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Patel P, Mishra KK, Ghosh K. Confirmatory Assay for Laboratory Diagnosis of Malaria Using Molecular Approach. Acta Parasitol 2024; 69:1000-1004. [PMID: 38498250 DOI: 10.1007/s11686-024-00831-0] [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: 10/12/2022] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Prompt malarial treatment and surveillance is crucial for accurate diagnosis of Plasmodium Sp. Gold standard microscopic examination has been widely applied for diagnosis of malaria in most part of the endemic areas. But in case of submicroscopic and asymptomatic microscopic diagnosis is questioned. The study aims to develop a simple, cost effective & robust nucleic acid amplification technique for the detection of malaria parasite. METHODS Study population included 50 clinically diagnosed positive malaria patient samples from various pathological laboratories. Microscopy by preparing thick film was carried out of every sample for primary screening in the available facility of Surat Raktadan Kendra & Research Centre- Blood Bank. The conventional PCR (Polymerase Chain Reaction) was applied for genus-specific amplification targeting the 18 S rRNA gene of Plasmodium. Agarose gel electrophoresis was used to separate and analyze the amplified PCR product using 2% Agarose gel. RESULTS AND CONCLUSION The study shows that nested PCR not only detected all microscopic positive samples, but also detected submicroscopic infections that were missed or misread by microscopy. Hence, the sensitivity of molecular based detection technique is proved to be more compared to microscopic examination.
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Affiliation(s)
- Parizad Patel
- Surat Raktadan Kendra & Research Centre (Regional Blood Transfusion & Research Centre), Khatodara Health Centre, 1st Floor, Udhana Magdalla Road, Khatodara, Surat, Gujarat, 395002, India
| | - Kanchan Kumar Mishra
- Surat Raktadan Kendra & Research Centre (Regional Blood Transfusion & Research Centre), Khatodara Health Centre, 1st Floor, Udhana Magdalla Road, Khatodara, Surat, Gujarat, 395002, India
| | - Kanjaksha Ghosh
- Surat Raktadan Kendra & Research Centre (Regional Blood Transfusion & Research Centre), Khatodara Health Centre, 1st Floor, Udhana Magdalla Road, Khatodara, Surat, Gujarat, 395002, India
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Awosolu OB, Yahaya ZS, Farah Haziqah MT, Olusi TA. Performance Evaluation of Nested Polymerase Chain Reaction (Nested PCR), Light Microscopy, and Plasmodium falciparum Histidine-Rich Protein 2 Rapid Diagnostic Test (PfHRP2 RDT) in the Detection of Falciparum Malaria in a High-Transmission Setting in Southwestern Nigeria. Pathogens 2022; 11:1312. [PMID: 36365063 PMCID: PMC9694681 DOI: 10.3390/pathogens11111312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 09/16/2023] Open
Abstract
Malaria remains a major public health challenge worldwide. In order to ensure a prompt and accurate malaria diagnosis, the World Health Organization recommended the confirmatory parasitological diagnosis of malaria by microscopy and malaria rapid diagnostic test (RDT) prior to antimalarial administration and treatment. This study was designed to evaluate the performance of nested polymerase chain reaction (nested PCR), light microscopy, and Plasmodium falciparum histidine-rich protein 2 rapid diagnostic test (PfHRP2 RDT) in the detection of falciparum malaria in Akure, Nigeria. A cross-sectional and hospital-based study involving 601 febrile volunteer participants was conducted in Akure, Nigeria. Approximately 2-3 mL venous blood samples were obtained from each study participant for parasitological confirmation by microscopy and PfHRP2-based malaria RDT. Thick and thin films were prepared and viewed under the light microscope for parasite detection, parasite density quantification, and species identification, respectively. Dry blood spot samples were prepared on 3MM Whatman filter paper for nested PCR. The overall prevalence of microscopy, PfHRP2 RDT, and nested PCR were 64.89% (390/601), 65.7% (395/601), and 67.39% (405/601), respectively. The estimates of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Youden's j index of microscopy and RDT were 96.30, 100.00, 100.00, 92.89, 97.50, 0.963, and 95.06, 94.90, 97.47, 90.29, 95.01, and 0.899, respectively. Malaria RDT recorded higher false negativity, compared microscopy (4.94% vs. 3.70%). A near perfect agreement was reported between microscopy and nested PCR, and between PfHRP2 RDT and nested PCR with Cohen's kappa (k) values of 0.94 and 0.88, respectively. This study revealed that PfHRP2 RDT and microscopy continues to remain sensitive and specific for falciparum malaria diagnosis in the study area.
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Affiliation(s)
- Oluwaseun Bunmi Awosolu
- School of Biological Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
- Vector Control Research Unit, Universiti Sains Malaysia, Minden, Penang 11800, Malaysia
- Department of Biology, Federal University of Technology, Akure 340252, Nigeria
| | - Zary Shariman Yahaya
- School of Biological Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
- Vector Control Research Unit, Universiti Sains Malaysia, Minden, Penang 11800, Malaysia
| | | | - Titus Adeniyi Olusi
- Vector Control Research Unit, Universiti Sains Malaysia, Minden, Penang 11800, Malaysia
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Assessing the diagnostic performance of a novel RT-PCR fluorescence method for the detection of human plasmodium species. PLoS One 2022; 17:e0272094. [PMID: 35925877 PMCID: PMC9352105 DOI: 10.1371/journal.pone.0272094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 07/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Malaria elimination effort is hampered not only by the lack of effective medication but also due to the lack of sensitive diagnostic tools to detect infections with low levels of parasitemia. Therefore, more sensitive and specific high-throughput molecular diagnostic approaches are needed for accurate malaria diagnosis. Methods In the present study, the performance of a novel single-tube MC004 real-time polymerase chain reaction (PCR) assay (MRC-Holland, Amsterdam, the Netherlands) was assessed for the detection of infection and discrimination of Plasmodium species. Blood samples (n = 150) were collected from malaria suspected patients at Adama malaria diagnosis and treatment centre, Adama, central Ethiopia. The positive predictive value (PPV), negative predictive value (NPV), analytical sensitivity and specificity of the assay were assessed against the conventional microscopic method. Results Plasmodium species were detected in 59 (39.3%) of the samples by microscopy and in 62 (41.3%) by the novel MC004 RT-PCR. Plasmodium vivax, Plasmodium falciparum and mixed infections with Plasmodium falciparum & Plasmodium vivax accounted for 47.5%, 40.6% and 11.9% respectively as detected by microscopy. The MC004 RT-PCR assay identified 59.7% and 40.3% of the samples positive for Plasmodium vivax and Plasmodium falciparum respectively. The sensitivity, specificity, PPV, and NPV of the MC004 RT-PCR assay were 95.8%, 97.8%, 92%, and 98.9%, respectively. No mixed infections were detected using the MC004 assay. Conclusion The MC004 RT-PCR assay is a useful tool for the early detection of malaria and identification of Plasmodium species with a high degree of sensitivity and specificity. Due to its high sensitivity, and simplicity (being a single-tube assay), the MC004 is suitable for use in clinical settings and epidemiological studies.
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Fuehrer HP, Campino S, Sutherland CJ. The primate malaria parasites Plasmodium malariae, Plasmodium brasilianum and Plasmodium ovale spp.: genomic insights into distribution, dispersal and host transitions. Malar J 2022; 21:138. [PMID: 35505317 PMCID: PMC9066925 DOI: 10.1186/s12936-022-04151-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/05/2022] [Indexed: 01/04/2023] Open
Abstract
During the twentieth century, there was an explosion in understanding of the malaria parasites infecting humans and wild primates. This was built on three main data sources: from detailed descriptive morphology, from observational histories of induced infections in captive primates, syphilis patients, prison inmates and volunteers, and from clinical and epidemiological studies in the field. All three were wholly dependent on parasitological information from blood-film microscopy, and The Primate Malarias” by Coatney and colleagues (1971) provides an overview of this knowledge available at that time. Here, 50 years on, a perspective from the third decade of the twenty-first century is presented on two pairs of primate malaria parasite species. Included is a near-exhaustive summary of the recent and current geographical distribution for each of these four species, and of the underlying molecular and genomic evidence for each. The important role of host transitions in the radiation of Plasmodium spp. is discussed, as are any implications for the desired elimination of all malaria species in human populations. Two important questions are posed, requiring further work on these often ignored taxa. Is Plasmodium brasilianum, circulating among wild simian hosts in the Americas, a distinct species from Plasmodium malariae? Can new insights into the genomic differences between Plasmodium ovale curtisi and Plasmodium ovale wallikeri be linked to any important differences in parasite morphology, cell biology or clinical and epidemiological features?
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Affiliation(s)
- Hans-Peter Fuehrer
- Institute of Parasitology, Department of Pathobiology, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210, Vienna, Austria
| | - Susana Campino
- Department of Infection Biology, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Colin J Sutherland
- Department of Infection Biology, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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Mirahmadi H, Shahrakipour A, Mehravaran A, Rahmati-Balaghaleh M, Zarean M, Etemadi S, Shahraki M, Solgi R. Evaluation of Multiplex/Nested Polymerase Chain Reaction and Loop-Mediated Isothermal Amplification for Malaria Diagnosis in Southeastern Iran. Am J Trop Med Hyg 2022; 106:841-845. [PMID: 35100562 PMCID: PMC8922511 DOI: 10.4269/ajtmh.21-0970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/15/2021] [Indexed: 11/07/2022] Open
Abstract
Malaria is one of the most serious health problems in many countries, including Iran. Accurate diagnosis is important regardless of the elimination status of a country. A cross-sectional study was performed on 105 people who were suspected to be positive for malaria infection in Sistan and Baluchistan, Iran. Blood smears (thin and thick films) were stained with 10% Giemsa. DNA was extracted from the prepared thin and thick films for molecular methods. Multiplex/nested polymerase chain reaction (mn-PCR), loop-mediated isothermal amplification (LAMP), and light microscopy (LM) were compared with nested PCR (nPCR) as a gold standard. Of 105 subjects, 52 (49.5%), 58 (55.2%), 58 (55.2%), and 63 (60%) were positive for malaria by LM, nPCR, mn-PCR, and LAMP, respectively. The sensitivity, specificity, and kappa were 92.1%, 100%, and 0.9 for LAMP and 100%, 100%, and 1 for mn-PCR, respectively. Eight cases of coinfection (Plasmodium vivax and Plasmodium falciparum) that were not detected by LM method were diagnosed by mn-PCR and LAMP. In the present study, the high sensitivity and specificity of LAMP and mn-PCR indicate that these two tests are good alternatives to nPCR for malaria diagnosis.
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Affiliation(s)
- Hadi Mirahmadi
- Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran;,Department of Parasitology and Mycology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Azam Shahrakipour
- Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran;,Department of Parasitology and Mycology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ahmad Mehravaran
- Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran;,Department of Parasitology and Mycology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mansour Rahmati-Balaghaleh
- Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran;,Department of Parasitology and Mycology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Zarean
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;,Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran;,Address correspondence to Rahmat Solgi, Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran, E-mail: or Mehdi Zarean, Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, E-mail:
| | - Soodabeh Etemadi
- Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran;,Department of Parasitology and Mycology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Shahraki
- Department of Parasitology and Mycology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Rahmat Solgi
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran;,Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran,Address correspondence to Rahmat Solgi, Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran, E-mail: or Mehdi Zarean, Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, E-mail:
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Evaluating performance of multiplex real time PCR for the diagnosis of malaria at elimination targeted low transmission settings of Ethiopia. Malar J 2022; 21:9. [PMID: 34986840 PMCID: PMC8734331 DOI: 10.1186/s12936-021-04029-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Malaria incidence has declined in Ethiopia in the past 10 years. Current malaria diagnostic tests, including light microscopy and rapid antigen-detecting diagnostic tests (RDTs) cannot reliably detect low-density infections. Studies have shown that nucleic acid amplification tests are highly sensitive and specific in detecting malaria infection. This study took place with the aim of evaluating the performance of multiplex real time PCR for the diagnosis of malaria using patient samples collected from health facilities located at malaria elimination targeted low transmission settings in Ethiopia. METHODS A health facility-based, cross-sectional survey was conducted in selected malaria sentinel sites. Malaria-suspected febrile outpatients referred to laboratory for malaria testing between December 2019 and March 2020 was enrolled into this study. Sociodemographic information and capillary blood samples were collected from the study participants and tested at spot with RDTs. Additionally, five circles of dry blood spot (DBS) samples on Whatman filter paper and thick and thin smear were prepared for molecular testing and microscopic examination, respectively. Multiplex real time PCR assay was performed at Ethiopian Public Health Institute (EPHI) malaria laboratory. The performance of multiplex real time PCR assay, microscopy and RDT for the diagnosis of malaria was compared and evaluated against each other. RESULTS Out of 271 blood samples, multiplex real time PCR identified 69 malaria cases as Plasmodium falciparum infection, 16 as Plasmodium vivax and 3 as mixed infections. Of the total samples, light microscopy detected 33 as P. falciparum, 18 as P. vivax, and RDT detected 43 as P. falciparum, 17 as P. vivax, and one mixed infection. Using light microscopy as reference test, the sensitivity and specificity of multiplex real time PCR were 100% (95% CI (93-100)) and 83.2% (95% CI (77.6-87.9)), respectively. Using multiplex real time PCR as a reference, light microscopy and RDT had sensitivity of 58% (95% CI 46.9-68.4) and 67% (95% CI 56.2-76.7); and 100% (95% CI 98-100) and 98.9% (95% CI 96-99.9), respectively. Substantial level of agreement was reported between microscopy and multiplex real time PCR results with kappa value of 0.65. CONCLUSIONS Multiplex real-time PCR had an advanced performance in parasite detection and species identification on febrile patients' samples than did microscopy and RDT in low malaria transmission settings. It is highly sensitive malaria diagnostic method that can be used in malaria elimination programme, particularly for community based epidemiological samples. Although microscopy and RDT had reduced performance when compared to multiplex real time PCR, still had an acceptable performance in diagnosis of malaria cases on patient samples at clinical facilities.
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Mirahmadi H, Rahmati-Balaghaleh M, Afzalaghaee M, Zarean M, Shamsian SA, Mehravaran A, Raissi V, Etemadi S. Detection of malaria using blood smear by light microscopy, RDT and nested-PCR for suspected patients in south-eastern Iran. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ketema T, Bacha K, Getahun K, del Portillo HA, Bassat Q. Plasmodium vivax epidemiology in Ethiopia 2000-2020: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009781. [PMID: 34525091 PMCID: PMC8476039 DOI: 10.1371/journal.pntd.0009781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/27/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ethiopia is one of the scarce African countries where Plasmodium vivax and P. falciparum co-exist. There has been no attempt to derive a robust prevalence estimate of P. vivax in the country although a clear understanding of the epidemiology of this parasite is essential for informed decisions. This systematic review and meta-analysis, therefore, is aimed to synthesize the available evidences on the distribution of P. vivax infection by different locations/regions, study years, eco-epidemiological zones, and study settings in Ethiopia. METHODS This study was conducted in accordance with Preferred Reposting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Studies conducted and published over the last two decades (2000 to 2020) that reported an estimate of P. vivax prevalence in Ethiopia were included. The Cochrane Q (χ2) and the I2 tests were used to assess heterogeneity, and the funnel plot and Egger's test were used to examine publication bias. A p-value of the χ2 test <0.05 and an I2 value >75% were considered presence of considerable heterogeneity. Random effect models were used to obtain pooled estimate of P. vivax infection prevalence. This study is registered with PROSPERO (International Prospective Register of Systematic Reviews): ID CRD42020201761. RESULTS We screened 4,932 records and included 79 studies that enrolled 1,676,659 confirmed malaria cases, from which 548,214 (32.69%) were P. vivax infections and 1,116,581 (66.59%) were due to P. falciparum. The rest were due to mixed infections. The pooled estimate of P. vivax prevalence rate was 8.93% (95% CI: 7.98-9.88%) with significant heterogeneity (I2 = 100%, p<0.0001). Regional differences showed significant effects (p<0.0001, and I2 = 99.4%) on the pooled prevalence of P. vivax, while study years (before and after the scaling up of interventional activities) did not show significant differences (p = 0.9, I2 = 0%). Eco-epidemiological zones considered in the analysis did show a significant statistical effect (p<0.001, I2 = 78.5%) on the overall pooled estimate prevalence. Also, the study setting showed significant differences (p = 0.001, and I2 = 90.3%) on the overall prevalence, where significant reduction of P. vivax prevalence (4.67%, 95%CI: 1.41-7.93%, p<0.0001) was observed in studies conducted at the community level. The studies included in the review demonstrated lack of publication bias qualitatively (symmetrical funnel plot) and quantitatively [Egger's test (coefficient) = -2.97, 95% CI: -15.06-9.13, p = 0.62]. CONCLUSION The estimated prevalence of P. vivax malaria in Ethiopia was 8.93% with P. vivax prevailing in the central west region of Ethiopia, but steadily extending to the western part of the country. Its distribution across the nation varies according to geographical location, study setting and study years.
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Affiliation(s)
- Tsige Ketema
- Jimma University, College of Natural Sciences, Department of Biology, Jimma, Ethiopia
- ISGlobal, Institute for Global Health, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Ketema Bacha
- Jimma University, College of Natural Sciences, Department of Biology, Jimma, Ethiopia
| | - Kefelegn Getahun
- Jimma University, College of Social Sciences and Humanity, Department of Geography and Environmental Studies, Jimma, Ethiopia
| | - Hernando A. del Portillo
- ISGlobal, Institute for Global Health, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
- IGTP, Germans Trias i Pujol Health Research Institute, Badalona, Spain
- ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Institute for Global Health, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
- ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
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Nadeem MF, Khattak AA, Zeeshan N, Awan UA, Alam S, Ahmed W, Gul S, Afroz A, Sughra K, Rashid U, Khan MAU. Molecular Epidemiology of Plasmodium species in Conflicted Federally Administered Tribal Area (FATA) Pakistan. BRAZ J BIOL 2021; 83:e247219. [PMID: 34468526 DOI: 10.1590/1519-6984.247219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022] Open
Abstract
Military conflicts have been significant obstacles in detecting and treating infectious disease diseases due to the diminished public health infrastructure, resulting in malaria endemicity. A variety of violent and destructive incidents were experienced by FATA (Federally Administered Tribal Areas). It was a struggle to pursue an epidemiological analysis due to continuing conflict and Talibanization. Clinical isolates were collected from Bajaur, Mohmand, Khyber, Orakzai agencies from May 2017 to May 2018. For Giemsa staining, full blood EDTA blood samples have been collected from symptomatic participants. Malaria-positive microscopy isolates were spotted on filter papers for future Plasmodial molecular detection by nested polymerase chain reaction (nPCR) of small subunit ribosomal ribonucleic acid (ssrRNA) genes specific primers. Since reconfirming the nPCR, a malariometric study of 762 patients found 679 positive malaria cases. Plasmodium vivax was 523 (77%), Plasmodium falciparum 121 (18%), 35 (5%) were with mixed-species infection (P. vivax plus P. falciparum), and 83 were declared negative by PCR. Among the five agencies of FATA, Khyber agency has the highest malaria incidence (19%) with followed by P. vivax (19%) and P. falciparum (4.1%). In contrast, Kurram has about (14%), including (10.8%) P. vivax and (2.7%) P. falciparum cases, the lowest malaria epidemiology. Surprisingly, no significant differences in the distribution of mixed-species infection among all five agencies. P. falciparum and P. vivax were two prevalent FATA malaria species in Pakistan's war-torn area. To overcome this rising incidence of malaria, this study recommends that initiating malaria awareness campaigns in school should be supported by public health agencies and malaria-related education locally, targeting children and parents alike.
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Affiliation(s)
- M F Nadeem
- University of Gujrat, Department of Biochemistry & Biotechnology, Gujrat, Punjab, Pakistan
| | - A A Khattak
- The University of Haripur, Department of Medical Laboratory Technology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - N Zeeshan
- University of Gujrat, Department of Biochemistry & Biotechnology, Gujrat, Punjab, Pakistan
| | - U A Awan
- The University of Haripur, Department of Medical Laboratory Technology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - S Alam
- The University of Haripur, Department of Microbiology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - W Ahmed
- The University of Haripur, Department of Microbiology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - S Gul
- National University of Medical Sciences, Department of Biological Sciences, Rawalpindi, Punjab, Pakistan
| | - A Afroz
- University of Gujrat, Department of Biochemistry & Biotechnology, Gujrat, Punjab, Pakistan
| | - K Sughra
- University of Gujrat, Department of Biochemistry & Biotechnology, Gujrat, Punjab, Pakistan
| | - U Rashid
- University of Gujrat, Department of Biochemistry & Biotechnology, Gujrat, Punjab, Pakistan
| | - M A U Khan
- University of Gujrat, Department of Biochemistry & Biotechnology, Gujrat, Punjab, Pakistan
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Comparative analysis of four malaria diagnostic tools and implications for malaria treatment in southwestern Nigeria. Int J Infect Dis 2021; 108:377-381. [PMID: 34044139 DOI: 10.1016/j.ijid.2021.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES One of the problems encountered in malaria control and elimination is inaccurate diagnosis, resulting from the degree of sensitivity of the different malaria diagnostic tools. Even though microscopy remains the gold standard for malaria diagnosis, more sensitive and robust diagnostic tools such as polymerase chain reactions (PCR) are used in research settings to monitor interventions and track sub-microscopic infections due to some of the drawbacks of microscopy. Since diagnosis is a critical determinant for rational malaria treatment, it is imperative that accurate diagnosis must be assured for an effective treatment plan. Therefore, this study compared two routinely used point of care malaria diagnostic tools with two molecular tools and discussed their implication for malaria treatment. DESIGN In this study, 436 individuals with suspected malaria were sampled and systematically tested using four methods, namely rapid diagnostic test (henceforth referred to as malaria RDT- mRDT), microscopy, nested PCR (nPCR), and quantitative PCR (qPCR). Test sensitivities and specificities were compared, and their level of concordance was determined. RESULTS With nPCR as the gold standard, a false positivity rate of 42.2%, 8.9%, and 57.8% was obtained for mRDT, microscopy, and qPCR. Similarly, false negativity rates of 12.5%, 62.5%, and 0.8% were obtained for each of the methods mentioned above, respectively. Of all the tools assessed, qPCR gave the highest sensitivity (99.2%) and moderate specificity (42.2%), followed by the mRDT kit used (87.5%). CONCLUSIONS With the detection of a high false positivity rate based on mRDT and a substantial proportion of sub-microscopic carriers in this study area by nested/quantitative PCR, we recommend that these molecular tools should be in specialized laboratories within the region to (i) track and treat sub-microscopic carriers to prevent their contribution to malaria transmission; (ii) provide reliable epidemiological data using high throughput testing tools for evaluating malaria interventions.
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Kotepui M, Masangkay FR, Kotepui KU, De Jesus Milanez G. Misidentification of Plasmodium ovale as Plasmodium vivax malaria by a microscopic method: a meta-analysis of confirmed P. ovale cases. Sci Rep 2020; 10:21807. [PMID: 33311528 PMCID: PMC7733466 DOI: 10.1038/s41598-020-78691-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/27/2020] [Indexed: 12/22/2022] Open
Abstract
Plasmodium ovale is a benign tertian malaria parasite that morphologically resembles Plasmodium vivax. P. ovale also shares similar tertian periodicity and can cause relapse in patients without a radical cure, making it easily misidentified as P. vivax in routine diagnosis. Therefore, its prevalence might be underreported worldwide. The present study aimed to quantify the prevalence of P. ovale misidentified as P. vivax malaria using data from studies reporting confirmed P. ovale cases by molecular methods. Studies reporting the misidentification of P. ovale as P. vivax malaria were identified from three databases, MEDLINE, Web of Science, and Scopus, without language restrictions, but the publication date was restricted to 1993 and 2020. The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). The random-effects model was used to estimate the pooled prevalence of the misidentification of P. ovale as P. vivax malaria by the microscopic method when compared to those with the reference polymerase chain reaction method. Subgroup analysis of participants was also performed to demonstrate the difference between imported and indigenous P. ovale cases. The heterogeneity of the included studies was assessed using Cochran's Q and I2 statistics. Publication bias across the included studies was assessed using the funnel plot and Egger’s test, and if required, contour-enhanced funnel plots were used to identify the source(s) of funnel plot asymmetry. Of 641 articles retrieved from databases, 22 articles met the eligibility criteria and were included in the present study. Of the 8,297 malaria-positive cases identified by the PCR method, 453 P. ovale cases were confirmed. The pooled prevalence of misidentification of P. ovale as P. vivax malaria by the microscopic method was 11% (95% CI: 7–14%, I2: 25.46%). Subgroup analysis of the participants demonstrated a higher prevalence of misidentification in indigenous cases (13%, 95% CI: 6–21%, I2: 27.8%) than in imported cases (10%, 95% CI: 6–14%, I2: 24.1%). The pooled prevalence of misidentification of P. vivax as P. ovale malaria by the microscopic method was 1%, without heterogeneity (95% CI: 0–3%, I2: 16.8%). PCR was more sensitive in identifying P. ovale cases than the microscopic method (p < 0.00001, OR: 2.76, 95% CI: 1.83–4.15, I2: 65%). Subgroup analysis of participants demonstrated the better performance of PCR in detecting P. ovale malaria in indigenous cases (p: 0.0009, OR: 6.92, 95% CI: 2.21–21.7%, I2: 68%) than in imported cases (p: 0.0004, OR: 2.15, 95% CI: 1.41–3.29%, I2: 63%). P. ovale infections misidentified as P. vivax malaria by the microscopic method were frequent and led to underreported P. ovale cases. The molecular identification of P. ovale malaria in endemic areas is needed because a higher rate of P. ovale misidentification was found in endemic or indigenous cases than in imported cases. In addition, updated courses, enhanced training, and refreshers for microscopic examinations, particularly for P. ovale identification, are necessary to improve the microscopic identification of Plasmodium species in rural health centres where PCR is unavailable.
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Affiliation(s)
- Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
| | - Frederick Ramirez Masangkay
- Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University-Manila, Manila, Philippines
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | - Giovanni De Jesus Milanez
- Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University-Manila, Manila, Philippines
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Dong Y, Deng Y, Xu Y, Chen M, Wei C, Zhang C, Mao X, Xue J. Analysis of initial laboratory diagnosis of malaria and its accuracy compared with re-testing from 2013 to 2018 in Yunnan Province, China. Malar J 2020; 19:409. [PMID: 33183296 PMCID: PMC7664069 DOI: 10.1186/s12936-020-03477-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/02/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND According to China's Malaria Eradication Action Plan, malaria cases diagnosed and reported by health authorities at the county level must be further re-confirmed by provincial laboratories. The Yunnan Province Malaria Diagnostic Reference Laboratory (YPMDRL) began the synchronous implementation of microscopic examinations and nested polymerase chain reaction (nested-PCR) testing to re-test the malaria cases initially diagnosed by county-level laboratories and to evaluate the consistency of Plasmodium species identified between by YPMDRL and by the county-level laboratories from 2013 to 2018 in Yunnan Province. METHODS Data on malaria initial diagnosis completed by county-level laboratories in Yunnan Province were collected weekly from the "China Disease Prevention and Control Information System" from 2013 to 2018. The YPMDRL performed Plasmodium microscopic examination and 18S rRNA gene nested-PCR testing on every malaria case managed by the China Disease Prevention and Control Information System. The re-testing detection results were fed back to the initial diagnosis and reporting unit for revision of malaria case types. RESULTS A total of 2,869 malaria cases were diagnosed and reported by county-level laboratories in Yunnan Province from 2013 to 2018. The re-testing rate was 95.6% (2,742/2,869), and the re-testing rate increased from 2013 to 2018. Among the re-tested 2,742 cases, 96.7% (2651/2742), 2.2% (59/2742), and 1.1% (32/2742) were doubly examined by microscopy and by nested-PCR, only by microscopy, and only by nested-PCR, respectively. The total Plasmodium species accuracy rate at county-level laboratories was 92.6% (2,543/2,742) reference to the diagnosis by YPMDRL. Among the inconsistent 199 cases, they were identified as including 103 negative cases, 45 falciparum malaria cases, 30 vivax malaria cases, 11 ovale malaria cases, and 10 malariae malaria cases by YPMDRL. From 2013 to 2018, the revised and registered malaria cases by the China Disease Prevention and Control Information System in Yunnan Province was 2,747 cases, including 2,305 vivax malaria cases, 421 falciparum malaria cases, 11 ovale malaria cases, and 10 malariae malaria cases. CONCLUSIONS The double re-testing strategy by microscopy and by gene testing increases the accuracy of diagnoses malaria in Yunnan Province, and gene testing can reliably differentiate Plasmodium species. The re-testing results provided by YPMDRL are the authoritative basis for revising malaria kind in Yunnan Province.
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Affiliation(s)
- Ying Dong
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory, Yunnan Centre of Malaria Research, Pu'er, 665000, China.
| | - Yan Deng
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Yanchun Xu
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Mengni Chen
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Chun Wei
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Canglin Zhang
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Xianghua Mao
- Yunnan Institute of Parasitic Diseases Control, Yunnan Provincial Key Laboratory, Yunnan Centre of Malaria Research, Pu'er, 665000, China
| | - Jingbo Xue
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China
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Oboh MA, Oyebola KM, Idowu ET, Badiane AS, Otubanjo OA, Ndiaye D. Rising report of Plasmodium vivax in sub-Saharan Africa: Implications for malaria elimination agenda. SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2020.e00596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Xie Y, Wu K, Cheng W, Jiang T, Yao Y, Xu M, Yang Y, Tan H, Li J. Molecular epidemiological surveillance of Africa and Asia imported malaria in Wuhan, Central China: comparison of diagnostic tools during 2011-2018. Malar J 2020; 19:321. [PMID: 32883296 PMCID: PMC7470674 DOI: 10.1186/s12936-020-03387-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/25/2020] [Indexed: 01/17/2023] Open
Abstract
Background Malaria remains a serious public health problem globally. As the elimination of indigenous malaria continues in China, imported malaria has gradually become a major health hazard. Well-timed and accurate diagnoses could support the timely implementation of therapeutic schedules, reveal the prevalence of imported malaria and avoid transmission of the disease. Methods Blood samples were collected in Wuhan, China, from August 2011 to December 2018. All patients accepted microscopy and rapid diagnosis test (RDT) examinations. Subsequently, each of the positive or suspected positive cases was tested for four human-infectious Plasmodium species by using 18S rRNA-based nested PCR and Taqman probe-based real-time PCR. The results of the microscopy and the two molecular diagnostic methods were analysed. Importation origins were traced by country, and the prevalence of Plasmodium species was analysed by year. Results A total of 296 blood samples, including 288 that were microscopy and RDT positive, 7 RDT and Plasmodium falciparum positive, and 1 suspected case, were collected and reanalysed. After application of the two molecular methods and sequencing, 291 cases including 245 P. falciparum, 15 Plasmodium vivax, 20 Plasmodium ovale, 6 Plasmodium malariae and 5 mixed infections (3 P. falciparum + P. ovale, 2 P. vivax + P. ovale) were confirmed. These patients had returned from Africa (95.53%) and Asia (4.47%). Although the prevalence displayed a small-scale fluctuation, the overall trend of the imported cases increased yearly. Conclusions These results emphasize the necessity of combined utilization of the four tools for malaria diagnosis in clinic and in field surveys of potential risk regions worldwide including Wuhan.
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Affiliation(s)
- Yiting Xie
- Department of Human Parasitology, School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.,Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Kai Wu
- Department of Schistosomiasis and Endemic Diseases, Wuhan City Center for Disease Prevention and Control, Wuhan, 430015, People's Republic of China
| | - Weijia Cheng
- Department of Human Parasitology, School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.,Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Tingting Jiang
- Department of Human Parasitology, School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.,Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Yi Yao
- Department of Human Parasitology, School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.,Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Mingxing Xu
- Department of Schistosomiasis and Endemic Diseases, Wuhan City Center for Disease Prevention and Control, Wuhan, 430015, People's Republic of China
| | - Yan Yang
- Department of Schistosomiasis and Endemic Diseases, Wuhan City Center for Disease Prevention and Control, Wuhan, 430015, People's Republic of China
| | - Huabing Tan
- Department of Human Parasitology, School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.,Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Jian Li
- Department of Human Parasitology, School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, 442000, People's Republic of China. .,Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.
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Oboh MA, Singh US, Ndiaye D, Badiane AS, Ali NA, Bharti PK, Das A. Presence of additional Plasmodium vivax malaria in Duffy negative individuals from Southwestern Nigeria. Malar J 2020; 19:229. [PMID: 32590997 PMCID: PMC7318376 DOI: 10.1186/s12936-020-03301-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background Malaria in sub-Saharan Africa (sSA) is thought to be mostly caused by Plasmodium falciparum. Recently, growing reports of cases due to Plasmodium ovale, Plasmodium malariae, and Plasmodium vivax have been increasingly observed to play a role in malaria epidemiology in sSA. This in fact is due to the usage of very sensitive diagnostic tools (e.g. PCR), which have highlighted the underestimation of non-falciparum malaria in this sub-region. Plasmodium vivax was historically thought to be absent in sSA due to the high prevalence of the Duffy negativity in individuals residing in this sub-continent. Recent studies reporting detection of vivax malaria in Duffy-negative individuals from Mali, Mauritania, Cameroon challenge this notion. Methods Following previous report of P. vivax in Duffy-negative individuals in Nigeria, samples were further collected and assessed RDT and/or microscopy. Thereafter, malaria positive samples were subjected to conventional PCR method and DNA sequencing to confirm both single/mixed infections as well as the Duffy status of the individuals. Results Amplification of Plasmodium gDNA was successful in 59.9% (145/242) of the evaluated isolates and as expected P. falciparum was the most predominant (91.7%) species identified. Interestingly, four P. vivax isolates were identified either as single (3) or mixed (one P. falciparum/P. vivax) infection. Sequencing results confirmed all vivax isolates as truly vivax malaria and the patient were of Duffy-negative genotype. Conclusion Identification of additional vivax isolates among Duffy-negative individuals from Nigeria, substantiate the expanding body of evidence on the ability of P. vivax to infect RBCs that do not express the DARC gene. Hence, such genetic-epidemiological study should be conducted at the country level in order to evaluate the true burden of P. vivax in Nigeria.
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Affiliation(s)
- Mary Aigbiremo Oboh
- Medical Research Council Unit The Gambia at LSHTM, Fajara, P.O. Box 273, Banjul, Gambia.
| | - Upasana Shyamsunder Singh
- School of Earth and Environmental Sciences, University of Manchester, Manchester, UK.,Genomic Epidemiology Laboratory, Division of Vector Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | - Daouda Ndiaye
- Parasitology and Mycology Laboratory, Université Cheikh Anta Diop, Dakar, Senegal
| | - Aida Sadikh Badiane
- Parasitology and Mycology Laboratory, Université Cheikh Anta Diop, Dakar, Senegal
| | - Nazia Anwar Ali
- National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, 482003, India
| | - Praveen Kumar Bharti
- National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, 482003, India
| | - Aparup Das
- Genomic Epidemiology Laboratory, Division of Vector Borne Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, India.
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Detection of malaria with light microscopy and Nested polymerase chain reaction (Nested PCR) methods in peripheral blood expansions and investigation of the genetic diversity of Plasmodium species by 18S rRNA gene in Southeast of Iran. Microb Pathog 2019; 137:103782. [PMID: 31600540 DOI: 10.1016/j.micpath.2019.103782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/07/2019] [Accepted: 10/05/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Malaria is a public health concern that leads to about a million deaths worldwide every year. Malaria is caused by the genus Plasmodium, which includes P. falciparum, P. vivax, P. malariae, and P. ovale. Molecular phylogeny is essential to better recognition the evolution of the genus Plasmodium genus and detection of the relative degree of Plasmodium species in humans. The aim of this study was to detect malaria with Light Microscopy (LM) and Nested polymerase chain reaction (Nested PCR) methods in peripheral blood expansions and to investigate the genetic diversity of Plasmodium species by 18S rRNA gene in the southeast of Iran. METHODS A total of 97 blood smears were collected from patients suspected to malaria in a 6-year period in the southeast of Iran including Hormozgan, Kerman, and Sistan and Baluchestan provinces. Diagnosis of Plasmodium species on blood smears was performed using LM and Nested PCR methods. In addition, 16 Plasmodium-positive samples were chosen for the determination of genetic diversity. RESULTS Overall, 97 of 97 (100%) studied cases were positive by LM while 94 of 97 (96.8%) of them were detected as malaria by Nested PCR. Except for seven cases, Nested PCR confirmed the LM results. These samples involved two P. vivax and five P. falciparum in the LM method. Meanwhile, the Nested PCR was detected in all of the cases as a mixed infection with P. vivax and P. falciparum. The results of the phylogenetic analysis revealed two main clades and five different subclades. About 87.5% of the isolates were located in clade I and contained P. vivax. In addition, 12.5% of the studied isolates involved P. falciparum that was in clade II. CONCLUSION According to our results, Nested PCR method had higher sensitivity than LM and is suggested as a good approach for malaria detection. Consideration the wide diversity of tested isolates and the importance of vaccine development, which is affected by this diversity, further studies are needed in this regard.
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Prevalence of Plasmodium falciparum Pfcrt and Pfmdr1 alleles in settings with different levels of Plasmodium vivax co-endemicity in Ethiopia. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2019; 11:8-12. [PMID: 31539706 PMCID: PMC6796752 DOI: 10.1016/j.ijpddr.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
Plasmodium falciparum and P. vivax co-exist at different endemicity levels across Ethiopia. For over two decades Artemether-Lumefantrine (AL) is the first line treatment for uncomplicated P. falciparum, while chloroquine (CQ) is still used to treat P. vivax. It is currently unclear whether a shift from CQ to AL for P. falciparum treatment has implications for AL efficacy and results in a reversal of mutations in genes associated to CQ resistance, given the high co-endemicity of the two species and the continued availability of CQ for the treatment of P. vivax. This study thus assessed the prevalence of Pfcrt-K76T and Pfmdr1-N86Y point mutations in P. falciparum. 18S RNA gene based nested PCR confirmed P. falciparum samples (N = 183) collected through community and health facility targeted cross-sectional surveys from settings with varying P. vivax and P. falciparum endemicity were used. The proportion of Plasmodium infections that were P. vivax was 62.2% in Adama, 41.4% in Babile, 30.0% in Benishangul-Gumuz to 6.9% in Gambella. The Pfcrt-76T mutant haplotype was observed more from samples with higher endemicity of P. vivax as being 98.4% (61/62), 100% (31/31), 65.2% (15/23) and 41.5% (22/53) in samples from Adama, Babile, Benishangul-Gumuz and Gambella, respectively. However, a relatively higher proportion of Pfmdr1-N86 allele (77.3–100%) were maintained in all sites. The observed high level of the mutant Pfcrt-76T allele in P. vivax co-endemic sites might require that utilization of CQ needs to be re-evaluated in settings co-endemic for the two species. A country-wide assessment is recommended to clarify the implication of the observed level of variation in drug resistance markers on the efficacy of AL-based treatment against uncomplicated P. falciparum malaria.
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Ramesh A, Nakielny S, Hsu J, Kyohere M, Byaruhanga O, de Bourcy C, Egger R, Dimitrov B, Juan YF, Sheu J, Wang J, Kalantar K, Langelier C, Ruel T, Mpimbaza A, Wilson MR, Rosenthal PJ, DeRisi JL. Metagenomic next-generation sequencing of samples from pediatric febrile illness in Tororo, Uganda. PLoS One 2019; 14:e0218318. [PMID: 31220115 PMCID: PMC6586300 DOI: 10.1371/journal.pone.0218318] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/31/2019] [Indexed: 12/15/2022] Open
Abstract
Febrile illness is a major burden in African children, and non-malarial causes of fever are uncertain. In this retrospective exploratory study, we used metagenomic next-generation sequencing (mNGS) to evaluate serum, nasopharyngeal, and stool specimens from 94 children (aged 2–54 months) with febrile illness admitted to Tororo District Hospital, Uganda. The most common microbes identified were Plasmodium falciparum (51.1% of samples) and parvovirus B19 (4.4%) from serum; human rhinoviruses A and C (40%), respiratory syncytial virus (10%), and human herpesvirus 5 (10%) from nasopharyngeal swabs; and rotavirus A (50% of those with diarrhea) from stool. We also report the near complete genome of a highly divergent orthobunyavirus, tentatively named Nyangole virus, identified from the serum of a child diagnosed with malaria and pneumonia, a Bwamba orthobunyavirus in the nasopharynx of a child with rash and sepsis, and the genomes of two novel human rhinovirus C species. In this retrospective exploratory study, mNGS identified multiple potential pathogens, including 3 new viral species, associated with fever in Ugandan children.
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Affiliation(s)
- Akshaya Ramesh
- Weill Institute for Neurosciences, University of California, San Francisco, California, United States of America
- Department of Neurology, University of California, San Francisco, California, United States of America
- * E-mail: (AR); (JLD)
| | - Sara Nakielny
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, United States of America
| | - Jennifer Hsu
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Mary Kyohere
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Charles de Bourcy
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Rebecca Egger
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Boris Dimitrov
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Yun-Fang Juan
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Jonathan Sheu
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - James Wang
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Katrina Kalantar
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, United States of America
| | - Charles Langelier
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Theodore Ruel
- Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco, California, United States of America
| | - Arthur Mpimbaza
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Michael R. Wilson
- Weill Institute for Neurosciences, University of California, San Francisco, California, United States of America
- Department of Neurology, University of California, San Francisco, California, United States of America
| | - Philip J. Rosenthal
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, California, United States of America
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, United States of America
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
- * E-mail: (AR); (JLD)
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Bahk YY, Lee HW, Na BK, Kim J, Jin K, Hong YS, Kim TS. Epidemiological Characteristics of Re-emerging Vivax Malaria in the Republic of Korea (1993-2017). THE KOREAN JOURNAL OF PARASITOLOGY 2018; 56:531-543. [PMID: 30630273 PMCID: PMC6327199 DOI: 10.3347/kjp.2018.56.6.531] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/02/2018] [Indexed: 12/27/2022]
Abstract
Historically, Plasmodium vivax malaria has been one of the most highly endemic parasitic diseases in the Korean Peninsula. Until the 1970s, vivax malaria was rarely directly lethal and was controlled through the Korean Government Program administered by the National Malaria Eradication Service in association with the World Health Organization's Global Malaria Eradication Program. Vivax malaria has re-emerged in 1993 near the Demilitarized Zone between South and North Korea and has since become an endemic infectious disease that now poses a serious public health threat through local transmission in the Republic of Korea. This review presents major lessons learned from past and current malaria research, including epidemiological and biological characteristics of the re-emergent disease, and considers some interesting patterns of diversity. Among other features, this review highlights temporal changes in the genetic make-up of the parasitic population, patient demographic features, and spatial distribution of cases, which all provide insight into the factors contributing to local transmission. The data indicate that vivax malaria in Korea is not expanding expo- nentially. However, continued surveillance is needed to prevent future resurgence.
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Affiliation(s)
- Young Yil Bahk
- Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju 27478, Korea
| | - Hyeong-Woo Lee
- Insitute of Research and Development, Scorpiogen Co., Hankyong National University, Anseong 17579, Korea
| | - Byoung-Kuk Na
- Department of Parasitology and Tropical Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju 52727, Korea
| | - Jeonga Kim
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, UAB Comprehensive Diabetes Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Kyoung Jin
- Korea Health Evaluation Institute, Sahmyook University, Seoul 01795, Korea
| | - Yeong Seon Hong
- Korea Health Evaluation Institute, Sahmyook University, Seoul 01795, Korea
| | - Tong-Soo Kim
- Department of Parasitology and Tropical Medicine, Inha University School of Medicine, Incheon 22212, Korea
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Oboh MA, Badiane AS, Ntadom G, Ndiaye YD, Diongue K, Diallo MA, Ndiaye D. Molecular identification of Plasmodium species responsible for malaria reveals Plasmodium vivax isolates in Duffy negative individuals from southwestern Nigeria. Malar J 2018; 17:439. [PMID: 30486887 PMCID: PMC6263541 DOI: 10.1186/s12936-018-2588-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/22/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Malaria in Nigeria is principally due to Plasmodium falciparum and, to a lesser extent to Plasmodium malariae and Plasmodium ovale. Plasmodium vivax is thought to be absent in Nigeria in particular and sub-Saharan Africa in general, due to the near fixation of the Duffy negative gene in this population. Nevertheless, there are frequent reports of P. vivax infection in Duffy negative individuals in the sub-region, including reports from two countries sharing border with Nigeria to the west (Republic of Benin) and east (Cameroon). Additionally, there were two cases of microscopic vivax-like malaria from Nigerian indigenous population. Hence molecular surveillance of the circulating Plasmodium species in two states (Lagos and Edo) of southwestern Nigeria was carried out. METHODS A cross-sectional survey between September 2016 and March 2017 was conducted. 436 febrile patients were included for the present work. Venous blood of these patients was subjected to RDT as well as microscopy. Further, parasite DNA was isolated from positive samples and PCR diagnostic was employed followed by direct sequencing of the 18S rRNA of Plasmodium species as well as sequencing of a portion of the promoter region of the Duffy antigen receptor for chemokines. Samples positive for P. vivax were re-amplified several times and finally using the High Fidelity Taq to rule out any bias introduced. RESULTS Of the 256 (58.7%) amplifiable malaria parasite DNA, P. falciparum was, as expected, the major cause of infection, either alone 85.5% (219/256; 97 from Edo and 122 from Lagos), or mixed with P. malariae 6.3% (16/256) or with P. vivax 1.6% (4/256). Only one of the five P. vivax isolates was found to be a single infection. DNA sequencing and subsequent alignment of the 18S rRNA of P. vivax with the reference strains displayed very high similarities (100%). Remarkably, the T-33C was identified in all P. vivax samples, thus confirming that all vivax-infected patients in the current study are Duffy negative. CONCLUSION The present study gave the first molecular evidence of P. vivax in Nigeria in Duffy negative individuals. Though restricted to two states; Edo in South-South and Lagos in South-west Nigeria, the real burden of this species in Nigeria and sub-Saharan Africa might have been underestimated, hence there is need to put in place a country-wide, as well as a sub-Saharan Africa-wide surveillance and appropriate control measures.
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MESH Headings
- Child, Preschool
- Cross-Sectional Studies
- DNA, Protozoan/chemistry
- DNA, Protozoan/genetics
- DNA, Ribosomal/chemistry
- DNA, Ribosomal/genetics
- Duffy Blood-Group System/genetics
- Female
- Humans
- Infant
- Infant, Newborn
- Malaria, Vivax/epidemiology
- Malaria, Vivax/parasitology
- Male
- Nigeria/epidemiology
- Plasmodium vivax/classification
- Plasmodium vivax/genetics
- Plasmodium vivax/isolation & purification
- RNA, Ribosomal, 18S/genetics
- Receptors, Cell Surface/genetics
- Sequence Analysis, DNA
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Affiliation(s)
- Mary Aigbiremo Oboh
- Parasitology and Mycology Laboratory, Université Cheikh Anta Diop, Dakar, Senegal.
| | - Aida Sadikh Badiane
- Parasitology and Mycology Laboratory, Université Cheikh Anta Diop, Dakar, Senegal
| | - Godwin Ntadom
- National Malaria Elimination Programme/Epidemiology Division, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Yaye Die Ndiaye
- Parasitology and Mycology Laboratory, Université Cheikh Anta Diop, Dakar, Senegal
| | - Khadim Diongue
- Parasitology and Mycology Laboratory, Université Cheikh Anta Diop, Dakar, Senegal
| | - Mamadou Alpha Diallo
- Parasitology and Mycology Laboratory, Université Cheikh Anta Diop, Dakar, Senegal
| | - Daouda Ndiaye
- Parasitology and Mycology Laboratory, Université Cheikh Anta Diop, Dakar, Senegal
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Mirahmadi H, Shahrakipour A, Mehravaran A, Khorashad AS, Rahmati-Balaghaleh M, Zarean M. Evaluation of malaria multiplex/nested PCR performance at low parasite densities and mixed infection in Iran: A country close to malaria elimination. INFECTION GENETICS AND EVOLUTION 2018; 65:283-287. [PMID: 30096462 DOI: 10.1016/j.meegid.2018.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Malaria is still a major public health problem in subtropical and tropical regions. The rapid and accurate diagnosis of malaria remains a challenge in most of the endemic areas. The primary objective of the present study was to evaluate the performance of multiplex/nested PCR in detecting Plasmodium falciparum at low parasite densities and mixed infection. METHODS The study was performed in the Sistan-Baluchestan province of the southeastern Iran, from May 2015 to July 2016. A total of 105 patients suspected to malaria infection were enrolled in the study. The obtained DNA products, extracted from the thick/thin films, were analyzed by multiplex/nested PCR using genus-specific primers and compared with light microscopy. RESULTS 43 samples were confirmed to be infected by microscopic examination. Among 43 microscopically diagnosed P. falciparum cases, 11.4% (12/105) were confirmed by multiplex/nested PCR, 36.2% (38/105) were confirmed as P. vivax, 1.9% (2/105) had mixed infections with P. falciparum and P. vivax. Among microscopy-negative samples, 10 samples turned malaria-positive in nPCR. In multiplex/nested PCR, the rate of mixed infections was 8.6% (9/105). When compared to LM, the sensitivity, specificity, positive predictive value and negative predictive value of multiplex/nested PCR were calculated to be 82.8, 91.5, 92.3 and 81.1%, respectively. CONCLUSION In this study, we showed that microscopic examination of blood smears does not reliably distinguish Plasmodium species in the case of mixed infections. Therefore, it seems that multiplex/nested PCR is a good candidate for examining the presence of malaria parasites in clinically suspected but microscopically negative cases.
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Affiliation(s)
- Hadi Mirahmadi
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Parasitology and Mycology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Azam Shahrakipour
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Parasitology and Mycology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ahmad Mehravaran
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Parasitology and Mycology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Salami Khorashad
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Parasitology and Mycology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mansour Rahmati-Balaghaleh
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Parasitology and Mycology, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mehdi Zarean
- Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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22
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Nissen A, Cook J, Loha E, Lindtjørn B. Proximity to vector breeding site and risk of Plasmodium vivax infection: a prospective cohort study in rural Ethiopia. Malar J 2017; 16:380. [PMID: 28927422 PMCID: PMC5605991 DOI: 10.1186/s12936-017-2031-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/14/2017] [Indexed: 11/15/2022] Open
Abstract
Background Despite falling incidence and mortality since the turn of the century, malaria remains an important global health challenge. In the future fight against malaria, greater emphasis will have to be placed on understanding and addressing malaria caused by the Plasmodium vivax parasite. Unfortunately, due to years of neglect and underfunding, there are currently many gaps in knowledge of P. vivax malaria. The aims of the present study were to explore the association between distance to vector breeding site and P. vivax infection in rural Ethiopia, and, secondarily, to test whether this association varies with age. Methods A prospective, cohort study of all residents in the Chano Mille Kebele in southern Ethiopia from April 2009 to March 2011 (n = 8121). Weekly household follow up visits included screening for febrile cases (active surveillance). Participants were also asked to contact the local health centre if they experienced subjective fever between visits (passive surveillance). Plasmodium vivax infection was confirmed using microscopy by two independent readers. Information was collected on demographics and household characteristics including GPS-determined distance to vector breeding site. Data was analysed using Cox regression modelling. Results Overall the P. vivax infection rate was 12.3/1000 person-years (95% CI 10.5–14.5). Mean household distance to breeding site was 2449 m (range 1646–3717 m). Fully adjusted results showed very strong evidence of an association between proximity to breeding site and P. vivax infection: rate ratio = 3.47 (95% CI 2.15–5.60; P < 0.001) comparing the group closest to the breeding site (distance < 2100 m; n = 1383) to the group furthest away (distance > 2700 m; n = 2460). There was no evidence that age was an effect modifier in the association. Conclusion Results showed strong evidence that household proximity to vector breeding site is positively associated with P. vivax infection in rural Ethiopia, and that this association is constant across age groups. The findings might influence how net-distribution and indoor residual spraying campaigns are planned, help guide strategies on water resource development by highlighting potential health effects of man-made dams near human habitats, and add to current educational information given to people living close to breeding sites.
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Affiliation(s)
- Alexander Nissen
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, P.O. Box 181, 0409, Oslo, Norway.
| | - Jackie Cook
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Eskindir Loha
- School of Public and Environmental Health, Hawassa University, Awassa, Ethiopia
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
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Muhammad RH, Nock IH, Ndams IS, George JB, Deeni Y. Distribution of pfmdr1 and pfcrt chloroquine drug resistance alleles in north-western Nigeria. MALARIAWORLD JOURNAL 2017; 8:15. [PMID: 34532238 PMCID: PMC8415075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND In Nigeria, decline in the sensitivity of Plasmodium falciparum to Artemisinin Combination Therapy (ACT) has prompted the unofficial use of chloroquine (CQ) for self-medication. This study was designed to determine the prevalence and distribution of CQ resistant/susceptible alleles of CQ resistance transporter (Pfcrt) and P. falciparum multidrug resistance gene 1 (Pfmdr1) in view of the possible re-introduction of CQ for malaria treatment. MATERIALS AND METHODS Four hundred and sixty six (466) P. falciparum positive samples were randomly collected from five states of northwest Nigeria. The samples were amplified using RT- PCR at codon 76 for Pfcrt and codon 86 for Pfmdr1. Data was analysed using chi-square, odds ratios and paired t-tests. RESULTS Drug susceptible alleles (N86) were most prevalent in the study population (47.9%; 223/466), followed by the drug resistance alleles 86Y (28.3%; 132/466), followed by the drug susceptible alleles K76 (17.4%; 81/466), the resistant alleles 76T (12.4%; 58/466) and finally the mixed infection mutation K76T (3.6%; 17/466). Differences between the distributions of the Pfmdr1 and Pfcrt alleles were significant (P<0.05). There were significant differences (P<0.05) between N86 and 86Y alleles, but no significant differences between K76 and 76T alleles, including the prevalence of the various alleles across the different age groups. CONCLUSION The results of this study suggest the possibility of (re)introducing CQ for malaria treatment in north-western Nigeria and provide insight in the genetic background of P. falciparum in the study area.
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Affiliation(s)
| | | | | | | | - Yusuf Deeni
- University of Abertay, Bell Street Dundee DD1 1HG, UK
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24
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Defining the next generation of Plasmodium vivax diagnostic tests for control and elimination: Target product profiles. PLoS Negl Trop Dis 2017; 11:e0005516. [PMID: 28369085 PMCID: PMC5391123 DOI: 10.1371/journal.pntd.0005516] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/13/2017] [Accepted: 03/21/2017] [Indexed: 12/28/2022] Open
Abstract
The global prevalence of malaria has decreased over the past fifteen years, but similar gains have not been realized against Plasmodium vivax because this species is less responsive to conventional malaria control interventions aimed principally at P. falciparum. Approximately half of all malaria cases outside of Africa are caused by P. vivax. This species places dormant forms in human liver that cause repeated clinical attacks without involving another mosquito bite. The diagnosis of acute patent P. vivax malaria relies primarily on light microscopy. Specific rapid diagnostic tests exist but typically perform relatively poorly compared to those for P. falciparum. Better diagnostic tests are needed for P. vivax. To guide their development, FIND, in collaboration with P. vivax experts, identified the specific diagnostic needs associated with this species and defined a series of three distinct target product profiles, each aimed at a particular diagnostic application: (i) point-of-care of acutely ill patients for clinical care purposes; (ii) point-of-care asymptomatic and otherwise sub-patent residents for public health purposes, e.g., mass screen and treat campaigns; and (iii) ultra-sensitive not point-of-care diagnosis for epidemiological research/surveillance purposes. This report presents and discusses the rationale for these P. vivax-specific diagnostic target product profiles. These contribute to the rational development of fit-for-purpose diagnostic tests suitable for the clinical management, control and elimination of P. vivax malaria. Plasmodium vivax is the second most prevalent Plasmodium species amongst the five that can infect humans and cause malaria. The control and elimination of P. vivax is complicated by its specific biology, such as hard-to-detect low densities of blood-circulating parasites in infected individuals, the existence of persistent liver forms causing relapse, or the early appearance of sexual stages of the parasite during the course of an infection, which facilitates its transmission. These difficulties are reinforced by the fact that most antimalarial tools have been developed primarily for P. falciparum, the most prevalent malaria species, and are not always as effective for P. vivax. Current tools for the diagnosis of P. vivax are of limited effectiveness. Rapid diagnostic tests exist but show, in average, lower performance than similar test for P. falciparum. P. vivax diagnosis often relies on light microscopy which is challenging to maintain at a high quality and not sensitive enough to detect a large fraction of all infections. Recognizing that better diagnostic tools for P. vivax are needed, we report in this study the development of new target product profiles to define the specific characteristics of such tests. The establishment of these consensus-based documents is an important first step to guide research and development efforts toward better diagnostic solutions for P. vivax malaria and to accelerate the elimination of this species alongside P. falciparum.
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Kang JM, Cho PY, Moe M, Lee J, Jun H, Lee HW, Ahn SK, Kim TI, Pak JH, Myint MK, Lin K, Kim TS, Na BK. Comparison of the diagnostic performance of microscopic examination with nested polymerase chain reaction for optimum malaria diagnosis in Upper Myanmar. Malar J 2017; 16:119. [PMID: 28302168 PMCID: PMC5356273 DOI: 10.1186/s12936-017-1765-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/28/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Accurate diagnosis of Plasmodium infection is crucial for prompt malaria treatment and surveillance. Microscopic examination has been widely applied as the gold standard for malaria diagnosis in most part of malaria endemic areas, but its diagnostic value has been questioned, particularly in submicroscopic malaria. In this study, the diagnostic performance of microscopic examination and nested polymerase chain reaction (PCR) was evaluated to establish optimal malaria diagnosis method in Myanmar. METHODS A total of 1125 blood samples collected from residents in the villages and towns located in Naung Cho, Pyin Oo Lwin, Tha Beik Kyin townships and Mandalay of Upper Myanmar were screened by microscopic examination and species-specific nested PCR method. RESULTS Among the 1125 blood samples, 261 samples were confirmed to be infected with malaria by microscopic examination. Evaluation of the 1125 samples by species-specific nested PCR analysis revealed that the agreement between microscopic examination and nested PCR was 87.3% (261/299). Nested PCR successfully detected 38 Plasmodium falciparum or Plasmodium vivax infections, which were missed in microscopic examination. Microscopic examinations also either misdiagnosed the infected Plasmodium species, or did not detect mixed infections with different Plasmodium species in 31 cases. CONCLUSIONS The nested PCR method is more reliable than conventional microscopic examination for the diagnosis of malaria infections, and this is particularly true in cases of mixed infections and submicroscopic infections. Given the observed higher sensitivity and specificity of nested PCR, the molecular method holds enormous promise in malaria diagnosis and species differentiation, and can be applied as an effective monitoring tool for malaria surveillance, control and elimination in Myanmar.
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Affiliation(s)
- Jung-Mi Kang
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea.,BK21Plus Team for Anti-Aging Biotechnology and Industry, Department of Convergence Medical Science, Gyeongsang National University, Jinju, 52727, Republic of Korea
| | - Pyo-Yun Cho
- Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Mya Moe
- Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar
| | - Jinyoung Lee
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea
| | - Hojong Jun
- Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Hyeong-Woo Lee
- Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Seong Kyu Ahn
- Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Tae Im Kim
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea
| | - Jhang Ho Pak
- Department of Convergence Medicine, University of Ulsan College of Medicine and Asan Institute for Life Sciences, Asan Medical Center, Seoul, 05505, Republic of Korea
| | - Moe Kyaw Myint
- Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar
| | - Khin Lin
- Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar.
| | - Tong-Soo Kim
- Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea.
| | - Byoung-Kuk Na
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea. .,BK21Plus Team for Anti-Aging Biotechnology and Industry, Department of Convergence Medical Science, Gyeongsang National University, Jinju, 52727, Republic of Korea.
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Tadesse FG, van den Hoogen L, Lanke K, Schildkraut J, Tetteh K, Aseffa A, Mamo H, Sauerwein R, Felger I, Drakeley C, Gadissa E, Bousema T. The shape of the iceberg: quantification of submicroscopic Plasmodium falciparum and Plasmodium vivax parasitaemia and gametocytaemia in five low endemic settings in Ethiopia. Malar J 2017; 16:99. [PMID: 28253867 PMCID: PMC5335517 DOI: 10.1186/s12936-017-1749-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/24/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The widespread presence of low-density asymptomatic infections with concurrent gametocytes may be a stumbling block for malaria elimination. This study investigated the asymptomatic reservoir of Plasmodium falciparum and Plasmodium vivax infections in schoolchildren from five settings in northwest Ethiopia. METHODS Two cross-sectional surveys were conducted in June and November 2015, enrolling 551 students from five schools and 294 students from three schools, respectively. Finger prick whole blood and plasma samples were collected. The prevalence and density of P. falciparum and P. vivax parasitaemia and gametocytaemia were determined by 18S rRNA quantitative PCR (qPCR) and pfs25 and pvs25 reverse transcriptase qPCR. Antibodies against blood stage antigens apical membrane antigen-1 (AMA-1) and merozoite surface protein-1 (MSP-119) were measured for both species. RESULTS Whilst only 6 infections were detected by microscopy in 881 slides (0.7%), 107 of 845 blood samples (12.7%) were parasite positive by (DNA-based) qPCR. qPCR parasite prevalence between sites and surveys ranged from 3.8 to 19.0% for P. falciparum and 0.0 to 9.0% for P. vivax. The median density of P. falciparum infections (n = 85) was 24.4 parasites/µL (IQR 18.0-34.0) and the median density of P. vivax infections (n = 28) was 16.4 parasites/µL (IQR 8.8-55.1). Gametocyte densities by (mRNA-based) qRT-PCR were strongly associated with total parasite densities for both P. falciparum (correlation coefficient = 0.83, p = 0.010) and P. vivax (correlation coefficient = 0.58, p = 0.010). Antibody titers against P. falciparum AMA-1 and MSP-119 were higher in individuals who were P. falciparum parasite positive in both surveys (p < 0.001 for both comparisons). DISCUSSION This study adds to the available evidence on the wide-scale presence of submicroscopic parasitaemia by quantifying submicroscopic parasite densities and concurrent gametocyte densities. There was considerable heterogeneity in the occurrence of P. falciparum and P. vivax infections and serological markers of parasite exposure between the examined low endemic settings in Ethiopia.
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Affiliation(s)
- Fitsum G Tadesse
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Medical Biotechnology Unit, Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia.,Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Lotus van den Hoogen
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Kjerstin Lanke
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jodie Schildkraut
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kevin Tetteh
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robert Sauerwein
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ingrid Felger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands. .,Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.
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Ebstie YA, Abay SM, Tadesse WT, Ejigu DA. Tafenoquine and its potential in the treatment and relapse prevention of Plasmodium vivax malaria: the evidence to date. Drug Des Devel Ther 2016; 10:2387-99. [PMID: 27528800 PMCID: PMC4970641 DOI: 10.2147/dddt.s61443] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Despite declining global malaria incidence, the disease continues to be a threat to people living in endemic regions. In 2015, an estimated 214 million new malaria cases and 438,000 deaths due to malaria were recorded. Plasmodium vivax is the second most common cause of malaria next to Plasmodium falciparum. Vivax malaria is prevalent especially in Southeast Asia and the Horn of Africa, with enormous challenges in controlling the disease. Some of the challenges faced by vivax malaria-endemic countries include limited access to effective drugs treating liver stages of the parasite (schizonts and hypnozoites), emergence/spread of drug resistance, and misperception of vivax malaria as nonlethal. Primaquine, the only 8-aminoquinoline derivative approved by the US Food and Drug Administration, is intended to clear intrahepatic hypnozoites of P. vivax (radical cure). However, poor adherence to a prolonged treatment course, drug-induced hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency, and the emergence of resistance make it imperative to look for alternative drugs. Therefore, this review focuses on data accrued to date on tafenoquine and gives insight on the potential role of the drug in preventing relapse and radical cure of patients with vivax malaria.
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Affiliation(s)
| | | | - Wondmagegn T Tadesse
- Department of Pharmacology and Clinical Pharmacy, School of Medicine, College of Health Sciences, Addis Ababa University
| | - Dawit A Ejigu
- Department of Pharmacology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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28
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Ranjan P, Ghoshal U. Utility of nested polymerase chain reaction over the microscopy and immuno-chromatographic test in the detection of Plasmodium species and their clinical spectrum. Parasitol Res 2016; 115:3375-85. [DOI: 10.1007/s00436-016-5098-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
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Lima GFMDC, Lucchi NW, Silva-Flannery L, Macedo- de- Oliveira A, Hristov AD, Inoue J, Costa-Nascimento MDJ, Udhayakumar V, Di Santi SM. Still Searching for a Suitable Molecular Test to Detect Hidden Plasmodium Infection: A Proposal for Blood Donor Screening in Brazil. PLoS One 2016; 11:e0150391. [PMID: 26959994 PMCID: PMC4784969 DOI: 10.1371/journal.pone.0150391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/12/2016] [Indexed: 11/18/2022] Open
Abstract
Background Efforts have been made to establish sensitive diagnostic tools for malaria screening in blood banks in order to detect malaria asymptomatic carriers. Microscopy, the malaria reference test in Brazil, is time consuming and its sensitivity depends on microscopist experience. Although molecular tools are available, some aspects need to be considered for large-scale screening: accuracy and robustness for detecting low parasitemia, affordability for application to large number of samples and flexibility to perform on individual or pooled samples. Methodology In this retrospective study, we evaluated four molecular assays for detection of malaria parasites in a set of 56 samples previously evaluated by expert microscopy. In addition, we evaluated the effect of pooling samples on the sensitivity and specificity of the molecular assays. A well-characterized cultured sample with 1 parasite/μL was included in all the tests evaluated. DNA was extracted with QIAamp DNA Blood Mini Kit and eluted in 50 μL to concentrate the DNA. Pools were assembled with 10 samples each. Molecular protocols targeting 18S rRNA, included one qPCR genus specific (Lima-genus), one duplex qPCR genus/Pf (PET-genus, PET-Pf) and one duplex qPCR specie-specific (Rougemont: Roug-Pf/Pv and Roug-Pm/Po). Additionally a nested PCR protocol specie-specific was used (Snou-Pf, Snou-Pv, Snou-Pm and Snou-Po). Results The limit of detection was 3.5 p/μL and 0.35p/μl for the PET-genus and Lima-genus assays, respectively. Considering the positive (n = 13) and negative (n = 39) unpooled individual samples according to microscopy, the sensitivity of the two genus qPCR assays was 76.9% (Lima-genus) and 72.7% (PET-genus). The Lima-genus and PET-genus showed both sensitivity of 86.7% in the pooled samples. The genus protocols yielded similar results (Kappa value of 1.000) in both individual and pooled samples. Conclusions Efforts should be made to improve performance of molecular tests to enable the detection of low-density parasitemia if these tests are to be utilized for blood transfusion screening.
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Affiliation(s)
| | - Naomi W. Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Luciana Silva-Flannery
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Atlanta Research and Education Foundation, Decatur-GA, Atlanta, Georgia, United States of America
| | - Alexandre Macedo- de- Oliveira
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Angelica D Hristov
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Juliana Inoue
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Maria de Jesus Costa-Nascimento
- Núcleo de Estudos em Malária, Superintendência de Controle de Endemias, Secretaria de Estado da Saúde de São Paulo /Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Silvia M Di Santi
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Núcleo de Estudos em Malária, Superintendência de Controle de Endemias, Secretaria de Estado da Saúde de São Paulo /Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
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Hahn WO, Pottinger PS. Malaria in the Traveler: How to Manage Before Departure and Evaluate Upon Return. Med Clin North Am 2016; 100:289-302. [PMID: 26900114 PMCID: PMC4764883 DOI: 10.1016/j.mcna.2015.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Malaria is the clinical syndrome when a patient experiences symptoms in response to infection with one of several strains of the Plasmodium parasite. This article is intended for health care providers to become familiar with some of the basics of care of patients who are travelling to or returning from an area with ongoing malaria transmission. The specific focus is on patients from nonendemic areas who plan on travel for a finite period to an area where malaria is endemic.
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Affiliation(s)
- William O. Hahn
- Fellow, Medicine (Division of Infectious Disease), University of Washington, Seattle, WA
| | - Paul S. Pottinger
- Associate Professor, Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA
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Díaz PB, Lozano PM, Rincón JMR, García L, Reyes F, Llanes AB. Quality of malaria diagnosis and molecular confirmation of Plasmodium ovale curtisi in a rural area of the southeastern region of Ethiopia. Malar J 2015; 14:357. [PMID: 26383920 PMCID: PMC4574541 DOI: 10.1186/s12936-015-0893-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/02/2015] [Indexed: 11/20/2022] Open
Abstract
Background Approximately 50 million people (60 %) live in malaria risk areas in Ethiopia, at altitudes below 2000 m. According to official data, 60–70 % of malaria cases are due to Plasmodium falciparum, and 40–30 % by Plasmodium vivax. The species Plasmodium ovale was detected in 2013 in the northwest of the country, being the first report of the presence of this species in Ethiopia since the 60 s. The aim of this study was to assess the diagnosis by microscopy and PCR, and demonstrate the presence of other Plasmodium species in the country. Methods The survey was conducted in Bulbula, situated in the Rift Valley (West Arsi Province, Oromia Region). From December 2010 to October 2011, 3060 samples were collected from patients with symptoms of malaria; the diagnosis of malaria was done by microscopy and confirmation by PCR. Results 736 samples were positive for malaria by microscopy. After removing the 260 samples (109 positives and 151 negatives) for which it was not possible to do PCR, there were a total of 2800 samples, 1209 are used for its confirmation by PCR and quality control (627 are positives and 582 negatives by microscopy). From the 627 positive samples, 604 were confirmed as positive by PCR, 23 false positives were detected, and the group of 582 negative samples, 184 were positive by PCR (false negatives), which added to the previous positive samples is a total of 788, positive samples for some species of Plasmodium sp. 13.3 % more positives were detected with the PCR than the microscopy. Importantly, 23 samples were detected by PCR as P. ovale, after the sequencing of these samples was determined as P. ovale curtisi. Conclusions The PCR detected more positive samples than the microscopy; in addition, P. ovale and P. ovale/P. vivax were detected that had not been detected by microscopy, which can affect in the infection control.
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Affiliation(s)
- Pedro Berzosa Díaz
- National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain.
| | - Patricia Mula Lozano
- National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain.
| | | | - Luz García
- National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain.
| | - Francisco Reyes
- Gambo General Rural Hospital, Gambo, West Arsi Province, Oromia Region, Ethiopia.
| | - Agustín Benito Llanes
- National Centre of Tropical Medicine, Institute of Health Carlos III, C/Monforte de Lemos 5, 28029, Madrid, Spain.
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Tadesse FG, Pett H, Baidjoe A, Lanke K, Grignard L, Sutherland C, Hall T, Drakeley C, Bousema T, Mamo H. Submicroscopic carriage of Plasmodium falciparum and Plasmodium vivax in a low endemic area in Ethiopia where no parasitaemia was detected by microscopy or rapid diagnostic test. Malar J 2015; 14:303. [PMID: 26242243 PMCID: PMC4524028 DOI: 10.1186/s12936-015-0821-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/23/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Motivated by the success in malaria control that was documented over the last decade Ethiopia is aiming at malaria elimination by 2020 in selected districts. It is currently unknown if asymptomatic, submicroscopic malaria parasite carriage may form a hurdle to achieve elimination. The elimination effort may further be complicated by possible glucose-6 phosphate dehydrogenase (G6PD) deficiency which would hinder the use of 8-aminoquinolines in the elimination efforts. METHOD In February 2014 a community-based cross-sectional survey was conducted in Malo, southwest Ethiopia. Finger-prick blood samples (n = 555) were tested for presence of Plasmodium falciparum and Plasmodium vivax with microscopy, rapid diagnostic test (RDT), and nested polymerase chain reaction (nPCR). Multiplicity of P. falciparum infections was determined based on genotyping the polymorphic merozoite surface protein-2 (MSP-2) gene. Individuals were also genotyped for mutations in the gene that produces G6PD. RESULTS All study participants were malaria infection negative by microscopy and RDT. Nested PCR revealed P. falciparum mono-infection in 5.2% (29/555), P. vivax mono-infection in 4.3% (24/555) and mixed infection in 0.2% (1/555) of individuals. All parasitemic individuals were afebrile (axillary temperature <37.5°C). None of the study participants carried mutations for the G6PD African A-(202GA) and Mediterranean (563CT) variants. All infections, except one, were single-clone infection by MSP-2 genotyping. CONCLUSION The detection of a substantial number of subpatent malaria infections in an apparently asymptomatic population without evidence for malaria transmission by conventional diagnostics raises questions about the path to malaria elimination. It is currently unknown how important these infections are for sustaining malaria transmission in the study sites. The absence of G6PD deficiency indicates that 8-aminoquinolines may be safely deployed to accelerate elimination initiatives.
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Affiliation(s)
- Fitsum G Tadesse
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein 26-28, 6525GA, Nijmegen, The Netherlands.
- Medical Biotechnology Unit, Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia.
| | - Helmi Pett
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein 26-28, 6525GA, Nijmegen, The Netherlands.
| | - Amrish Baidjoe
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein 26-28, 6525GA, Nijmegen, The Netherlands.
| | - Kjerstin Lanke
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein 26-28, 6525GA, Nijmegen, The Netherlands.
| | - Lynn Grignard
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Colin Sutherland
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Tom Hall
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Chris Drakeley
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein 26-28, 6525GA, Nijmegen, The Netherlands.
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia.
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Port JR, Nguetse C, Adukpo S, Velavan TP. A reliable and rapid method for molecular detection of malarial parasites using microwave irradiation and loop mediated isothermal amplification. Malar J 2014; 13:454. [PMID: 25421401 PMCID: PMC4256729 DOI: 10.1186/1475-2875-13-454] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background Improved living conditions together with appropriate diagnosis can reduce avoidable malarial deaths substantially. Microscopy remains the gold standard in the diagnosis of malaria. However, rapid molecular diagnostic tests (RmDT) are becoming increasingly important and will, most likely, be the diagnostic techniques of choice in the next years. Methods In this study, a rapid and reliable nucleic acid extraction procedure from human blood and malarial parasites using microwave irradiation as a promising platform is described. In addition, a tailored loop mediated isothermal amplification (LAMP) methodology that utilizes hydroxynaphthol blue (HNB) and Bst 2.0 DNA polymerases in molecular detection of malarial parasites is described. Results Following microwave irradiation for DNA isolation, conventional PCR assays were able to detect up to five malaria parasites/μl. The LAMP methodology described here was capable to detect as low as one Plasmodium falciparum parasite/μl after DNA extraction by microwave irradiation. A turnover time of 45 minutes from nucleic acid extraction to final visual read-out was achieved. Conclusions The described procedure offers a cheap, simple and fast method of molecular detection of malaria parasites. This test can easily be performed in basic laboratories. The methodology has been validated as a proof of concept and has specifically be developed for use at low-resource settings. Such RmDTs may aid health providers to make timely therapeutic interventions in malaria endemic regions.
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Affiliation(s)
| | | | | | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, University of Tübingen, Wilhelmstrasse 27, 72074 Tübingen, Germany.
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Tajebe A, Magoma G, Aemero M, Kimani F. Detection of mixed infection level of Plasmodium falciparum and Plasmodium vivax by SYBR Green I-based real-time PCR in North Gondar, north-west Ethiopia. Malar J 2014; 13:411. [PMID: 25326079 PMCID: PMC4210478 DOI: 10.1186/1475-2875-13-411] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/09/2014] [Indexed: 11/21/2022] Open
Abstract
Background Malaria is caused by five Plasmodium species and transmitted by anopheline mosquitoes. It occurs in single and mixed infections. Mixed infection easily leads to misdiagnosis. Accurate detection of malaria species is vital. Therefore, the study was conducted to determine the level of mixed infection and misdiagnosis of malaria species in the study area using SYBR Green I-based real time PCR. Methods The study was conducted in seven health centres from North Gondar, north-west Ethiopia. The data of all febrile patients, who attended the outpatient department for malaria diagnosis, from October to December 2013, was recorded. Dried blood spots were prepared from 168 positive samples for molecular re-evaluation. Parasite DNA was extracted using a commercial kit and Plasmodium species were re-evaluated with SYBR Green I-based real time PCR to detect mixed infections and misdiagnosed mono-infections. Results Among 7343 patients who were diagnosed for malaria in six study sites within the second quarter of the Ethiopian fiscal year (2013) 1802 (24.54%) were positive for malaria parasite. Out of this, 1,216 (67.48%) Plasmodium falciparum, 553 (30.68%) Plasmodium vivax and 33 (1.8%) mixed infections of both species were recorded. The result showed high prevalence of P. falciparum and P. vivax, but very low prevalence of mixed infections. Among 168 samples collected on dried blood spot 7 (4.17%) were P. vivax, 158 (94.05%) were P. falciparum and 3 (1.80%) were mixed infections of both species. After re-evaluation 10 (5.95%) P. vivax, 112 (66.67%) P. falciparum, 21 (12.50%) P. falciparum + P. vivax mixed infection, and 17 (10.12%) Plasmodium ovale positive rate was recorded. The re-evaluation showed high level of mixed infection, and misdiagnosis of P. ovale and P. vivax. Conclusions The result shows that P. falciparum prevalence is higher than P. vivax in the study area. The results, obtained from SYBR Green I-based real time PCR, indicated that the diagnosis efficiency of microscopy is very low for species-specific and mixed infection detection. Therefore, real time PCR-based species diagnosis should be applied for clinical diagnosis and quality control purposes in order to prevent the advent of drug resistant strains due to misdiagnosis and mistreatment.
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Affiliation(s)
- Addimas Tajebe
- Pan African University Institute for Basic Sciences Innovation and Technology JKUAT, P,O, Box 62000-00200, Nairobi, Kenya.
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Mekonnen SK, Aseffa A, Berhe N, Teklehaymanot T, Clouse RM, Gebru T, Medhin G, Velavan TP. Return of chloroquine-sensitive Plasmodium falciparum parasites and emergence of chloroquine-resistant Plasmodium vivax in Ethiopia. Malar J 2014; 13:244. [PMID: 24964730 PMCID: PMC4230645 DOI: 10.1186/1475-2875-13-244] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/19/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Increased resistance by Plasmodium falciparum parasites led to the withdrawal of the antimalarial drugs chloroquine and sulphadoxine-pyrimethamine in Ethiopia. Since 2004 artemether-lumefantrine has served to treat uncomplicated P. falciparum malaria. However, increasing reports on delayed parasite clearance to artemisinin opens up a new challenge in anti-malarial therapy. With the complete withdrawal of CQ for the treatment of Plasmodium falciparum malaria, this study assessed the evolution of CQ resistance by investigating the prevalence of mutant alleles in the pfmdr1 and pfcrt genes in P. falciparum and pvmdr1 gene in Plasmodium vivax in Southern and Eastern Ethiopia. METHODS Of the 1,416 febrile patients attending primary health facilities in Southern Ethiopia, 329 febrile patients positive for P. falciparum or P. vivax were recruited. Similarly of the 1,304 febrile patients from Eastern Ethiopia, 81 febrile patients positive for P. falciparum or P. vivax were included in the study. Of the 410 finger prick blood samples collected from malaria patients, we used direct sequencing to investigate the prevalence of mutations in pfcrt and pfmdr1. This included determining the gene copy number in pfmdr1 in 195 P. falciparum clinical isolates, and mutations in the pvmdr1 locus in 215 P. vivax clinical isolates. RESULTS The pfcrt K76 CQ-sensitive allele was observed in 84.1% of the investigated P.falciparum clinical isolates. The pfcrt double mutations (K76T and C72S) were observed less than 3%. The pfcrt SVMNT haplotype was also found to be present in clinical isolates from Ethiopia. The pfcrt CVMNK-sensitive haplotypes were frequently observed (95.9%). The pfmdr1 mutation N86Y was observed only in 14.9% compared to 85.1% of the clinical isolates that carried sensitive alleles. Also, the sensitive pfmdr1 Y184 allele was more common, in 94.9% of clinical isolates. None of the investigated P. falciparum clinical isolates carried S1034C, N1042D and D1246Y pfmdr1 polymorphisms. All investigated P. falciparum clinical isolates from Southern and Eastern Ethiopia carried only a single copy of the mutant pfmdr1 gene. CONCLUSION The study reports for the first time the return of chloroquine sensitive P. falciparum in Ethiopia. These findings support the rationale for the use of CQ-based combination drugs as a possible future alternative.
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