rural Tanzania: microscopy versus real-time polymerase chain reaction. Malar J 2015; 14:85. [PMID: 25889613 PMCID: PMC4337228 DOI: 10.1186/s12936-015-0597-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/30/2015] [Indexed: 11/28/2022] Open
Abstract
Background The World Health Organization (WHO) recommends parasitologic confirmation of suspected malaria cases before treatment. Due to the limited availability of quality microscopy services, this recommendation has become scalable following increased use of antigen-detecting malaria rapid diagnostic tests (RDTs) in many malaria-endemic countries. This study was carried out to monitor quality of RDT performance in selected health facilities using two quality assurance (QA) methods: reference microscopy and detection of parasite DNA by real-time quantitative polymerase chain reaction (qPCR) on dried blood spots (DBS). Methods Blood samples for QA were collected from patients undergoing RDT for diagnostic confirmation of malaria during two to three consecutive days per month in 12 health facilities in rural Tanzania. Stained blood smears (BS) were first examined at the district hospitals (BS1) and then at a reference laboratory (BS2). Discordant BS1 and BS2 results prompted a third examination. Molecular analysis was carried out at the Ifakara Health Institute laboratory in Bagamoyo. Results Malaria RDTs had a higher positivity rate (6.5%) than qPCR (4.2%) or microscopy (2.9% for BS1 and 2.5% for BS2). Poor correlation was observed between RDT and BS results: BS1 (K = 0.5), BS2 (K = 0.43) and qPCR (K = 0.45), challenging the utility of these tests for RDT QA. In addition, many challenges related to qPCR processing were recorded and long delays in obtaining QA test results for both microscopy and qPCR. Conclusions Overall there was limited agreement among the three diagnostic approaches and neither microscopy nor qPCR appear to be good QA options for RDTs under field conditions.
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Affiliation(s)
- Irene M Masanja
- Health System Sciences, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
| | - Meredith L McMorrow
- Malaria Branch, Centers for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA. .,US Public Health Services, Rockville, Maryland, USA.
| | - Mussa B Maganga
- Health System Sciences, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
| | - Debora Sumari
- Health System Sciences, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
| | - Venkatachalam Udhayakumar
- Malaria Branch, Centers for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Peter D McElroy
- Malaria Branch, Centers for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA. .,US President Malaria Initiative (PMI), Dar es Salaam, United Republic of Tanzania.
| | - S Patrick Kachur
- Malaria Branch, Centers for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA. .,US Public Health Services, Rockville, Maryland, USA.
| | - Naomi W Lucchi
- Malaria Branch, Centers for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Abba K, Kirkham AJ, Olliaro PL, Deeks JJ, Donegan S, Garner P, Takwoingi Y. Rapid diagnostic tests for diagnosing uncomplicated non-falciparum or Plasmodium vivax malaria in endemic countries. Cochrane Database Syst Rev 2014; 2014:CD011431. [PMID: 25519857 PMCID: PMC4453861 DOI: 10.1002/14651858.cd011431] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In settings where both Plasmodium vivax and Plasmodium falciparum infection cause malaria, rapid diagnostic tests (RDTs) need to distinguish which species is causing the patients' symptoms, as different treatments are required. Older RDTs incorporated two test lines to distinguish malaria due to P. falciparum, from malaria due to any other Plasmodium species (non-falciparum). These RDTs can be classified according to which antibodies they use: Type 2 RDTs use HRP-2 (for P. falciparum) and aldolase (all species); Type 3 RDTs use HRP-2 (for P. falciparum) and pLDH (all species); Type 4 use pLDH (fromP. falciparum) and pLDH (all species).More recently, RDTs have been developed to distinguish P. vivax parasitaemia by utilizing a pLDH antibody specific to P. vivax. OBJECTIVES To assess the diagnostic accuracy of RDTs for detecting non-falciparum or P. vivax parasitaemia in people living in malaria-endemic areas who present to ambulatory healthcare facilities with symptoms suggestive of malaria, and to identify which types and brands of commercial test best detect non-falciparum and P. vivax malaria. SEARCH METHODS We undertook a comprehensive search of the following databases up to 31 December 2013: Cochrane Infectious Diseases Group Specialized Register; MEDLINE; EMBASE; MEDION; Science Citation Index; Web of Knowledge; African Index Medicus; LILACS; and IndMED. SELECTION CRITERIA Studies comparing RDTs with a reference standard (microscopy or polymerase chain reaction) in blood samples from a random or consecutive series of patients attending ambulatory health facilities with symptoms suggestive of malaria in non-falciparum endemic areas. DATA COLLECTION AND ANALYSIS For each study, two review authors independently extracted a standard set of data using a tailored data extraction form. We grouped comparisons by type of RDT (defined by the combinations of antibodies used), and combined in meta-analysis where appropriate. Average sensitivities and specificities are presented alongside 95% confidence intervals (95% CI). MAIN RESULTS We included 47 studies enrolling 22,862 participants. Patient characteristics, sampling methods and reference standard methods were poorly reported in most studies. RDTs detecting 'non-falciparum' parasitaemiaEleven studies evaluated Type 2 tests compared with microscopy, 25 evaluated Type 3 tests, and 11 evaluated Type 4 tests. In meta-analyses, average sensitivities and specificities were 78% (95% CI 73% to 82%) and 99% (95% CI 97% to 99%) for Type 2 tests, 78% (95% CI 69% to 84%) and 99% (95% CI 98% to 99%) for Type 3 tests, and 89% (95% CI 79% to 95%) and 98% (95% CI 97% to 99%) for Type 4 tests, respectively. Type 4 tests were more sensitive than both Type 2 (P = 0.01) and Type 3 tests (P = 0.03).Five studies compared Type 3 tests with PCR; in meta-analysis, the average sensitivity and specificity were 81% (95% CI 72% to 88%) and 99% (95% CI 97% to 99%) respectively. RDTs detecting P.vivax parasitaemiaEight studies compared pLDH tests to microscopy; the average sensitivity and specificity were 95% (95% CI 86% to 99%) and 99% (95% CI 99% to 100%), respectively. AUTHORS' CONCLUSIONS RDTs designed to detect P. vivax specifically, whether alone or as part of a mixed infection, appear to be more accurate than older tests designed to distinguish P. falciparum malaria from non-falciparum malaria. Compared to microscopy, these tests fail to detect around 5% ofP. vivax cases. This Cochrane Review, in combination with other published information about in vitro test performance and stability in the field, can assist policy-makers to choose between the available RDTs.
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Affiliation(s)
- Katharine Abba
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
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Yansouni CP, Merckx J, Libman MD, Ndao M. Recent advances in clinical parasitology diagnostics. Curr Infect Dis Rep 2014; 16:434. [PMID: 25230603 DOI: 10.1007/s11908-014-0434-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Microscopy has several limitations in the diagnosis of parasitic infection. New technologies have emerged to address some of these limitations. We review recent advances in three key areas. The detection of enteric protozoa is a commonly requested test, particularly with increasing travel to and migration from endemic countries. Microscopy is slow and labor intensive and requires a high level of technical expertise. It also lacks both sensitivity and specificity. Recently developed nucleic acid amplification tests are automated and rapid and show superior accuracy. Proteomics shows promise for both the diagnosis of infections where parasite detection is difficult and the potential for accurate assessment of cure in these cases. Finally, rapid and simple diagnostic tests suitable for use in low-resource settings are now allowing for improved study and control of infection in endemic regions.
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Affiliation(s)
- Cedric P Yansouni
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, 1650 Cedar Avenue, Room L10.509, Montreal, H3G 1A4, Canada
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Plasmodium falciparum parasites lacking histidine-rich protein 2 and 3: a review and recommendations for accurate reporting. Malar J 2014; 13:283. [PMID: 25052298 PMCID: PMC4115471 DOI: 10.1186/1475-2875-13-283] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/27/2014] [Indexed: 11/21/2022] Open
Abstract
Malaria rapid diagnostic tests (RDTs) play a critical role in malaria case management, surveillance and case investigations. Test performance is largely determined by design and quality characteristics, such as detection sensitivity, specificity, and thermal stability. However, parasite characteristics such as variable or absent expression of antigens targeted by RDTs can also affect RDT performance. Plasmodium falciparum parasites lacking the PfHRP2 protein, the most common target antigen for detection of P. falciparum, have been reported in some regions. Therefore, accurately mapping the presence and prevalence of P. falciparum parasites lacking pfhrp2 would be an important step so that RDTs targeting alternative antigens, or microscopy, can be preferentially selected for use in such regions. Herein the available evidence and molecular basis for identifying malaria parasites lacking PfHRP2 is reviewed, and a set of recommended procedures to apply for future investigations for parasites lacking PfHRP2, is proposed.
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What should the ideal HIV self-test look like? A usability study of test prototypes in unsupervised HIV self-testing in Kenya, Malawi, and South Africa. AIDS Behav 2014; 18 Suppl 4:S422-32. [PMID: 24947852 DOI: 10.1007/s10461-014-0818-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HIV self-testing (HIVST) is increasingly being sought and offered globally, yet there is limited information about the test features that will be required for an HIV self-test to be easy to use, acceptable to users, and feasible for manufacturers to produce. We conducted formative usability research with participants who were naïve to HIVST using five prototypes in Kenya, Malawi, and South Africa. The tests selected ranged from early-stage prototypes to commercially ready products and had a diverse set of features. A total of 150 lay users were video-recorded conducting unsupervised self-testing and interviewed to understand their opinions of the test. Participants did not receive a test result, but interpreted standardized result panels. This study demonstrated that users will refer to the instructions included with the test, but these can be confusing or difficult to follow. Errors were common, with less than 25% of participants conducting all steps correctly and 47.3% of participants performing multiple errors, particularly in sample collection and transfer. Participants also had difficulty interpreting results. To overcome these issues, the ideal HIV self-test requires pictorial instructions that are easy to understand, simple sample collection with integrated test components, fewer steps, and results that are easy to interpret.
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Maltha J, Guiraud I, Lompo P, Kaboré B, Gillet P, Van Geet C, Tinto H, Jacobs J. Accuracy of PfHRP2 versus Pf-pLDH antigen detection by malaria rapid diagnostic tests in hospitalized children in a seasonal hyperendemic malaria transmission area in Burkina Faso. Malar J 2014; 13:20. [PMID: 24418119 PMCID: PMC3896846 DOI: 10.1186/1475-2875-13-20] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In most sub-Saharan African countries malaria rapid diagnostic tests (RDTs) are now used for the diagnosis of malaria. Most RDTs used detect Plasmodium falciparum histidine-rich protein-2 (PfHRP2), though P. falciparum-specific parasite lactate dehydrogenase (Pf-pLDH)-detecting RDTs may have advantages over PfHRP2-detecting RDTs. Only few data are available on the use of RDTs in severe illness and the present study compared Pf-pLDH to PfHRP2-detection. METHODS Hospitalized children aged one month to 14 years presenting with fever or severe illness were included over one year. Venous blood samples were drawn for malaria diagnosis (microscopy and RDT), culture and complete blood count. Leftovers were stored at -80 °C and used for additional RDT analysis and PCR. An RDT targeting both PfHRP2 and Pf-pLDH was performed on all samples for direct comparison of diagnostic accuracy with microscopy as reference method. PCR was performed to explore false-positive RDT results. RESULTS In 376 of 694 (54.2%) included children, malaria was microscopically confirmed. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value were 100.0, 70.9, 69.4 and 100.0%, respectively for PfHRP2-detection and 98.7, 94.0, 91.6 and 99.1%, respectively for Pf-pLDH-detection. Specificity and PPV were significantly lower for PfHRP2-detection (p <0.001). For both detection antigens, specificity was lowest for children one to five years and in the rainy season. PPV for both antigens was highest in the rainy season, because of higher malaria prevalence. False positive PfHRP2 results were associated with prior anti-malarial treatment and positive PCR results (98/114 (86.0%) samples tested). CONCLUSION Among children presenting with severe febrile illness in a seasonal hyperendemic malaria transmission area, the present study observed similar sensitivity but lower specificity and PPV of PfHRP2 compared to Pf-pLDH-detection. Further studies should assess the diagnostic accuracy and safety of an appropriate Pf-pLDH-detecting RDT in field settings and if satisfying, replacement of PfHRP2 by Pf-pLDH-detecting RDTs should be considered.
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Affiliation(s)
- Jessica Maltha
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, B 2000, Antwerp, Belgium.
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Schlagenhauf P, Petersen E. Standby emergency treatment of malaria in travelers: experience to date and new developments. Expert Rev Anti Infect Ther 2014; 10:537-46. [PMID: 22702318 DOI: 10.1586/eri.12.42] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, Institute for Social and Preventive Medicine, University of Zürich, Zürich, Switzerland.
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Stevenson L, Kelley M, Gorovits B, Kingsley C, Myler H, Osterlund K, Muruganandam A, Minamide Y, Dominguez M. Large molecule specific assay operation: recommendation for best practices and harmonization from the global bioanalysis consortium harmonization team. AAPS J 2014; 16:83-8. [PMID: 24242296 PMCID: PMC3889533 DOI: 10.1208/s12248-013-9542-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 10/15/2013] [Indexed: 11/30/2022] Open
Abstract
The L2 Global Harmonization Team on large molecule specific assay operation for protein bioanalysis in support of pharmacokinetics focused on the following topics: setting up a balanced validation design, specificity testing, selectivity testing, dilutional linearity, hook effect, parallelism, and testing of robustness and ruggedness. The team additionally considered the impact of lipemia, hemolysis, and the presence of endogenous analyte on selectivity assessments as well as the occurrence of hook effect in study samples when no hook effect had been observed during pre-study validation.
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Affiliation(s)
- Lauren Stevenson
- Biogen Idec, 14 Cambridge Center, Cambridge, Massachusetts, 02142, USA,
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Murphy SC, Shott JP, Parikh S, Etter P, Prescott WR, Stewart VA. Malaria diagnostics in clinical trials. Am J Trop Med Hyg 2013; 89:824-39. [PMID: 24062484 PMCID: PMC3820323 DOI: 10.4269/ajtmh.12-0675] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 08/05/2013] [Indexed: 11/07/2022] Open
Abstract
Malaria diagnostics are widely used in epidemiologic studies to investigate natural history of disease and in drug and vaccine clinical trials to exclude participants or evaluate efficacy. The Malaria Laboratory Network (MLN), managed by the Office of HIV/AIDS Network Coordination, is an international working group with mutual interests in malaria disease and diagnosis and in human immunodeficiency virus/acquired immunodeficiency syndrome clinical trials. The MLN considered and studied the wide array of available malaria diagnostic tests for their suitability for screening trial participants and/or obtaining study endpoints for malaria clinical trials, including studies of HIV/malaria co-infection and other malaria natural history studies. The MLN provides recommendations on microscopy, rapid diagnostic tests, serologic tests, and molecular assays to guide selection of the most appropriate test(s) for specific research objectives. In addition, this report provides recommendations regarding quality management to ensure reproducibility across sites in clinical trials. Performance evaluation, quality control, and external quality assessment are critical processes that must be implemented in all clinical trials using malaria tests.
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Affiliation(s)
- Sean C. Murphy
- Department of Laboratory Medicine, University of Washington Medical Center, Seattle, Washington; Division of Intramural Research, National Institute of Allergy and Infectious Diseases,National Institutes of Health, Bethesda, Maryland; Yale University School of Public Health, New Haven, Connecticut; Office of HIV/AIDS Network Coordination, Fred Hutchinson Cancer Research Center, Seattle, Washington; Hydas World Health, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Shakely D, Elfving K, Aydin-Schmidt B, Msellem MI, Morris U, Omar R, Weiping X, Petzold M, Greenhouse B, Baltzell KA, Ali AS, Björkman A, Mårtensson A. The usefulness of rapid diagnostic tests in the new context of low malaria transmission in Zanzibar. PLoS One 2013; 8:e72912. [PMID: 24023791 PMCID: PMC3762850 DOI: 10.1371/journal.pone.0072912] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/12/2013] [Indexed: 11/19/2022] Open
Abstract
Background We assessed if histidine-rich-protein-2 (HRP2) based rapid diagnostic test (RDT) remains an efficient tool for Plasmodium falciparum case detection among fever patients in Zanzibar and if primary health care workers continue to adhere to RDT results in the new epidemiological context of low malaria transmission. Further, we evaluated the performance of RDT within the newly adopted integrated management of childhood illness (IMCI) algorithm in Zanzibar. Methods and Findings We enrolled 3890 patients aged ≥2 months with uncomplicated febrile illness in this health facility based observational study conducted in 12 primary health care facilities in Zanzibar, between May-July 2010. One patient had an inconclusive RDT result. Overall 121/3889 (3.1%) patients were RDT positive. The highest RDT positivity rate, 32/528 (6.1%), was found in children aged 5–14 years. RDT sensitivity and specificity against PCR was 76.5% (95% CI 69.0–83.9%) and 99.9% (95% CI 99.7–100%), and against blood smear microscopy 78.6% (95% CI 70.8–85.1%) and 99.7% (95% CI 99.6–99.9%), respectively. All RDT positive, but only 3/3768 RDT negative patients received anti-malarial treatment. Adherence to RDT results was thus 3887/3889 (99.9%). RDT performed well in the IMCI algorithm with equally high adherence among children <5 years as compared with other age groups. Conclusions The sensitivity of HRP-2 based RDT in the hands of health care workers compared with both PCR and microscopy for P. falciparum case detection was relatively low, whereas adherence to test results with anti-malarial treatment was excellent. Moreover, the results provide evidence that RDT can be reliably integrated in IMCI as a tool for improved childhood fever management. However, the relatively low RDT sensitivity highlights the need for improved quality control of RDT use in primary health care facilities, but also for more sensitive point-of-care malaria diagnostic tools in the new epidemiological context of low malaria transmission in Zanzibar. Trial registration ClinicalTrials.gov NCT01002066
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Affiliation(s)
- Delér Shakely
- Malaria Research, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Kungälv Hospital, Kungälv, Sweden
- * E-mail:
| | - Kristina Elfving
- Malaria Research, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Berit Aydin-Schmidt
- Malaria Research, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mwinyi I. Msellem
- Zanzibar Malaria Control Programme, Ministry of Health, Zanzibar, Tanzania
| | - Ulrika Morris
- Malaria Research, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Rahila Omar
- Zanzibar Malaria Control Programme, Ministry of Health, Zanzibar, Tanzania
| | - Xu Weiping
- Malaria Research, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Max Petzold
- Centre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Kimberly A. Baltzell
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Abdullah S. Ali
- Zanzibar Malaria Control Programme, Ministry of Health, Zanzibar, Tanzania
| | - Anders Björkman
- Malaria Research, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Mårtensson
- Malaria Research, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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