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Orimadegun AE, Dada-Adegbola HO, Michael OS, Adepoju AA, Funwei RI, Olusola FI, Ajayi IO, Ogunkunle OO, Ademowo OG, Jegede AS, Baba E, Hamade P, Webster J, Chandramohan D, Falade CO. SD-Bioline malaria rapid diagnostic test performance and time to become negative after treatment of malaria infection in Southwest Nigerian Children. Ann Afr Med 2023; 22:470-480. [PMID: 38358148 PMCID: PMC10775936 DOI: 10.4103/aam.aam_220_21] [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: 10/18/2021] [Revised: 10/10/2022] [Accepted: 12/09/2022] [Indexed: 02/16/2024] Open
Abstract
Context and Aim Given the challenges of microscopy, we compared its performance with SD-Bioline malaria rapid diagnostic test (MRDT) and polymerase chain reaction (PCR) and evaluated the time it took for positive results to become negative after treatment of children with acute uncomplicated malaria. Subjects and Methods We present the report of 485 participants with complete MRDT, microscopy, and PCR data out of 511 febrile children aged 3-59 months who participated in a cohort study over a 12-month period in rural and urban areas of Ibadan, Nigeria. MRDT-positive children received antimalaria and tested at every visit over 28 days. Speciation was also carried out by PCR. Results With microscopy as the gold standard, SD-Bioline™ had 95.2% sensitivity, 66.4% specificity, 67.5% positive predictive value (PPV), and 94.9 negative predictive value (NPV), while with PCR the findings were 84.3% sensitivity, 66.5% specificity, 72.7% PPV, and 80.1% NPV. PCR speciation of malaria parasites revealed 91.6% Plasmodium falciparum, 18.9% Plasmodium malariae, and 4.4% Plasmodium ovale. Among the 47 children with P. malariae infections, 66.0% were coinfected with P. falciparum, while 54.6% cases of P. ovale occurred as coinfections with P. falciparum. The median time to a negative MRDT was 23.2 days, while the median time to a negative malaria microscopy was 3.8 days. The two survival curves were significantly different. Conclusions The SD-BiolineTM MRDT performed well, with remarkable persistence of rapid test-positive for an average of 23 days post treatment. The prevalence of P. malaria is somewhat greater than expected.
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Affiliation(s)
| | | | - Obaro S. Michael
- Department of Pharmacology and Therapeutics, College of Medicine, Ibadan, Nigeria
| | | | | | | | - IkeOluwapo O. Ajayi
- Department of Epidemiology and Biostatistics, College of Medicine, Ibadan, Nigeria
| | | | - Olusegun George Ademowo
- Department of Pharmacology and Therapeutics, College of Medicine, Ibadan, Nigeria
- Institute for Advanced Medical Research and Training, College of Medicine, Ibadan, Nigeria
| | - Ayodele Samuel Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Ebenezer Baba
- Malaria Consortium Regional Office for Africa, Kampala, Uganda
| | | | - Jayne Webster
- London School of Tropical Medicine and Hygiene, London, United Kingdom
| | | | - Catherine Olufunke Falade
- Department of Pharmacology and Therapeutics, College of Medicine, Ibadan, Nigeria
- Institute for Advanced Medical Research and Training, College of Medicine, Ibadan, Nigeria
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Singh K, Bharti PK, Devi NC, Ahmed N, Sharma A. Plasmodium malariae Detected by Microscopy in the International Bordering Area of Mizoram, a Northeastern State of India. Diagnostics (Basel) 2022; 12:diagnostics12082015. [PMID: 36010365 PMCID: PMC9407229 DOI: 10.3390/diagnostics12082015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Northeastern states of India share international borders with Myanmar, China, Bangladesh, and Bhutan, contributing 7.45% of the overall malaria cases in the country. Mizoram accounts for the highest malaria burden in the northeastern states, with perennial transmission in the hilly and deep-forested areas. Plasmodium falciparum (93%) is the most prevalent human Plasmodium species, followed by P. vivax; however, information on P. ovale and P. malariae is negligible. Rapid diagnostic tests (RDTs) are the most preferred malaria diagnostic tool followed by microscopy in this high malaria-endemic region. The present epidemiological study was carried out in July and August 2019 to assess the malaria burden in and around the Chawngte primary health center, Lawngtlai District of Mizoram, using RDTs and microscopy as diagnostic tools. World Health Organization-certified level I microscopists examined the blood smears. Diagnosis using RDTs resulted in 151 malaria cases (P. falciparum: 136; P. vivax: 15) out of 948 screened fever cases. However, blood smear examination detected 179 cases (P. falciparum: 154; P. vivax: 17; mixed P. falciparum + P. vivax infection: 3; P. malariae: 5). Analysis revealed that the risk of malaria infection was higher in the ≥5-year-old subjects than in the under-5 age group. The mean parasite density of P. malariae (1455.00/μL blood) was the lowest; cf. with P. falciparum: 12,275.08/μL blood. Surveillance at the point-of-care level using microscopy was able to detect all the four human Plasmodium species and their mixed infections, including P. malariae, which were missed with RDTs. Thus, the quality of microscopy along with trained manpower should be strengthened to diagnose all human malaria parasite species (particularly P. malariae and P. ovale) until the molecular tools are deployed at the field level to achieve malaria elimination by 2030.
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Affiliation(s)
- Kuldeep Singh
- ICMR—National Institute of Malaria Research, Field Station, Guwahati 781005, India
- Correspondence:
| | | | - Naorem Chaoba Devi
- ICMR—National Institute of Malaria Research, Field Station, Guwahati 781005, India
| | - Naseem Ahmed
- ICMR—National Institute of Malaria Research, New Delhi 110077, India
| | - Amit Sharma
- ICMR—National Institute of Malaria Research, New Delhi 110077, India
- International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
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Rahi M, Sharma A. Malaria control initiatives that have the potential to be gamechangers in India's quest for malaria elimination. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 2:100009. [PMID: 37383297 PMCID: PMC10306036 DOI: 10.1016/j.lansea.2022.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Malaria continues to have devastating effect on people's lives especially in developing countries. India is slated for malaria elimination by 2030. Though India has sustained a decline in malaria burden at the national level the epidemiological picture remains heterogenous. India's road to malaria elimination plan is riddled with many roadblocks. Major challenges include insufficient surveillance, slow and aggregated data reporting especially in exigent situations like cross-border areas and vulnerable high-risk groups. More than half of total malaria cases were due to Plasmodium vivax (P. vivax) in India as reported by national malaria control programme in 2019. This translates into substantial burden of P. vivax malaria in absolute numbers. P. vivax malaria, which is difficult to resolve as compared to other species, poses a threat to India's elimination plans by virtue of its tendency to develop hypnozoites, due to poor compliance to primaquine (PQ), due to host factors like G 6 PD deficiency and other genes that affect PQ metabolism. Also, India's malaria endemic areas largely coincide geographically with tribal regions which are poor in healthcare infrastructure. The tribal population disproportionately bears a huge burden of malaria. They also harbour more G6PD deficient individuals than non-tribal regions. Therefore, in addition to inadequate diagnostic facilities (for both malaria and G6PD testing) these remote rural and tribal communities suffer from lack of timely treatment, incomplete radical treatment due to poor compliance and thus repeated episodes of P. vivax due to relapses and/or reinfections. Another challenge is that the the current diagnostic tools in the national programme in India and other countries are mostly available only via the programme and are able to detect patent infections on the whole. These therefore miss low-density infections which are another major limitation for their use in malaria endemic countries. Drug and insecticide resistance need to be constantly monitored as they have direct impact on the efficacy of the current tools. Need for better vector control products for the diverse entomological requirements is also felt. India is the second most populous country in the world with majority of its population at risk of malaria. Despite many agencies (government and non-government) working in the field of malaria, there needs to be more synergy at the local or central level for malaria control. Here, we have proposed solutions for specific facets of the malaria programme. Surveillance, data visualization and analysis can all be supported through over the counter availability of rapid diagnostics, adoption of molecular tools like PCR (requiring additional infrastructure and expertise), mobile applications for data capture and use of malaria data dashboard. Management could be augmented by inclusion of tafenoquine for treatment of P. vivax malaria with a companion point-of care diagnostic which has been developed to assess G6PD enzyme activity. A switchover to artemether-lumefantrine for the entire country can also be considered. Vector control can be strengthened by commercial availability of insecticidal bednets and exploration of novel vector control tools like ivermectin. Lastly, enhancing synergy amongst various stakeholders would also catalyze the malaria elimination plans. Funding The authors have received no funding for this paper.
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Affiliation(s)
- Manju Rahi
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research (ICMR), New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Amit Sharma
- Academy of Scientific and Innovative Research, Ghaziabad, India
- ICMR-National Institute of Malaria Research, New Delhi, India
- Molecular Medicine, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Deora N, Yadav C, Pande V, Sinha A. A systematic review and meta-analysis on sub-microscopic Plasmodium infections in India: Different perspectives and global challenges. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 2:100012. [PMID: 37383294 PMCID: PMC10305983 DOI: 10.1016/j.lansea.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background The long-term maintenance of parasite biomass below the detection threshold of microscopy may stymie malaria elimination. Variation in microscopists' competencies to detect and correctly identify parasite species reflect in microscopy sensitivity, resulting in incorrect species-specific burden. Methods The study estimated Plasmodium SMI pooled burden from published reports using a random effect model & identifies their hotspots in India. The study applied a prediction model for the first time on Indian data, emphasizing the importance of such models that can predict PCR-prevalence from slide- prevalence. Findings A total of 17,449 samples from 39 districts were examined for Plasmodium by microscopy and PCR. The overall heterogeneity in clinic-based and community-based studies was 91% and 96%, respectively, with the pooled prevalence of 3.63%. The SMI prevalence in individual studies ranged from 38.4% to 0.4%. Sensitivity of microscopy for mono-P. vivax (91%) was found to be better than mono-P. falciparum (82 %). But surprisingly, it was much lower for mixed PfPv (45%). Interpretation Primary regional data in the form of SMIs hot spots should be generated from countries on the verge of malaria elimination, and genetic monitoring should be integrated into national programs, particularly in key areas for successful malaria elimination. Funding Not applicable.
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Affiliation(s)
- Nimita Deora
- ICMR-National Institute of Malaria Research, New Delhi, India
- Department of Biotechnology, Kumaun University, Nainital, Uttarakhand, India
| | - C.P. Yadav
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Veena Pande
- Department of Biotechnology, Kumaun University, Nainital, Uttarakhand, India
| | - Abhinav Sinha
- ICMR-National Institute of Malaria Research, New Delhi, India
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Pasaribu AP, Nasution IS, Sembiring K, Fahmi F, Pasaribu S. Comparison of the performance of the CareStart Malaria Pf/Pan Combo test and field microscopy in the diagnosis of Plasmodium vivax malaria in North Sumatera, Indonesia. Malar J 2022; 21:27. [PMID: 35093067 PMCID: PMC8800299 DOI: 10.1186/s12936-022-04057-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background In areas where malaria is endemic and where trained microscopists are not available, rapid diagnostic tests (RDTs) are needed not only to allow prompt treatment without delay but also to prevent overdiagnosis and overtreatment based on clinical judgements that may lead to drug resistance. This study aimed to compare the performances of the CareStart Pf/Pan Combo test to field microscopy, which is considered to be the gold standard for malaria diagnosis. Methods Any person with a fever or a history of fever within 48 h who came to the health centre was recruited for the study and tested both by the CareStart Pf/Pan test and by field microscopy. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were analysed with both methods. Results Two-hundred study participants were enrolled: 96 (48%) were found to be positive through microscopy, while 100 (50%) participants were found to be positive through RDT. The RDT produced four false-positive results. High sensitivity and specificity were observed for the CareStart Pf/Pan test (100 and 96.15%, respectively). The CareStart Pf/Pan test also showed excellent agreement with the field microscopy results. Conclusion The Carestart Pf/Pan could be used as an alternative diagnostic test in malaria-endemic areas where facility for performing microscopy is not available.
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Abstract
BACKGROUND Plasmodium vivax (P vivax) is a focus of malaria elimination. It is important because P vivax and Plasmodium falciparum infection are co-endemic in some areas. There are asymptomatic carriers of P vivax, and the treatment for P vivax and Plasmodium ovale malaria differs from that used in other types of malaria. Rapid diagnostic tests (RDTs) will help distinguish P vivax from other malaria species to help treatment and elimination. There are RDTs available that detect P vivax parasitaemia through the detection of P vivax-specific lactate dehydrogenase (LDH) antigens. OBJECTIVES To assess the diagnostic accuracy of RDTs for detecting P vivax malaria infection in people living in malaria-endemic areas who present to ambulatory healthcare facilities with symptoms suggestive of malaria; and to identify which types and brands of commercial tests best detect P vivax malaria. SEARCH METHODS We undertook a comprehensive search of the following databases up to 30 July 2019: Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (OVID); Science Citation Index Expanded (SCI-EXPANDED) and Conference Proceedings Citation Index-Science (CPCI-S), both in the Web of Science. SELECTION CRITERIA Studies comparing RDTs with a reference standard (microscopy or polymerase chain reaction (PCR)) in blood samples from patients attending ambulatory health facilities with symptoms suggestive of malaria in P vivax-endemic areas. DATA COLLECTION AND ANALYSIS For each included study, two review authors independently extracted data using a pre-piloted data extraction form. The methodological quality of the studies were assessed using a tailored Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. We grouped studies according to commercial brand of the RDT and performed meta-analysis when appropriate. The results given by the index tests were based on the antibody affinity (referred to as the strength of the bond between an antibody and an antigen) and avidity (referred to as the strength of the overall bond between a multivalent antibody and multiple antigens). All analyses were stratified by the type of reference standard. The bivariate model was used to estimate the pooled sensitivity and specificity with 95% confidence intervals (CIs), this model was simplified when studies were few. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 10 studies that assessed the accuracy of six different RDT brands (CareStart Malaria Pf/Pv Combo test, Falcivax Device Rapid test, Immuno-Rapid Malaria Pf/Pv test, SD Bioline Malaria Ag Pf/Pv test, OnSite Pf/Pv test and Test Malaria Pf/Pv rapid test) for detecting P vivax malaria. One study directly compared the accuracy of two RDT brands. Of the 10 studies, six used microscopy, one used PCR, two used both microscopy and PCR separately and one used microscopy corrected by PCR as the reference standard. Four of the studies were conducted in Ethiopia, two in India, and one each in Bangladesh, Brazil, Colombia and Sudan. The studies often did not report how patients were selected. In the patient selection domain, we judged the risk of bias as unclear for nine studies. We judged all studies to be of unclear applicability concern. In the index test domain, we judged most studies to be at low risk of bias, but we judged nine studies to be of unclear applicability concern. There was poor reporting on lot testing, how the RDTs were stored, and background parasitaemia density (a key variable determining diagnostic accuracy of RDTs). Only half of the included studies were judged to be at low risk of bias in the reference standard domain, Studies often did not report whether the results of the reference standard could classify the target condition or whether investigators knew the results of the RDT when interpreting the results of the reference standard. All 10 studies were judged to be at low risk of bias in the flow and timing domain. Only two brands were evaluated by more than one study. Four studies evaluated the CareStart Malaria Pf/Pv Combo test against microscopy and two studies evaluated the Falcivax Device Rapid test against microscopy. The pooled sensitivity and specificity were 99% (95% CI 94% to 100%; 251 patients, moderate-certainty evidence) and 99% (95% CI 99% to 100%; 2147 patients, moderate-certainty evidence) for CareStart Malaria Pf/Pv Combo test. For a prevalence of 20%, about 206 people will have a positive CareStart Malaria Pf/Pv Combo test result and the remaining 794 people will have a negative result. Of the 206 people with positive results, eight will be incorrect (false positives), and of the 794 people with a negative result, two would be incorrect (false negative). For the Falcivax Device Rapid test, the pooled sensitivity was 77% (95% CI: 53% to 91%, 89 patients, low-certainty evidence) and the pooled specificity was 99% (95% CI: 98% to 100%, 621 patients, moderate-certainty evidence), respectively. For a prevalence of 20%, about 162 people will have a positive Falcivax Device Rapid test result and the remaining 838 people will have a negative result. Of the 162 people with positive results, eight will be incorrect (false positives), and of the 838 people with a negative result, 46 would be incorrect (false negative). AUTHORS' CONCLUSIONS The CareStart Malaria Pf/Pv Combo test was found to be highly sensitive and specific in comparison to microscopy for detecting P vivax in ambulatory healthcare in endemic settings, with moderate-certainty evidence. The number of studies included in this review was limited to 10 studies and we were able to estimate the accuracy of 2 out of 6 RDT brands included, the CareStart Malaria Pf/Pv Combo test and the Falcivax Device Rapid test. Thus, the differences in sensitivity and specificity between all the RDT brands could not be assessed. More high-quality studies in endemic field settings are needed to assess and compare the accuracy of RDTs designed to detect P vivax.
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Affiliation(s)
- Ridhi Agarwal
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Leslie Choi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Samuel Johnson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Alemayehu GS, Lopez K, Dieng CC, Lo E, Janies D, Golassa L. Evaluation of PfHRP2 and PfLDH Malaria Rapid Diagnostic Test Performance in Assosa Zone, Ethiopia. Am J Trop Med Hyg 2020; 103:1902-1909. [PMID: 32840197 PMCID: PMC7646789 DOI: 10.4269/ajtmh.20-0485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/26/2020] [Indexed: 11/07/2022] Open
Abstract
In malaria-endemic countries, rapid diagnostic tests (RDTs) targeting Plasmodium falciparum histidine-rich protein 2 (PfHRP2) and lactate dehydrogenase (PfLDH) have been widely used. However, little is known regarding the diagnostic performances of these RDTs in the Assosa zone of northwest Ethiopia. The objective of this study was to determine the diagnostic performances of PfHRP2 and PfLDH RDTs using microscopy and quantitative PCR (qPCR) as a reference test. A health facility-based cross-sectional study design was conducted from malaria-suspected study participants at selected health centers from November to December 2018. Finger-prick blood samples were collected for microscopy, RDTs, and qPCR method. The prevalence of P. falciparum was 26.4%, 30.3%, and 24.1% as determined by microscopy, PfHRP2 RDT, and PfLDH RDT, respectively. Compared with microscopy, the sensitivity and specificity of the PfHRP2 RDT were 96% and 93%, respectively, and those of the PfLDH RDT were 89% and 99%, respectively. Compared with qPCR, the specificity of the PfHRP2 RDT (93%) and PfLDH RDT (98%) was high, but the sensitivity of the PfHRP2 RDT (77%) and PfLDH RDT (70%) was relatively low. These malaria RDTs and reference microscopy methods showed reasonable agreement with a kappa value above 0.85 and provided accurate diagnosis of P. falciparum malaria. Thus, the current malaria RDT in the Ministry of Health program can be used in the Assosa zone of Ethiopia. However, continuous monitoring of the performance of PfHRP2 RDT is important to support control and elimination of malaria in Ethiopia.
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Affiliation(s)
| | - Karen Lopez
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Cheikh Cambel Dieng
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Eugenia Lo
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Daniel Janies
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Pati P, Dhangadamajhi G, Bal M, Ranjit M. High proportions of pfhrp2 gene deletion and performance of HRP2-based rapid diagnostic test in Plasmodium falciparum field isolates of Odisha. Malar J 2018; 17:394. [PMID: 30373573 PMCID: PMC6206925 DOI: 10.1186/s12936-018-2502-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/03/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND With the documentation of cases of falciparum malaria negative by rapid diagnostic tests (RDT), though at low frequency from natural isolates in a small pocket of Odisha, it became absolutely necessary to investigate the status of HRP-2 based RDT throughout the state and in different seasons of the year. METHODS Suspected individuals were screened for malaria infection by microscopy and RDT in 25/30 districts of Odisha, India. Discrepancies in results were confirmed by PCR. False negative RDT samples for Plasmodium falciparum mono-infection were evaluated for detection of HRP2 antigen in ELISA and genotyped for pfhrp2, pfhrp3 and their flanking genes. Multiplicity of infection was ascertained based on msp1 and msp2 genotyping and parasitaemia level was determined by microscopy. RESULTS Of the total 1058 patients suspected for malaria, 384 were microscopically confirmed for P. falciparum mono-infection and RDT failure was observed in 58 samples at varying proportion in different regions of the state. The failure in detection was due to undetectable level of HRP-2. Although most of these samples were screened during rainy season (45/345), significantly high proportion (9/17) of RDT negative samples were obtained during the summer compared to rainy season (P = 0.0002; OR = 7.5). PCR genotyping of pfhrp2 and pfhrp3 in RDT negative samples showed 38/58 (65.5) samples to be pfhrp2 negative and 24/58 (41.4) to be pfhrp3 negative including dual negative in 17/58 (29.3). Most of the RDT negative samples (39/58) were with single genotype infection and high proportions of pfhrp2 deletion (7/9) was observed in summer. No difference in parasitaemia level was observed between RDT positive and RDT negative patients. CONCLUSION High prevalence of parasites with pfhrp2 deletion including dual deletions (pfhrp2 and pfhrp3) is a serious cause of concern, as these patients could not be given a correct diagnosis and treatment. Therefore, HRP2-based RDT for diagnosing P. falciparum infection in Odisha is non-reliable and must be performed in addition to or replaced by other appropriate diagnostic tools for clinical management of the disease.
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Affiliation(s)
- Pallabi Pati
- Molecular Epidemiology Laboratory, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India
| | | | - Madhusmita Bal
- Immunology Laboratory, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India
| | - Manoranjan Ranjit
- Molecular Epidemiology Laboratory, ICMR-Regional Medical Research Centre, Bhubaneswar, 751023, India.
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Nderu D, Kimani F, Thiong'o K, Akinyi M, Karanja E, Meyer CG, Velavan TP. PfHRP2-PfHRP3 diversity among Kenyan isolates and comparative evaluation of PfHRP2/pLDH malaria RDT with microscopy and nested PCR methodologies. Parasitol Int 2018; 67:793-799. [PMID: 30138695 DOI: 10.1016/j.parint.2018.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/08/2018] [Accepted: 08/18/2018] [Indexed: 01/24/2023]
Abstract
Rapid diagnostic tests (RDT) are valuable tools that support prudent and timely use of antimalarial drugs, particularly if reliable microscopy is not available. However, the performance and reliability of these tests vary between and within geographical regions. The present study evaluated the performance of routine malaria RDT in Kenyan febrile patients in Busia County, Kenya. A cross sectional study design was employed to recruit febrile patients attending health facilities between August and November 2016. A total of 192 febrile patients who were slide positive and negative were evaluated for their infection status by nested PCR and RDTs (PfHRP2/pLDH). In addition, P. falciparum diversity of the histidine-rich proteins 2 and 3, that influences the RDT test results were determined. All individuals were P. falciparum positive. Among the investigated 192 febrile patients, 76 (40%) were positive by microscopy, 101 (53%) by RDTs and 80 (42%) were PCR positive. The performance of the CareStart™ HRP2/pLDH (pf) RDTs was better than microscopy (Sensitivity 94%; Specificity 75%) and Nucleic acid testing (sensitivity 95%, specificity 77%) with high negative predictive values, indicating the suitability of the RDT in routine practice. Specific pfhrp2/pfhrp3 deletions shown to associate with RDT false negativity was not observed. However, high genetic diversity among pfhrp2 gene was observed. Eleven new PfHRP2 and nine PfHRP3 repeats were observed. False positivity by microscopy and under reporting of infections may thus be a barrier in malaria control and elimination programs. The HRP2/pLDH(Pf) based RDT yet demonstrate to be an effective tool for malaria surveillance program.
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Affiliation(s)
- David Nderu
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; School of Health Sciences, Kirinyaga University, 10300 Kerugoya, Kenya
| | - Francis Kimani
- Center for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kelvin Thiong'o
- Center for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maureen Akinyi
- Center for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Evaline Karanja
- Department of Biochemistry and Biotechnology, School of Biological and Life Sciences, Technical University of Kenya, Nairobi, Kenya
| | - Christian G Meyer
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Vietnamese-German Centre for Medical Research (VG-CARE), Hanoi, Viet Nam; Faculty of Medicine, Duy Tan University, Da Nang, Viet Nam
| | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Vietnamese-German Centre for Medical Research (VG-CARE), Hanoi, Viet Nam; Faculty of Medicine, Duy Tan University, Da Nang, Viet Nam; Fondation Congolaise pour la Recherche Médicale, Brazzaville, Congo.
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Momčilović S, Cantacessi C, Arsić-Arsenijević V, Otranto D, Tasić-Otašević S. Rapid diagnosis of parasitic diseases: current scenario and future needs. Clin Microbiol Infect 2018; 25:290-309. [PMID: 29730224 DOI: 10.1016/j.cmi.2018.04.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Parasitic diseases are one of the world's most devastating and prevalent infections, causing millions of morbidities and mortalities annually. In the past, many of these infections have been linked predominantly to tropical or subtropical areas. Nowadays, however, climatic and vector ecology changes, a significant increase in international travel, armed conflicts, and migration of humans and animals have influenced the transmission of some parasitic diseases from 'book pages' to reality in developed countries. It has also been noted that many patients who have never travelled to endemic areas suffer from blood-borne infections caused by protozoa. In the light of existing knowledge, this new trend can be explained by the fact that in the process of migration a large number of asymptomatic carriers become a part of the blood bank donor and transplant donor populations. Accurate and rapid diagnosis represents the crucial weapon in the fight against parasitic infections. AIMS To review old and new approaches for rapid diagnosis of parasitic infections. SOURCES Data for this review were obtained through searches of PubMed using combinations of the following terms: parasitological diagnostics, microscopy, lateral flow assays, immunochromatographic assays, multiplex-PCR, and transplantation. CONTENT In this review, we provide a brief account of the advantages and limitations of rapid methods for diagnosis of parasitic diseases and focus our attention on current and future research in this area. The approximate costs associated with the use of different techniques and their applicability in endemic and non-endemic areas are also discussed. IMPLICATIONS Microscopy remains the cornerstone of parasitological diagnostics, especially in the field and low-resource settings, and provides epidemiological assessment of parasite burden. However, increased use and availability of point-of-care tests and molecular assays in modern era allow more rapid and accurate diagnoses and increased sensitivity in the identification of parasitic infections.
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Affiliation(s)
- S Momčilović
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Serbia.
| | - C Cantacessi
- Department of Veterinary Medicine, University of Cambridge, UK
| | - V Arsić-Arsenijević
- Department for Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Serbia
| | - D Otranto
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Italy
| | - S Tasić-Otašević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Serbia; Center of Microbiology and Parasitology, Public Health Institute Niš, Serbia
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Kaur H, Sehgal R, Bansal D, Sultan AA, Bhalla A, Singhi SC. Development of Visually Improved Loop Mediated Isothermal Amplification for the Diagnosis of Plasmodium vivax Malaria in a Tertiary Hospital in Chandigarh, North India. Am J Trop Med Hyg 2018; 98:1374-1381. [PMID: 29557335 DOI: 10.4269/ajtmh.17-0857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
More than 80% of the global burden of the Plasmodium vivax is contributed by mainly three countries (India, Indonesia, and Pakistan). Reports from last decades have highlighted the occurrence of severe P. vivax malaria which was earlier considered to be benign. The recent trends of increasing P. vivax-associated morbidity and mortality emphasizes the need for early and accurate diagnosis of P. vivax malaria for the timely management of patients. Microscopy is considered a gold standard but needs experienced laboratory technologists. Over the last few years, Polymerase chain reaction (PCR) is being used as a highly sensitive and specific test but it requires expensive equipment which limits its use in the field. Therefore, in the present study, utility of visually improved loop-mediated isothermal amplification (LAMP) for the detection of P. vivax was evaluated targeting 18SrRNA gene in 145 microscopically confirmed P. vivax and 20 P. vivax negative patients. Sensitivity and specificity of LAMP was assessed with respect to microscopy and multiplex nested PCR (nPCR). Results of the LAMP assay was also correlated with rapid diagnostic test, multiplex nPCR and real-time PCR results. Overall, sensitivity and specificity of P. vivax-specific LAMP compared with microscopy were found to be 100% and 85%, respectively. Furthermore, detection limit for LAMP was found to be 0.8 copies/μL and it was also able to detect three complicated cases of P. vivax which were missed by microscopy. This study showed a LAMP assay to be a rapid and very sensitive method for the early diagnosis of both complicated and uncomplicated P. vivax malaria.
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Affiliation(s)
- Hargobinder Kaur
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devendra Bansal
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Ali A Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunit C Singhi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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The Incidence of Current Infection with Different Human Malaria Species by Polymerase Chain Reaction for Diagnosis of Suspicious Malaria Patients on Elimination Region Sistan and Baluchistan Province, Southeast of Iran. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.58254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Singh US, Siwal N, Pande V, Das A. Can Mixed Parasite Infections Thwart Targeted Malaria Elimination Program in India? BIOMED RESEARCH INTERNATIONAL 2017; 2017:2847548. [PMID: 28900620 PMCID: PMC5576395 DOI: 10.1155/2017/2847548] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/09/2017] [Accepted: 07/13/2017] [Indexed: 12/31/2022]
Abstract
India is highly endemic to malaria with prevalence of all five species of human malaria parasites of Plasmodium genus. India is set for malaria elimination by 2030. Since cases of mixed Plasmodium species infections remain usually undetected but cause huge disease burden, in order to understand the distributional prevalence of both monospecies infections and mixed species infections in India, we collated published data on the differential infection incidences of the five different malaria parasites based on PCR diagnostic assay. About 11% of total cases were due to mixed species infection. Among several interesting observations on both single and mixed parasitic infections, incidences of Plasmodium falciparum monoinfection were found to be significantly higher than P. vivax monoinfection. Also, P. malariae seems to be emerging as a potential malaria threat in India. Putting all the facts together, it appears that the dream of achieving malaria elimination in India will not be completely successful without dealing with mixed species infection.
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Affiliation(s)
- Upasana Shyamsunder Singh
- Division of Genomic Epidemiology, ICMR-Centre for Research in Medical Entomology, No. 4, Sarojini Street, Chinna Chokkikulam, Madurai 625002, India
| | - Nisha Siwal
- Division of Genomic Epidemiology, ICMR-Centre for Research in Medical Entomology, No. 4, Sarojini Street, Chinna Chokkikulam, Madurai 625002, India
| | - Veena Pande
- Department of Biotechnology, Kumaun University, Nainital 263001, India
| | - Aparup Das
- Division of Genomic Epidemiology, ICMR-Centre for Research in Medical Entomology, No. 4, Sarojini Street, Chinna Chokkikulam, Madurai 625002, India
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Kumar Bharti P, Singh Chandel H, Krishna S, Nema S, Ahmad A, Udhayakumar V, Singh N. Sequence variation in Plasmodium falciparum Histidine Rich Proteins 2 and 3 in Indian isolates: Implications for Malaria Rapid Diagnostic Test Performance. Sci Rep 2017; 7:1308. [PMID: 28465622 PMCID: PMC5430971 DOI: 10.1038/s41598-017-01506-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/29/2017] [Indexed: 11/09/2022] Open
Abstract
Commercial malaria rapid diagnostic tests (RDTs) detect P. falciparum histidine rich protein 2 (PfHRP2) and cross react with PfHRP3, a structural homologue. Here, we analysed natural variations in PfHRP2 and PfHRP3 sequences from Indian isolates and correlated these variations with RDT reactivity. A total 1392 P. falciparum positive samples collected from eight endemic states were PCR amplified for Pfhrp2 and Pfhrp3 genes and were sequenced. The deduced protein sequences were analysed for repeat variations and correlated with RDT reactivity. Out of 1392 PCR amplified samples, a single sample was Pfhrp2 negative and two samples were Pfhrp3 negative. Complete Pfhrp2 and Pfhrp3 sequences were obtained for 769 samples and 750 samples, respectively. A total of 16 distinct repeat motifs were observed for Pfhrp2 and 11 for Pfhrp3, including some new repeat types. No correlation was found between variations in the size of Pfhrp2 repeat types 2 and 7, nor between any combinations of repeat motifs, and performance of a commercial RDT at low parasite densities. The findings suggest that sequence diversity in Pfhrp2 and Pfhrp3 genes in Indian isolates is not likely to negatively influence performance of currently used PfHRP2 RDTs.
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Affiliation(s)
- Praveen Kumar Bharti
- National Institute for Research in Tribal Health (NIRTH), Garha, Jabalpur, 482003, India
| | - Himanshu Singh Chandel
- National Institute for Research in Tribal Health (NIRTH), Garha, Jabalpur, 482003, India
| | - Sri Krishna
- National Institute for Research in Tribal Health (NIRTH), Garha, Jabalpur, 482003, India
| | - Shrikant Nema
- National Institute for Research in Tribal Health (NIRTH), Garha, Jabalpur, 482003, India
| | - Amreen Ahmad
- National Institute for Research in Tribal Health (NIRTH), Garha, Jabalpur, 482003, India
| | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, 30329, USA
| | - Neeru Singh
- National Institute for Research in Tribal Health (NIRTH), Garha, Jabalpur, 482003, India.
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Shukla MK, Singh N, Sharma RK, Barde PV. Utility of dengue NS1 antigen rapid diagnostic test for use in difficult to reach areas and its comparison with dengue NS1 ELISA and qRT-PCR. J Med Virol 2017; 89:1146-1150. [DOI: 10.1002/jmv.24764] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 10/12/2016] [Accepted: 12/22/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Mohan K. Shukla
- National Institute for Research in Tribal Health (ICMR); Jabalpur Madhya Pradesh India
| | - Neeru Singh
- National Institute for Research in Tribal Health (ICMR); Jabalpur Madhya Pradesh India
| | - Ravendra K. Sharma
- National Institute for Research in Tribal Health (ICMR); Jabalpur Madhya Pradesh India
| | - Pradip V. Barde
- National Institute for Research in Tribal Health (ICMR); Jabalpur Madhya Pradesh India
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Wanja EW, Kuya N, Moranga C, Hickman M, Johnson JD, Moseti C, Anova L, Ogutu B, Ohrt C. Field evaluation of diagnostic performance of malaria rapid diagnostic tests in western Kenya. Malar J 2016; 15:456. [PMID: 27604888 PMCID: PMC5015256 DOI: 10.1186/s12936-016-1508-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria continues to be a major burden in the endemic regions of Kenya. Health outcomes associated with case management are dependent on the use of appropriate diagnostic methods. Rapid diagnostic tests (RDTs) have provided an important tool to help implement the WHO recommended parasite-based diagnosis in regions where expert microscopy is not available. One of the questions that must be answered when implementing RDTs is whether these tests are useful in a specific endemic region, as well as the most appropriate RDT to use. Data on the sensitivity and specificity of RDT test kits is important information to help guide test selection by national malaria control programmes. METHODS This study evaluated the diagnostic performance of RDTs including First Response (FR), CareStart (CS), SD Bioline (SD), and Binax Now (BN). The performance of these malaria kits was compared to microscopy, the gold standard, for the detection of malaria parasites. The malaria RDTs were also compared to PCR which is a more sensitive reference test. Five-hundred participants were included in the study through community screening (50 %) and testing suspected malaria cases referred from health facilities. RESULTS Of the 500 participants recruited, 33 % were malaria positive by microscopy while 51.2 % were positive by PCR. Compared to microscopy, the sensitivity of eight RDTs to detect malaria parasites was 90.3-94.8 %, the specificity was 73.3-79.3 %, the positive predictive value was 62.2-68.8 %, and the negative predictive value was 94.3-96.8 %. Compared to PCR, the sensitivity of the RDTs to detect malaria parasites was 71.1-75.4 %, the specificity was 80.3-84.4 %, the positive predictive value was 80.3-83.3 %, and the negative predictive value was 73.7-76.1 %. The RDTs had a moderate measure of agreement with both microscopy (>80.1 %) and PCR (>77.6 %) with a κ > 0.6. CONCLUSION The performance of the evaluated RDTs using field samples was moderate; hence they can significantly improve the quality of malaria case management in endemic regions in Kenya by ensuring appropriate treatment of malaria positive individuals and avoiding indiscriminate use of anti-malarial drugs for parasite negative patients.
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Affiliation(s)
- Elizabeth W Wanja
- Malaria Diagnostics Centre, Kenya Medical Research Institute/United States Army Medical Research Unit, Kenya, Box 54, Kisumu, 40100, Kenya.
| | - Nickline Kuya
- Malaria Diagnostics Centre, Kenya Medical Research Institute/United States Army Medical Research Unit, Kenya, Box 54, Kisumu, 40100, Kenya
| | - Collins Moranga
- Malaria Diagnostics Centre, Kenya Medical Research Institute/United States Army Medical Research Unit, Kenya, Box 54, Kisumu, 40100, Kenya
| | - Mark Hickman
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Jacob D Johnson
- Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA, 98431, USA
| | - Carolyne Moseti
- Malaria Diagnostics Centre, Kenya Medical Research Institute/United States Army Medical Research Unit, Kenya, Box 54, Kisumu, 40100, Kenya
| | - Lalaine Anova
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Bernhards Ogutu
- Malaria Diagnostics Centre, Kenya Medical Research Institute/United States Army Medical Research Unit, Kenya, Box 54, Kisumu, 40100, Kenya
| | - Colin Ohrt
- Translational Medicine International, LLC, 35 Trung Van Road, Hanoi, Vietnam
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Singh N, Bharti PK, Kumre NS. Active v. passive surveillance for malaria in remote tribal belt of Central India: Implications for malaria elimination. Pathog Glob Health 2016; 110:178-84. [PMID: 27585412 DOI: 10.1080/20477724.2016.1223920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Balaghat district in Central India is characterized by perennial malaria transmission. In this study, we have estimated malaria parasite rates by microscopic examination of blood smears by conducting active (ACD) and passive surveillance (PCD) in the villages of Baihar community health center (CHC) during January 2012-December 2012. Comparison of the results of two methods revealed that ACD (active case detection) in villages provides relatively large numbers of malaria positive cases (1408/3601) as compared to PCD (passive case detection) at CHC (139/2743) (OR 12.03, 95% CI, 9.97-14.57, p < 0.0001). Similarly, large numbers of Plasmodium falciparum cases (1194) were found (SFR, 33.2%) in villages, while only 98 P. falciparum cases (SFR, 3.6%) were found at CHC (OR 13.39, 95% CI, 10.80-16.73, p < 0.0001). Likewise, Plasmodium vivax were 211 (SVR, 5.9%) in villages by ACD (OR 4.1, 95% CI, 2.91-5.9, p < 0.0001), while only 41 P. vivax (SVR, 1.5%) were found at CHC. In this cross-sectional study, we discussed the potential role of ACD in strengthening of surveillance for high coverage. For malaria elimination initiative, a surveillance system must be more sensitive than PCD along with effective tools for vector control to target high-risk population who are not visiting the health facility and seed transmission to the surrounding population. The study highlights the substantial difference in the malaria positivity rate by two methods in difficult and hard-to-reach areas and recommendations are made to understand how best to deploy ACD methods in the pursuit of malaria elimination.
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Affiliation(s)
- Neeru Singh
- a National Institute for Research in Tribal Health (NIRTH) , Indian Council of Medical Research (ICMR) , Jabalpur , India
| | - Praveen K Bharti
- a National Institute for Research in Tribal Health (NIRTH) , Indian Council of Medical Research (ICMR) , Jabalpur , India
| | - N S Kumre
- b Community Health Centre , Baihar, Balaghat , India
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Prevalence of pfhrp2 and/or pfhrp3 Gene Deletion in Plasmodium falciparum Population in Eight Highly Endemic States in India. PLoS One 2016; 11:e0157949. [PMID: 27518538 PMCID: PMC4982695 DOI: 10.1371/journal.pone.0157949] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/07/2016] [Indexed: 11/25/2022] Open
Abstract
Background Plasmodium falciparum encoded histidine rich protein (HRP2) based malaria rapid diagnostic tests (RDTs) are used in India. Deletion of pfhrp2 and pfhrp3 genes contributes to false negative test results, and large numbers of such deletions have been reported from South America, highlighting the importance of surveillance to detect such deletions. Methods This is the first prospective field study carried out at 16 sites located in eight endemic states of India to assess the performance of PfHRP2 based RDT kits used in the national malaria control programme. In this study, microscopically confirmed P. falciparum but RDT negative samples were assessed for presence of pfhrp2, pfhrp3, and their flanking genes using PCR. Results Among 1521 microscopically positive P. falciparum samples screened, 50 were negative by HRP2 based RDT test. Molecular testing was carried out using these 50 RDT negative samples by assuming that 1471 RDT positive samples carried pfhrp2 gene. It was found that 2.4% (36/1521) and 1.8% (27/1521) of samples were negative for pfhrp2 and pfhrp3 genes, respectively. However, the frequency of pfhrp2 deletions varied between the sites ranging from 0–25% (2.4, 95% CI; 1.6–3.3). The frequency of both pfhrp2 and pfhrp3 gene deletion varied from 0–8% (1.6, 95% CI; 1.0–2.4). Conclusion This study provides evidence for low level presence of pfhrp2 and pfhrp3 deleted P. falciparum parasites in different endemic regions of India, and periodic surveillance is warranted for reliable use of PfHRP2 based RDTs.
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Nair CB, Manjula J, Subramani PA, Nagendrappa PB, Manoj MN, Malpani S, Pullela PK, Subbarao PV, Ramamoorthy S, Ghosh SK. Differential Diagnosis of Malaria on Truelab Uno®, a Portable, Real-Time, MicroPCR Device for Point-Of-Care Applications. PLoS One 2016; 11:e0146961. [PMID: 26784111 PMCID: PMC4718663 DOI: 10.1371/journal.pone.0146961] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 12/23/2015] [Indexed: 11/27/2022] Open
Abstract
Background Sensitive and specific detection of malarial parasites is crucial in controlling the significant malaria burden in the developing world. Also important is being able to identify life threatening Plasmodium falciparum malaria quickly and accurately to reduce malaria related mortality. Existing methods such as microscopy and rapid diagnostic tests (RDTs) have major shortcomings. Here, we describe a new real-time PCR-based diagnostic test device at point-of-care service for resource-limited settings. Methods Truenat® Malaria, a chip-based microPCR test, was developed by bigtec Labs, Bangalore, India, for differential identification of Plasmodium falciparum and Plasmodium vivax parasites. The Truenat Malaria tests runs on bigtec’s Truelab Uno® microPCR device, a handheld, battery operated, and easy-to-use real-time microPCR device. The performance of Truenat® Malaria was evaluated versus the WHO nested PCR protocol. The Truenat® Malaria was further evaluated in a triple-blinded study design using a sample panel of 281 specimens created from the clinical samples characterized by expert microscopy and a rapid diagnostic test kit by the National Institute of Malaria Research (NIMR). A comparative evaluation was done on the Truelab Uno® and a commercial real-time PCR system. Results The limit of detection of the Truenat Malaria assay was found to be <5 parasites/μl for both P. falciparum and P. vivax. The Truenat® Malaria test was found to have sensitivity and specificity of 100% each, compared to the WHO nested PCR protocol based on the evaluation of 100 samples. The sensitivity using expert microscopy as the reference standard was determined to be around 99.3% (95% CI: 95.5–99.9) at the species level. Mixed infections were identified more accurately by Truenat Malaria (32 samples identified as mixed) versus expert microscopy and RDTs which detected 4 and 5 mixed samples, respectively. Conclusion The Truenat® Malaria microPCR test is a valuable diagnostic tool and implementation should be considered not only for malaria diagnosis but also for active surveillance and epidemiological intervention.
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Affiliation(s)
- Chandrasekhar Bhaskaran Nair
- bigtec Private Limited, 2nd Floor, Golden Heights, 59th C Cross, 4th M Block, Rajajinagar, Bangalore, 560 010, Karnataka, India
- School of Bio Sciences and Technology, School of Advanced Sciences VIT University, Vellore, Tamil Nadu, 632014, India
| | - Jagannath Manjula
- bigtec Private Limited, 2nd Floor, Golden Heights, 59th C Cross, 4th M Block, Rajajinagar, Bangalore, 560 010, Karnataka, India
| | - Pradeep Annamalai Subramani
- National Institute of Malaria Research, ICMR Complex, Poojanahalli, Kannamangala Post, Devanahalli, Bangalore, 562 110, Karnataka, India
| | - Prakash B. Nagendrappa
- Institute of Trans-disciplinary Health Sciences and Technology (IHST), FRLHT, 74/2, Jarakabande Kaval, Attur post, Via Yelahanka, Bangalore, 560 106, Karnataka, India
| | - Mulakkapurath Narayanan Manoj
- bigtec Private Limited, 2nd Floor, Golden Heights, 59th C Cross, 4th M Block, Rajajinagar, Bangalore, 560 010, Karnataka, India
| | - Sukriti Malpani
- bigtec Private Limited, 2nd Floor, Golden Heights, 59th C Cross, 4th M Block, Rajajinagar, Bangalore, 560 010, Karnataka, India
| | - Phani Kumar Pullela
- bigtec Private Limited, 2nd Floor, Golden Heights, 59th C Cross, 4th M Block, Rajajinagar, Bangalore, 560 010, Karnataka, India
| | - Pillarisetti Venkata Subbarao
- bigtec Private Limited, 2nd Floor, Golden Heights, 59th C Cross, 4th M Block, Rajajinagar, Bangalore, 560 010, Karnataka, India
| | - Siva Ramamoorthy
- School of Bio Sciences and Technology, School of Advanced Sciences VIT University, Vellore, Tamil Nadu, 632014, India
| | - Susanta K. Ghosh
- National Institute of Malaria Research, ICMR Complex, Poojanahalli, Kannamangala Post, Devanahalli, Bangalore, 562 110, Karnataka, India
- * E-mail:
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Ahmed R, Levy EI, Maratina SS, de Jong JJ, Asih PBS, Rozi IE, Hawley W, Syafruddin D, ter Kuile F. Performance of four HRP-2/pLDH combination rapid diagnostic tests and field microscopy as screening tests for malaria in pregnancy in Indonesia: a cross-sectional study. Malar J 2015; 14:420. [PMID: 26511932 PMCID: PMC4625567 DOI: 10.1186/s12936-015-0943-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria in pregnancy poses a major public health problem in Indonesia with an estimated six million pregnancies at risk of Plasmodium falciparum or Plasmodium vivax malaria annually. In 2010, Indonesia introduced a screen and treat policy for the control of malaria in pregnancy at first antenatal visit using microscopy or rapid diagnostic tests (RDTs). A diagnostic study was conducted in Sumba, Indonesia to compare the performance of four different RDTs in predominately asymptomatic pregnant women under field condition. METHODS Women were screened for malaria at antenatal visits using field microscopy and four HRP-2/pLDH combination RDTs (Carestart™, First-Response(®), Parascreen(®) and SD-Bioline(®)). The test results were compared with expert microscopy and nested PCR. End user experience of the RDTs in the field was assessed by questionnaire. RESULTS Overall 950 were recruited and 98.7 % were asymptomatic. The prevalence of malaria was 3.0-3.4 % by RDTs, and 3.6, 5.0 and 6.6 % by field microscopy, expert microscopy and PCR, respectively. The geometric-mean parasite density was low (P. falciparum = 418, P. vivax = 147 parasites/µL). Compared with PCR, the overall sensitivity of the RDTs and field microscopy to detect any species was 24.6-31.1 %; specificities were >98.4 %. Relative to PCR, First-Response(®) had the best diagnostic accuracy (any species): sensitivity = 31.1 %, specificity = 98.9 % and diagnostic odds ratio = 39.0 (DOR). The DOR values for Carestart™, Parascreen(®), SD-Bioline(®), and field microscopy were 23.4, 23.7, 23.5 and 29.2, respectively. The sensitivity of Pan-pLDH bands to detect PCR confirmed P. vivax mono-infection were 8.6-13.0 %. The sensitivity of the HRP-2 band alone to detect PCR confirmed P. falciparum was 10.3-17.9 %. Pan-pLDH detected P. falciparum cases undetected by the HRP-2 band resulting in a better test performance when both bands were combined. First Response(®) was preferred by end-users for the overall practicality. CONCLUSION The diagnostic accuracy to detect malaria among mostly asymptomatic pregnant women and perceived ease of use was slightly better with First-Response(®), but overall, differences between the four RDTs were small and performance comparable to field microscopy. Combination RDTs are a suitable alternative to field microscopy to screen for malaria in pregnancy in rural Indonesia. The clinical relevance of low density malaria infections detected by PCR, but undetected by RDTs or microscopy needs to be determined.
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Affiliation(s)
- Rukhsana Ahmed
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Elvira I Levy
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Sylvia S Maratina
- Malaria Laboratory, Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
| | - Judith J de Jong
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Puji B S Asih
- Malaria Laboratory, Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
| | - Ismail E Rozi
- Malaria Laboratory, Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
| | | | - Din Syafruddin
- Malaria Laboratory, Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
| | - Feiko ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Cheng Q, Cunningham J, Gatton ML. Systematic review of sub-microscopic P. vivax infections: prevalence and determining factors. PLoS Negl Trop Dis 2015; 9:e3413. [PMID: 25569135 PMCID: PMC4288718 DOI: 10.1371/journal.pntd.0003413] [Citation(s) in RCA: 104] [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: 09/02/2014] [Accepted: 11/12/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sub-microscopic (SM) Plasmodium infections represent transmission reservoirs that could jeopardise malaria elimination goals. A better understanding of the epidemiology of these infections and factors contributing to their occurrence will inform effective elimination strategies. While the epidemiology of SM P. falciparum infections has been documented, that of SM P. vivax infections has not been summarised. The objective of this study is to address this deficiency. METHODOLOGY/PRINCIPAL FINDINGS A systematic search of PubMed was conducted, and results of both light microscopy (LM) and polymerase chain reaction (PCR)-based diagnostic tests for P. vivax from 44 cross-sectional surveys or screening studies of clinical malaria suspects were analysed. Analysis revealed that SM P. vivax is prevalent across different geographic areas with varying transmission intensities. On average, the prevalence of SM P. vivax in cross-sectional surveys was 10.9%, constituting 67.0% of all P. vivax infections detected by PCR. The relative proportion of SM P. vivax is significantly higher than that of the sympatric P. falciparum in these settings. A positive relationship exists between PCR and LM P. vivax prevalence, while there is a negative relationship between the proportion of SM P. vivax and the LM prevalence for P. vivax. Amongst clinical malaria suspects, however, SM P. vivax was not identified. CONCLUSIONS/SIGNIFICANCE SM P. vivax is prevalent across different geographic areas, particularly areas with relatively low transmission intensity. Diagnostic tools with sensitivity greater than that of LM are required for detecting these infection reservoirs. In contrast, SM P. vivax is not prevalent in clinical malaria suspects, supporting the recommended use of quality LM and rapid diagnostic tests in clinical case management. These findings enable malaria control and elimination programs to estimate the prevalence and proportion of SM P. vivax infections in their settings, and develop appropriate elimination strategies to tackle SM P. vivax to interrupt transmission.
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Affiliation(s)
- Qin Cheng
- Drug Resistance and Diagnostics, Australian Army Malaria Institute, Enoggera, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- * E-mail:
| | - Jane Cunningham
- Global Malaria Program, World Health Organization, Geneva, Switzerland
| | - Michelle L. Gatton
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Abba K, Kirkham AJ, Olliaro PL, Deeks JJ, Donegan S, Garner P, Takwoingi Y. Rapid diagnostic tests for diagnosing uncomplicated non-falciparum or Plasmodium vivax malaria in endemic countries. Cochrane Database Syst Rev 2014; 2014:CD011431. [PMID: 25519857 PMCID: PMC4453861 DOI: 10.1002/14651858.cd011431] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In settings where both Plasmodium vivax and Plasmodium falciparum infection cause malaria, rapid diagnostic tests (RDTs) need to distinguish which species is causing the patients' symptoms, as different treatments are required. Older RDTs incorporated two test lines to distinguish malaria due to P. falciparum, from malaria due to any other Plasmodium species (non-falciparum). These RDTs can be classified according to which antibodies they use: Type 2 RDTs use HRP-2 (for P. falciparum) and aldolase (all species); Type 3 RDTs use HRP-2 (for P. falciparum) and pLDH (all species); Type 4 use pLDH (fromP. falciparum) and pLDH (all species).More recently, RDTs have been developed to distinguish P. vivax parasitaemia by utilizing a pLDH antibody specific to P. vivax. OBJECTIVES To assess the diagnostic accuracy of RDTs for detecting non-falciparum or P. vivax parasitaemia in people living in malaria-endemic areas who present to ambulatory healthcare facilities with symptoms suggestive of malaria, and to identify which types and brands of commercial test best detect non-falciparum and P. vivax malaria. SEARCH METHODS We undertook a comprehensive search of the following databases up to 31 December 2013: Cochrane Infectious Diseases Group Specialized Register; MEDLINE; EMBASE; MEDION; Science Citation Index; Web of Knowledge; African Index Medicus; LILACS; and IndMED. SELECTION CRITERIA Studies comparing RDTs with a reference standard (microscopy or polymerase chain reaction) in blood samples from a random or consecutive series of patients attending ambulatory health facilities with symptoms suggestive of malaria in non-falciparum endemic areas. DATA COLLECTION AND ANALYSIS For each study, two review authors independently extracted a standard set of data using a tailored data extraction form. We grouped comparisons by type of RDT (defined by the combinations of antibodies used), and combined in meta-analysis where appropriate. Average sensitivities and specificities are presented alongside 95% confidence intervals (95% CI). MAIN RESULTS We included 47 studies enrolling 22,862 participants. Patient characteristics, sampling methods and reference standard methods were poorly reported in most studies. RDTs detecting 'non-falciparum' parasitaemiaEleven studies evaluated Type 2 tests compared with microscopy, 25 evaluated Type 3 tests, and 11 evaluated Type 4 tests. In meta-analyses, average sensitivities and specificities were 78% (95% CI 73% to 82%) and 99% (95% CI 97% to 99%) for Type 2 tests, 78% (95% CI 69% to 84%) and 99% (95% CI 98% to 99%) for Type 3 tests, and 89% (95% CI 79% to 95%) and 98% (95% CI 97% to 99%) for Type 4 tests, respectively. Type 4 tests were more sensitive than both Type 2 (P = 0.01) and Type 3 tests (P = 0.03).Five studies compared Type 3 tests with PCR; in meta-analysis, the average sensitivity and specificity were 81% (95% CI 72% to 88%) and 99% (95% CI 97% to 99%) respectively. RDTs detecting P.vivax parasitaemiaEight studies compared pLDH tests to microscopy; the average sensitivity and specificity were 95% (95% CI 86% to 99%) and 99% (95% CI 99% to 100%), respectively. AUTHORS' CONCLUSIONS RDTs designed to detect P. vivax specifically, whether alone or as part of a mixed infection, appear to be more accurate than older tests designed to distinguish P. falciparum malaria from non-falciparum malaria. Compared to microscopy, these tests fail to detect around 5% ofP. vivax cases. This Cochrane Review, in combination with other published information about in vitro test performance and stability in the field, can assist policy-makers to choose between the available RDTs.
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Affiliation(s)
- Katharine Abba
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
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Ameyaw E, Nguah SB, Ansong D, Page I, Guillerm M, Bates I. The outcome of a test-treat package versus routine outpatient care for Ghanaian children with fever: a pragmatic randomized control trial. Malar J 2014; 13:461. [PMID: 25428264 PMCID: PMC4259007 DOI: 10.1186/1475-2875-13-461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Over-diagnosis of malaria among African children results in mismanagement of non-malaria infections. Limited laboratory capacity makes it difficult to implement policies that recommend pre-treatment confirmation of infections so a new approach with a package for on-the-spot management of fevers was evaluated. Methods Febrile children presenting to outpatient clinic were randomized to receive either a ‘test-treat’ package (history with clinical examination; point-of-care tests; choice of artesunate-amodiaquine, co-amoxiclav and/or paracetamol) or routine outpatient care in a secondary health care facility in Kumasi, Ghana. A diagnosis of malaria, bacterial, viral or mixed malarial and bacterial infections was made using pre-defined criteria. Outcome was resolution of all symptoms including fever on day 7. Results The median age of the patients was 37.5 months (IQR: 19 to 66 months), with 56.7% being males. Compared to routine care the test-treat package resulted in less diagnoses of malaria, (37.2% vs 46.2%, p = 0.190) and mixed malaria and bacterial infections (14.0% vs 53.8%, p < 0.001) but more diagnoses of viral (33.1% vs 0.0%, p < 0.001) and bacterial infections only (15.7% vs 0.0%, p < 0.001). Less anti-malarials (51.2% vs 100.0%, p < 0.001) and antibiotics (29.7% vs 48.7%, p < 0.001), were prescribed in the test-treat group on completion of study, more test-treat package patients were clinically well (99.2% vs 80.7%, p < 0.001) and febrile (0.8% vs 10.1%, p = 0.001) and less were admitted for inpatient care (0.0% vs 8.4% p = 0.001) compared to the routine care group. Conclusion Test-treat package improves the effectiveness of outpatient diagnosis and treatment of children with fever and reduces inappropriate prescribing of anti-malarials and antibiotics. The package provides clinicians with the option for immediate diagnosis and treatment of non-malaria fevers. The test-treat package now needs to be evaluated in other settings including primary health care facilities.
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Affiliation(s)
- Emmanuel Ameyaw
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
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Sousa LP, Mariuba LAM, Holanda RJ, Pimentel JP, Almeida MEM, Chaves YO, Borges D, Lima E, Crainey JL, Orlandi PP, Lacerda MV, Nogueira PA. A novel polyclonal antibody-based sandwich ELISA for detection of Plasmodium vivax developed from two lactate dehydrogenase protein segments. BMC Infect Dis 2014; 14:49. [PMID: 24475751 PMCID: PMC3913629 DOI: 10.1186/1471-2334-14-49] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immunoassays for Plasmodium detection are, presently, most frequently based on monoclonal antibodies (MAbs); Polyclonal antibodies (PAbs), which are cheaper to develop and manufacture, are much less frequently used. In the present study we describe a sandwich ELISA assay which is capable of detecting P. vivax Lactate Dehydrogenase (LDH) in clinical blood samples, without cross reacting with those infected with P. falciparum. METHODS Two recombinant proteins were produced from different regions of the P. vivax LDH gene. Two sandwich ELISA assay were then designed: One which uses mouse anti-LDH 1-43aa PAbs as primary antibodies ("Test 1") and another which uses anti-LDH 35-305aa PAbs ("Test 2") as the primary antibodies. Rabbit anti-LDH 1-43aa PAbs were used as capture antibodies in both ELISA assays. Blood samples taken from P. vivax and P. falciparum infected patients (confirmed by light microscopy) were analysed using both tests. RESULTS "Test 2" performed better at detecting microscopy-positive blood samples when compared to "Test 1", identifying 131 of 154 positive samples (85%); 85 positives (55%) were identified using "test 1". "Test 1" produced one false positive sample (from the 20 malaria-free control) blood samples; "test 2" produced none. Kappa coefficient analysis of the results produced a value of 0.267 when microscope-positive blood smears were compared with "test 1", but 0.734 when microscope-positive blood smears were compared with the results from "test 2". Positive predictive value (PPV) and negative predictive value (NPV) were observed to be 98% and 22% respectively, for "Test 1", and 99% and 45%, for "test 2". No cross reactivity was detected with P. falciparum positive blood samples (n = 15) with either test assay. CONCLUSION Both tests detected P. vivax infected blood and showed no evidence of cross-reacting with P. falciparum. Further studies will need to be conducted to establish the full potential of this technique for malaria diagnostics. As well as representing a promising new cost-effective novel technique for P. vivax diagnosis and research, the method for developing this assay also highlights the potential for PAb-based strategies for diagnostics in general.
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Mouatcho JC, Goldring JPD. Malaria rapid diagnostic tests: challenges and prospects. J Med Microbiol 2013; 62:1491-1505. [PMID: 24048274 DOI: 10.1099/jmm.0.052506-0] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In the last decade, there has been an upsurge of interest in developing malaria rapid diagnostic test (RDT) kits for the detection of Plasmodium species. Three antigens - Plasmodium falciparum histidine-rich protein 2 (PfHRP2), plasmodial aldolase and plasmodial lactate dehydrogenase (pLDH) - are currently used for RDTs. Tests targeting HRP2 contribute to more than 90% of the malaria RDTs in current use. However, the specificities, sensitivities, numbers of false positives, numbers of false negatives and temperature tolerances of these tests vary considerably, illustrating the difficulties and challenges facing current RDTs. This paper describes recent developments in malaria RDTs, reviewing RDTs detecting PfHRP2, pLDH and plasmodial aldolase. The difficulties associated with RDTs, such as genetic variability in the Pfhrp2 gene and the persistence of antigens in the bloodstream following the elimination of parasites, are discussed. The prospect of overcoming the problems associated with current RDTs with a new generation of alternative malaria antigen targets is also described.
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Affiliation(s)
- Joel C Mouatcho
- Department of Biochemistry, School of Life Science, University of Kwazulu-Natal, Pietermaritzburg, Private Bag X01 Scottsville 3209, South Africa
| | - J P Dean Goldring
- Department of Biochemistry, School of Life Science, University of Kwazulu-Natal, Pietermaritzburg, Private Bag X01 Scottsville 3209, South Africa
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Elahi R, Mohon AN, Khan WA, Haque R, Alam MS. Performance of a HRP-2/pLDH based rapid diagnostic test at the Bangladesh-India-Myanmar border areas for diagnosis of clinical malaria. Malar J 2013; 12:378. [PMID: 24172045 PMCID: PMC4228469 DOI: 10.1186/1475-2875-12-378] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background The rapid diagnostic test (RDT) has been adopted in contemporary malaria control and management programmes around the world as it represents a fast and apt alternative for malaria diagnosis in a resource-limited setting. This study assessed the performance of a HRP-2/pLDH based RDT (Parascreen® Pan/Pf) in a laboratory setting utilizing clinical samples obtained from the field. Methods Whole blood samples were obtained from febrile patients referred for malaria diagnosis by clinicians from two different Upazila Health Complexes (UHCs) located near the Bangladesh-India and Bangladesh-Myanmar border where malaria is endemic. RDT was performed on archived samples and sensitivity and specificity evaluated with expert microscopy (EM) and quantitative PCR (qPCR). Results A total of 327 clinical samples were made available for the study, of which 153 were Plasmodium falciparum-positive and 54 were Plasmodium vivax-positive. In comparison with EM, for P. falciparum malaria, the RDT had sensitivity: 96.0% (95% CI, 91.2-98.3) and specificity: 98.2% (95% CI, 94.6-99.5) and for P. vivax, sensitivity: 90.7% (95% CI, 78.9-96.5) and specificity: 98.9% (95% CI, 96.5-99.7). Comparison with qPCR showed, for P. falciparum malaria, sensitivity: 95.4% (95% CI, 90.5-98.0) and specificity: 98.8% (95% CI, 95.4-99.7) and for P. vivax malaria, sensitivity: 89.0% (95% CI,77.0-95.4) and specificity: 98.8% (95% CI, 96.5-99.7). Sensitivity varied according to different parasitaemia for falciparum and vivax malaria diagnosis. Conclusion Parascreen® Pan/Pf Rapid test for malaria showed acceptable sensitivity and specificity in border belt endemic areas of Bangladesh when compared with EM and qPCR.
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Affiliation(s)
| | | | | | | | - Mohammad Shafiul Alam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
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Houzé S, Boutron I, Marmorat A, Dalichampt M, Choquet C, Poilane I, Godineau N, Le Guern AS, Thellier M, Broutier H, Fenneteau O, Millet P, Dulucq S, Hubert V, Houzé P, Tubach F, Le Bras J, Matheron S. Performance of rapid diagnostic tests for imported malaria in clinical practice: results of a national multicenter study. PLoS One 2013; 8:e75486. [PMID: 24098699 PMCID: PMC3787089 DOI: 10.1371/journal.pone.0075486] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/18/2013] [Indexed: 11/26/2022] Open
Abstract
We compared the performance of four rapid diagnostic tests (RDTs) for imported malaria, and particularly Plasmodium falciparum infection, using thick and thin blood smears as the gold standard. All the tests are designed to detect at least one protein specific to P. falciparum (Plasmodium histidine-rich protein 2 (PfHRP2) or Plasmodium LDH (PfLDH)) and one pan-Plasmodium protein (aldolase or Plasmodium LDH (pLDH)). 1,311 consecutive patients presenting to 9 French hospitals with suspected malaria were included in this prospective study between April 2006 and September 2008. Blood smears revealed malaria parasites in 374 cases (29%). For the diagnosis of P. falciparum infection, the three tests detecting PfHRP2 showed high and similar sensitivity (96%), positive predictive value (PPV) (90%) and negative predictive value (NPV) (98%). The PfLDH test showed lower sensitivity (83%) and NPV (80%), despite good PPV (98%). For the diagnosis of non-falciparum species, the PPV and NPV of tests targeting pLDH or aldolase were 94-99% and 52-64%, respectively. PfHRP2-based RDTs are thus an acceptable alternative to routine microscopy for diagnosing P. falciparum malaria. However, as malaria may be misdiagnosed with RDTs, all negative results must be confirmed by the reference diagnostic method when clinical, biological or other factors are highly suggestive of malaria.
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Affiliation(s)
- Sandrine Houzé
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Bichat, Laboratoire de Parasitologie-Centre National de Référence du Paludisme, Paris, France
- Université Paris Descartes, UMR 216, Paris, France
- Institut de Recherche pour le Développement, UMR 216, Paris, France
| | - Isabelle Boutron
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Centre d’Épidémiologie Clinique, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Anne Marmorat
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Bichat, Laboratoire de Parasitologie-Centre National de Référence du Paludisme, Paris, France
| | - Marie Dalichampt
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Centre d’Épidémiologie Clinique, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Christophe Choquet
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Bichat, Service des Urgences, Paris, France
| | - Isabelle Poilane
- AP-HP (Assistance Publique des Hôpitaux de Paris), CHU Jean-Verdier, Laboratoire de Microbiologie, Bondy, France
| | - Nadine Godineau
- Hôpital Delafontaine, Laboratoire de Parasitologie, St-Denis, France
| | | | - Marc Thellier
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital de la Pitié-Salpêtrière, Laboratoire de Parasitologie, Paris, France
| | - Hélène Broutier
- Hôpital Robert-Ballenger, Laboratoire polyvalent, Aulnay-sous-Bois, France
| | - Odile Fenneteau
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Robert Debré, Laboratoire d’Hématologie, Paris, France
| | - Pascal Millet
- Hôpital Saint André, Laboratoire de Parasitologie - Mycologie, Bordeaux, France
- Université Bordeaux Segalen, EA 4575, Bordeaux, France
| | | | - Véronique Hubert
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Bichat, Laboratoire de Parasitologie-Centre National de Référence du Paludisme, Paris, France
| | - Pascal Houzé
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital St-Louis, Laboratoire de Biochimie, Paris, France
| | - Florence Tubach
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Bichat, Département d’Epidémiologie, Biostatistique et Recherche Clinique, Paris, France
- Université Paris 7 Denis Diderot, Paris, France
- INSERM 801, Paris, France
| | - Jacques Le Bras
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Bichat, Laboratoire de Parasitologie-Centre National de Référence du Paludisme, Paris, France
- Université Paris Descartes, UMR 216, Paris, France
| | - Sophie Matheron
- Université Paris 7 Denis Diderot, Paris, France
- AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Bichat, Service des Maladies Infectieuses et Tropicales, Paris, France
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Fançony C, Sebastião YV, Pires JE, Gamboa D, Nery SV. Performance of microscopy and RDTs in the context of a malaria prevalence survey in Angola: a comparison using PCR as the gold standard. Malar J 2013; 12:284. [PMID: 23941281 PMCID: PMC3751255 DOI: 10.1186/1475-2875-12-284] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/02/2013] [Indexed: 11/30/2022] Open
Abstract
Background Accurate identification of Plasmodium infections in community surveys is essential to successful malaria control. Microscopy and rapid diagnostic tests (RDTs) are the main techniques used to diagnose malaria in field-based surveys. While microscopy is still considered the gold standard, RDTs are growing in popularity as they allow for rapid and inexpensive diagnosis. Using data from a prevalence survey conducted in north-western Angola in 2010, the authors aimed to compare the performance of microscopy and RDTs in identifying Plasmodium falciparum infections, using polymerase chain reaction (PCR) as the gold standard. Methods Results from 3,307 subjects (1,225 preschool-aged children (zero to five year olds), 1,134 school-aged children (six to 15 year olds) and 948 mothers/caregivers (>15 years of age)), tested for P. falciparum infections, were utilized. The sensitivity, specificity, positive, and negative predictive values (PPV and NPV) of microscopy and Paracheck-Pf® were compared using the McNemar’s test and the weighted generalized score Chi-squared test for paired data. Results The prevalence of P. falciparum infections determined by PCR and microscopy was 15.9% and by Paracheck- Pf® was 16.3%. Compared to microscopy, Paracheck-Pf® had significantly higher sensitivity (72.8% versus 60%), specificity (94.3% versus 92.5%), PPV (70.7% versus 60%) and NPV (94.8% versus 92.5%). Both tests had significantly lower sensitivity in mothers (36.8% for microscopy and 43.7% for Paracheck-Pf®) than in their children (68.4% in zero to five years-old and 60.6% in six to 15 years-old for microscopy and 80.4% in zero to five year-olds and 76.5% in six to 15 year-olds for Paracheck-Pf®). Conclusion Both microscopy and RDTs performed suboptimally when compared to PCR. False negativity could be associated with the low parasite density profile of the samples. False positivity may be related to the well-described limitations of those techniques such as level of expertise of microscopists or persistent antigenicity from previous infections in the case of RDTs. Nevertheless, RDTs had enhanced performance comparatively to microscopy in detecting malaria infections, favouring their use in community cross-sectional malaria surveys, where expert performance of microscopy is hard to accomplish.
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Fried M, Muehlenbachs A, Duffy PE. Diagnosing malaria in pregnancy: an update. Expert Rev Anti Infect Ther 2013. [PMID: 23199403 DOI: 10.1586/eri.12.98] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pregnancy malaria (PM) due to Plasmodium falciparum is a major cause of morbidity and mortality for women and their offspring, but is difficult to recognize and diagnose. During PM, parasites typically sequester in the placenta, whereas peripheral blood smears often appear negative. In addition, many infected women remain asymptomatic, especially in areas of high transmission where systemic immunity is high, although sequelae including maternal anemia and intrauterine growth retardation develop insidiously and increase mortality. New rapid diagnostic tests (RDTs) have shown promise for malaria diagnosis in nonpregnant individuals, including a product recently approved by the US FDA for use in the USA. However, the sensitivity and specificity of RDTs for diagnosis of PM may be suboptimal. Here, we review the methods that are used to detect or diagnose PM, including blood smear microscopy, RDTs, PCR-based methods, and finally placental histology, which is often cited as the gold standard for use in research studies and clinical trials.
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Affiliation(s)
- Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD 20892, USA.
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Ghouth ASB, Nasseb FM, Al-Kaldy KH. The accuracy of the first response histidine-rich protein2 rapid diagnostic test compared with malaria microscopy for guiding field treatment in an outbreak of falciparum malaria. Trop Parasitol 2013; 2:35-7. [PMID: 23508787 PMCID: PMC3593507 DOI: 10.4103/2229-5070.97237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 06/16/2012] [Indexed: 11/08/2022] Open
Abstract
Background: Recent WHO guidelines recommended a universal “test and treat” strategy for malaria mainly by use of the rapid diagnostic test (RDT) in all areas. There are concerns about RDT that use the antigen histidine-rich protein2 (HRP2) to detect Plasmodium falciparum, because infection can persist after effective treatment. Aim: The aim of this paper is to describe the accuracy of the first response (HRP2)-RDT compared with malaria microscopy used for guiding the field treatment of patients in an outbreak situation in the Al-Rahabah area in Al-Rydah district in Hadramout/Yemen. Materials and Methods: An ad hoc cross sectional survey of all febrile patients in the affected area was conducted in May 2011. The field team was developed including the case management group and the entomology group. The group of case management prepared their plan based on “test and treat” strategy by using First Response Malaria Antigen HRP2 rapid diagnostic test for falciparum malaria, artemsinin-based combination therapy (ACT) according to the national policy of anti-malaria drugs in Yemen were supplied to treat those who were found to be RDT positive in the field; also blood smear films were taken from every patient with fever in order to validate the use of the RDT in the field. Blood film slides prepared and read by skilled lab technicians, the fourth reading was done by one lab expert in the malaria referral lab. Results: The accuracy parameters of HRP2 compared with microscopy are: Sensitivity (74%), specificity (94%). The positive predictive value is 68% and the negative predictive value is 96%. Total agreement is 148/162 (93%) and the overall prevalence is 14%. All the positive malaria cases were of P. falciparum either coming from RDT or microscopy. Conclusions: HRP2–rapid test is an acceptable test as a guide for field treatment in an outbreak situation where prompt response is indicated. Good prepared blood film slides should be used as it is feasible to evaluate the accuracy of RDTs as a quality control tool.
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Affiliation(s)
- Abdulla Salim Bin Ghouth
- Department of Family Medicine, Hadramout University, Malaria Control Program (Hadramout region/Yemen), Yemen
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Rawat M, Vijay S, Gupta Y, Tiwari PK, Sharma A. Imperfect duplicate insertions type of mutations in plasmepsin V modulates binding properties of PEXEL motifs of export proteins in Indian Plasmodium vivax. PLoS One 2013; 8:e60077. [PMID: 23555891 PMCID: PMC3612065 DOI: 10.1371/journal.pone.0060077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/21/2013] [Indexed: 01/12/2023] Open
Abstract
Introduction Plasmepsin V (PM-V) have functionally conserved orthologues across the Plasmodium genus who's binding and antigenic processing at the PEXEL motifs for export about 200–300 essential proteins is important for the virulence and viability of the causative Plasmodium species. This study was undertaken to determine P. vivax plasmepsin V Ind (PvPM-V-Ind) PEXEL motif export pathway for pathogenicity-related proteins/antigens export thereby altering plasmodium exportome during erythrocytic stages. Method We identify and characterize Plasmodium vivax plasmepsin-V-Ind (mutant) gene by cloning, sequence analysis, in silico bioinformatic protocols and structural modeling predictions based on docking studies on binding capacity with PEXEL motifs processing in terms of binding and accessibility of export proteins. Results Cloning and sequence analysis for genetic diversity demonstrates PvPM-V-Ind (mutant) gene is highly conserved among all isolates from different geographical regions of India. Imperfect duplicate insertion types of mutations (SVSE from 246–249 AA and SLSE from 266–269 AA) were identified among all Indian isolates in comparison to P.vivax Sal-1 (PvPM-V-Sal 1) isolate. In silico bioinformatics interaction studies of PEXEL peptide and active enzyme reveal that PvPM-V-Ind (mutant) is only active in endoplasmic reticulum lumen and membrane embedding is essential for activation of plasmepsin V. Structural modeling predictions based on docking studies with PEXEL motif show significant variation in substrate protein binding of these imperfect mutations with data mined PEXEL sequences. The predicted variation in the docking score and interacting amino acids of PvPM-V-Ind (mutant) proteins with PEXEL and lopinavir suggests a modulation in the activity of PvPM-V in terms of binding and accessibility at these sites. Conclusion/Significance Our functional modeled validation of PvPM-V-Ind (mutant) imperfect duplicate insertions with data mined PEXEL sequences leading to altered binding and substrate accessibility of the enzyme makes it a plausible target to investigate export mechanisms for in silico virtual screening and novel pharmacophore designing.
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Affiliation(s)
- Manmeet Rawat
- Protein Biochemistry and Structural Biology Division, National Institute of Malaria Research (ICMR), Dwarka, New Delhi, India
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Sonam Vijay
- Protein Biochemistry and Structural Biology Division, National Institute of Malaria Research (ICMR), Dwarka, New Delhi, India
| | - Yash Gupta
- Department of Microbiology and Molecular Biology, National JALMA Institute for Leprosy and Other Mycobacterial Diseases (ICMR), Agra, Uttar Pradesh, India
| | - Pramod Kumar Tiwari
- Centre for Genomics, Molecular and Human Genetics, Jiwaji University, Gwalior, Madhya Pradesh, India
| | - Arun Sharma
- Protein Biochemistry and Structural Biology Division, National Institute of Malaria Research (ICMR), Dwarka, New Delhi, India
- * E-mail:
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Singh N, Bharti PK, Singh MP, Mishra S, Shukla MM, Sharma RK, Singh RK. Comparative evaluation of bivalent malaria rapid diagnostic tests versus traditional methods in field with special reference to heat stability testing in Central India. PLoS One 2013; 8:e58080. [PMID: 23472135 PMCID: PMC3589473 DOI: 10.1371/journal.pone.0058080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Malaria presents a diagnostic challenge in areas where both Plasmodium falciparum and P.vivax are co-endemic. Bivalent Rapid Diagnostic tests (RDTs) showed promise as diagnostic tools for P.falciparum and P.vivax. To assist national malaria control programme in the selection of RDTs, commercially available seven malaria RDTs were evaluated in terms of their performance with special reference to heat stability. METHODOLOGY/PRINCIPAL FINDINGS This study was undertaken in four forested districts of central India (July, 2011- March, 2012). All RDTs were tested simultaneously in field along with microscopy as gold standard. These RDTs were stored in their original packing at 25°C before transport to the field or they were stored at 35°C and 45°C upto 100 days for testing the performance of RDTs at high temperature. In all 2841 patients with fever were screened for malaria of which 26% were positive for P.falciparum, and 17% for P.vivax. The highest sensitivity of any RDT for P.falciparum was 98% (95% CI; 95.9-98.8) and lowest sensitivity was 76% (95% CI; 71.7-79.6). For P.vivax highest and lowest sensitivity for any RDT was 80% (95% CI; 94.9 - 83.9) and 20% (95% CI; 15.6-24.5) respectively. Heat stability experiments showed that most RDTs for P.falciparum showed high sensitivity at 45°C upto 90 days. While for P.vivax only two RDTs maintained good sensitivity upto day 90 when compared with RDTs kept at room temperature. Agreement between observers was excellent for positive and negative readings for both P.falciparum and P.vivax (Kappa >0.6-0.9). CONCLUSION This is first field evaluation of RDTs regarding their temperature stability. Although RDTs are useful as diagnostic tool for P.falciparum and P.vivax even at high temperature, the quality of RDTs should be regulated and monitored more closely.
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Affiliation(s)
- Neeru Singh
- Regional Medical Research Centre for Tribals, Nagpur Road, Garha, Jabalpur, Madhya Pradesh, India.
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Tahar R, Sayang C, Ngane Foumane V, Soula G, Moyou-Somo R, Delmont J, Basco LK. Field evaluation of rapid diagnostic tests for malaria in Yaounde, Cameroon. Acta Trop 2013; 125:214-9. [PMID: 23085326 DOI: 10.1016/j.actatropica.2012.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 09/29/2012] [Accepted: 10/09/2012] [Indexed: 10/27/2022]
Abstract
Rapid diagnostic tests (RDTs) are affordable, alternative diagnostic tools. The present study aimed to evaluate RDTs available in Cameroon and compare their characteristics to follow the parasitological response of patients for 28 days. Malaria diagnosis was assessed in 179 febrile patients using conventional microscopy as the reference method. Parascreen detects both Plasmodium falciparum-specific histidine-rich protein 2 (Pf HRP-2) and Pan-specific plasmodial lactate dehydrogenase (pLDH) in all four human Plasmodium spp. Diaspot is based on the detection of Pf HRP-2. OptiMAL-IT (pLDH specific for P. falciparum and pLDH for all four human Plasmodium spp.) was assessed for comparison. The reliability of RDTs was evaluated by calculating the sensitivity, specificity, positive predictive value, negative predictive value, false-positive rate, false-negative rate, and likelihood ratio. The clinical outcome of 18 children treated with atovaquone-proguanil and followed for 28 days was evaluated using microscopy and RDTs. Of 179 samples, 133 (74.3%) were pure P. falciparum-positive smears, 4 (2.2%) pure P. malariae-positive smears, and 42 (23.5%) negative smears. Parascreen and Diaspot had high sensitivity (>92%) and positive predictive values (>94%). The specificities for Parascreen and Diaspot were 81.0% and 90.5%, respectively. The false-positive rates and the false-negative rates were 19.0% and 4.5% for Parascreen and 9.5% and 8.3% for Diaspot, respectively. Most false-negatives occurred in samples with low parasitaemia (<500 asexual parasites/μL). The performance of RDTs was better at higher parasitaemia (>500 asexual parasites/μL). Four pure P. malariae were only detected by the pan-Plasmodium bands of Parascreen and OptiMAL-IT. In blood samples from patients treated and followed-up for 28 days, HRP2-based RDTs remained positive in most samples until Day 28. Despite negative smears, OptiMAL-IT remained positive in several patients until Day 7 but was negative in all patients from Day 14 onwards. RDTs can improve the management of febrile patients. The validity, ease of use, and cost of HRP2-based tests were comparable. However, one of the current weaknesses of the RDT-based strategy using the tests available in Cameroon is inadequate sensitivity for low parasitaemia. In some cases, RDT results may require correct interpretation based on clinical history, clinical examination, and microscopic diagnosis.
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Evaluation of the sensitivity of a pLDH-based and an aldolase-based rapid diagnostic test for diagnosis of uncomplicated and severe malaria caused by PCR-confirmed Plasmodium knowlesi, Plasmodium falciparum, and Plasmodium vivax. J Clin Microbiol 2013; 51:1118-23. [PMID: 23345297 DOI: 10.1128/jcm.03285-12] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Plasmodium knowlesi can cause severe and fatal human malaria in Southeast Asia. Rapid diagnosis of all Plasmodium species is essential for initiation of effective treatment. Rapid diagnostic tests (RDTs) are sensitive for detection of uncomplicated and severe falciparum malaria but have not been systematically evaluated in knowlesi malaria. At a tertiary referral hospital in Sabah, Malaysia, we prospectively evaluated the sensitivity of two combination RDTs for the diagnosis of uncomplicated and severe malaria from all three potentially fatal Plasmodium species, using a pan-Plasmodium lactate dehydrogenase (pLDH)-P. falciparum histidine-rich protein 2 (PfHRP2) RDT (First Response) and a pan-Plasmodium aldolase-PfHRP2 RDT (ParaHIT). Among 293 hospitalized adults with PCR-confirmed Plasmodium monoinfection, the sensitivity of the pLDH component of the pLDH-PfHRP2 RDT was 74% (95/129; 95% confidence interval [CI], 65 to 80%), 91% (110/121; 95% CI, 84 to 95%), and 95% (41/43; 95% CI, 85 to 99%) for PCR-confirmed P. knowlesi, P. falciparum, and P. vivax infections, respectively, and 88% (30/34; 95% CI, 73 to 95%), 90% (38/42; 95% CI, 78 to 96%), and 100% (12/12; 95% CI, 76 to 100%) among patients tested before antimalarial treatment was begun. Sensitivity in severe malaria was 95% (36/38; 95% CI, 83 to 99), 100% (13/13; 95% CI, 77 to 100), and 100% (7/7; 95% CI, 65 to 100%), respectively. The aldolase component of the aldolase-PfHRP2 RDT performed poorly in all Plasmodium species. The pLDH-based RDT was highly sensitive for the diagnosis of severe malaria from all species; however, neither the pLDH- nor aldolase-based RDT demonstrated sufficiently high overall sensitivity for P. knowlesi. More sensitive RDTs are needed in regions of P. knowlesi endemicity.
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Mohon AN, Elahi R, Podder MP, Mohiuddin K, Hossain MS, Khan WA, Haque R, Alam MS. Evaluation of the OnSite (Pf/Pan) rapid diagnostic test for diagnosis of clinical malaria. Malar J 2012; 11:415. [PMID: 23234579 PMCID: PMC3544592 DOI: 10.1186/1475-2875-11-415] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 12/10/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Accurate diagnosis of malaria is an essential prerequisite for proper treatment and drug resistance monitoring. Microscopy is considered the gold standard for malaria diagnosis but has limitations. ELISA, PCR, and Real Time PCR are also used to diagnose malaria in reference laboratories, although their application at the field level is currently not feasible. Rapid diagnostic tests (RDTs) however, have been brought into field operation and widely adopted in recent days. This study evaluates OnSite (Pf/Pan) antigen test, a new RDT introduced by CTK Biotech Inc, USA for malaria diagnosis in a reference setting. METHODS Blood samples were collected from febrile patients referred for malaria diagnosis by clinicians. Subjects were included in this study from two different Upazila Health Complexes (UHCs) situated in two malaria endemic districts of Bangladesh. Microscopy and nested PCR were considered the gold standard in this study. OnSite (Pf/Pan) RDT was performed on preserved whole blood samples. RESULTS In total, 372 febrile subjects were included in this study. Of these subjects, 229 (61.6%) tested positive for Plasmodium infection detected by microscopy and nested PCR. OnSite (Pf/Pan) RDT was 94.2% sensitive (95% CI, 89.3-97.3) and 99.5% specific (95% CI, 97.4-00.0) for Plasmodium falciparum diagnosis and 97.3% sensitive (95% CI, 90.5-99.7) and 98.7% specific (95% CI, 96.6-99.6) for Plasmodium vivax diagnosis. Sensitivity varied with differential parasite count for both P. falciparum and P. vivax. The highest sensitivity was observed in febrile patients with parasitaemia that ranged from 501-1,000 parasites/μL regardless of the Plasmodium species. CONCLUSION The new OnSite (Pf/Pan) RDT is both sensitive and specific for symptomatic malaria diagnosis in standard laboratory conditions.
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Affiliation(s)
- Abu Naser Mohon
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rubayet Elahi
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Milka Patracia Podder
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Biology, Memorial University of Newfoundland, St. John’s, Canada
| | - Khaja Mohiuddin
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Wasif A Khan
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Shafiul Alam
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
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Sharma VP. Battling malaria iceberg incorporating strategic reforms in achieving Millennium Development Goals & malaria elimination in India. Indian J Med Res 2012; 136:907-25. [PMID: 23391787 PMCID: PMC3612321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Malaria control in India has occupied high priority in health sector consuming major resources of the Central and State governments. Several new initiatives were launched from time to time supported by foreign aids but malaria situation has remained static and worsened in years of good rainfall. At times malaria relented temporarily but returned with vengeance at the local, regional and national level, becoming more resilient by acquiring resistance in the vectors and the parasites. National developments to improve the economy, without health impact assessment, have had adverse consequences by providing enormous breeding grounds for the vectors that have become refractory to interventions. As a result, malaria prospers and its control is in dilemma, as finding additional resources is becoming difficult with the ongoing financial crisis. Endemic countries must contribute to make up the needed resources, if malaria is to be contained. Malaria control requires long term planning, one that will reduce receptivity and vulnerability, and uninterrupted financial support for sustained interventions. While this seems to be a far cry, the environment is becoming more receptive for vectors, and epidemics visit the country diverting major resources in their containment, e.g. malaria, dengue and dengue haemorrhagic fevers, and Chikungunya virus infection. In the last six decades malaria has taken deep roots and diversified into various ecotypes, the control of these ecotypes requires local knowledge about the vectors and the parasites. In this review we outline the historical account of malaria and methods of control that have lifted the national economy in many countries. While battles against malaria should continue at the local level, there is a need for large scale environmental improvement. Global Fund for AIDS, Tuberculosis and Malaria has provided huge funds for malaria control worldwide touching US$ 2 billion in 2011. Unfortunately it is likely to decline to US$ 1.5 billion in the coming years against the annual requirement of US$ 5 billion. While appreciating the foreign assistance, we wish to highlight the fact that unless we have internal strength of resources and manpower, sustained battles against malaria may face serious problems in achieving the final goal of malaria elimination.
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Affiliation(s)
- V. P. Sharma
- ICMR Chair in Public Health Research, Centre for Rural Development & Technology, Indian Institute of Technology, New Delhi, India,Reprint requests: Dr V.P. Sharma, ICMR Chair in Public Health Research, Centre for Rural Development & Technology Indian Institute of Technology, Hauz Khas, New Delhi 110 016, India e-mail:
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de Oliveira MRF, Giozza SP, Peixoto HM, Romero GAS. Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil. Malar J 2012. [PMID: 23176717 PMCID: PMC3533805 DOI: 10.1186/1475-2875-11-390] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Rapid diagnostic tests (RDT) for malaria have been demonstrated to be effective and they should replace microscopy in certain areas. Method The cost-effectiveness of five RDT and thick smear microscopy was estimated and compared. Data were collected on Brazilian Extra-Amazon Region. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, laboratory suppliers and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2010. Two costing methods were produced, based on exclusive-use microscopy or shared-use microscopy. The results were expressed in costs per adequately diagnosed cases in 2010 U.S. dollars. One-way sensitivity analysis was performed considering key model parameters. Results In the cost-effectiveness analysis with exclusive-use microscopy, the RDT CareStart™ was the most cost-effective diagnostic strategy. Microscopy was the most expensive and most effective, with an additional case adequately diagnosed by microscopy costing US$ 35,550.00 in relation to CareStart™. In opposite, in the cost-effectiveness analysis with shared-use microscopy, the thick smear was extremely cost-effective. Introducing into the analytic model with shared-use microscopy a probability for individual access to the diagnosis, assuming a probability of 100% of access for a public health system user to any RDT and, hypothetically, of 85% of access to microscopy, this test saw its effectiveness reduced and was dominated by the RDT CareStart™. Conclusion The analysis of cost-effectiveness of malaria diagnosis technologies in the Brazilian Extra-Amazon Region depends on the exclusive or shared use of the microscopy. Following the assumptions of this study, shared-use microscopy would be the most cost-effective strategy of the six technologies evaluated. However, if used exclusively for diagnosing malaria, microscopy would be the worst use of resources. Microscopy would not be the most cost-effective strategy, even when structure is shared with other programmes, when the probability of a patient having access to it was reduced. Under these circumstances, the RDT CareStart™ would be the most cost-effective strategy.
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Bharti PK, Chand SK, Singh MP, Mishra S, Shukla MM, Singh R, Singh N. Emergence of a new focus of Plasmodium malariae in forest villages of district Balaghat, Central India: implications for the diagnosis of malaria and its control. Trop Med Int Health 2012; 18:12-7. [PMID: 23107370 DOI: 10.1111/tmi.12005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE During an epidemiological study (January-July 2012) on malaria in forest villages of Central India, Plasmodium malariae-like malaria parasites were observed in blood smears of fever cases. We aimed to confirm the presence of P. malariae using molecular tools i.e. species-specific nested polymerase chain reaction (PCR) and DNA sequencing. METHODS All fever cases or cases with history of fever in 25 villages of Balaghat district were screened for malaria parasite using bivalent rapid diagnostic test and microscopy after obtaining written informed consent. Nested PCR was employed on microscopically suspected P. malariae cases. DNA sequences in the target region for PCR diagnosis were analysed for all the suspected cases of P. malariae. RESULTS Among the 22 microscopy suspected P. malariae cases, nested PCR confirmed the identity of P. malariae in 19 cases. Among these 14 were mono P. malariae infections, three were mixed infection of P. malariae with Plasmodium falciparum and two were mixed infection of P. malariae with Plasmodium vivax. Clinically P. malariae subjects generally presented with fever and headache. However, the typical 3-day pattern of quantum malaria was not observed. The parasite density of P. malariae was significantly lower than that of P. vivax and P. falciparum. DISCUSSIONS Plasmodium malariae may have been in existence in forest villages of central India but escaped identification due to its close resemblance to P. vivax. The results re-affirm the importance of molecular methods of testing on routine basis for efficacious control strategies against malaria.
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Affiliation(s)
- Praveen K Bharti
- Regional Medical Research Centre for Tribals, Jabalpur, Madhya Pradesh, India
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Singh N, Singh MP, Wylie BJ, Hussain M, Kojo YA, Shekhar C, Sabin L, Desai M, Udhayakumar V, Hamer DH. Malaria prevalence among pregnant women in two districts with differing endemicity in Chhattisgarh, India. Malar J 2012; 11:274. [PMID: 22882903 PMCID: PMC3489539 DOI: 10.1186/1475-2875-11-274] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/01/2012] [Indexed: 11/16/2022] Open
Abstract
Background In India, malaria is not uniformly distributed. Chhattisgarh is a highly malarious state where both Plasmodium falciparum and Plasmodium vivax are prevalent with a preponderance of P. falciparum. Malaria in pregnancy (MIP), especially when caused by P. falciparum, poses substantial risk to the mother and foetus by increasing the risk of foetal death, prematurity, low birth weight (LBW), and maternal anaemia. These risks vary between areas with stable and unstable transmission. The specific objectives of this study were to determine the prevalence of malaria, its association with maternal and birth outcomes, and use of anti-malarial preventive measures for development of evidence based interventions to reduce the burden of MIP. Methods A cross-sectional study of pregnant women presenting to antenatal clinics (ANC) or delivery units (DU), or hospitalized for non-obstetric illness was conducted over 12 months in high (Bastar) and low (Rajnandgaon) transmission districts in Chhattisgarh state. Intensity of transmission was defined on the basis of slide positivity rates with a high proportion due to P. falciparum. In each district, a rural and an urban health facility was selected. Results Prevalence of peripheral parasitaemia was low: 1.3% (35/2696) among women at ANCs and 1.9% at DUs (19/1025). Peripheral parasitaemia was significantly more common in Bastar (2.8%) than in Rajnandgaon (0.1%) (p < 0.0001). On multivariate analysis of ANC participants, residence in Bastar district (stable malaria transmission) was strongly associated with peripheral parasitaemia (adjusted OR [aOR] 43.4; 95% CI, 5.6-335.2). Additional covariates associated with parasitaemia were moderate anaemia (aOR 3.7; 95% CI 1.8-7.7), fever within the past week (aOR 3.2; 95% CI 1.2-8.6), and lack of formal education (aOR 4.6; 95% CI 2.0-10.7). Similarly, analysis of DU participants revealed that moderate anaemia (aOR 2.5; 95% CI 1.1-5.4) and fever within the past week (aOR 5.8; 95% CI 2.4-13.9) were strongly associated with peripheral and/or placental parasitaemia. Malaria-related admissions were more frequent among pregnant women in Bastar, the district with greater malaria prevalence (51% vs. 11%, p < 0.0001). Conclusions Given the overall low prevalence of malaria, a strategy of enhanced anti-vector measures coupled with intermittent screening and targeted treatment during pregnancy should be considered for preventing malaria-associated morbidity in central India.
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Affiliation(s)
- Neeru Singh
- Regional Medical Research Centre for Tribals, Jabalpur, Madhya Pradesh, India.
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Sharma R, Gohain S, Chandra J, Kumar V, Chopra A, Chatterjee S, Aneja S, Dutta AK. Plasmodium vivax malaria admissions and risk of mortality in a tertiary-care children's hospital in North India. Paediatr Int Child Health 2012; 32:152-7. [PMID: 22824663 DOI: 10.1179/2046905512y.0000000012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND In 2010, there was an increase in the severity of malaria admissions to Kalawati Saran Children's Hospital, New Delhi and this report describes the morbidity and mortality profile. METHOD A retrospective chart review of patients admitted with parasitologically confirmed malaria between January and December 2010. RESULTS There were 156 cases: P. vivax 105 (67.3%), P. falciparum 39 (25%) and mixed infections 12 (7.7%). Thrombocytopenia (platelet count <150×10(9)/L) was present in 90 (85.7%) patients with P. vivax mono-infection. There were 91 (58.3%) patients with severe malaria: P. vivax mono-infection 46 (50.5%), P. falciparum mono-infection 35 (38.5%) and mixed 10 (11%). Severe anaemia and severe thrombocytopenia (platelet count <20×10(9)/L) were detected significantly more often in P. falciparum and P. vivax mono-infection, respectively. Complications including cerebral malaria, acute renal failure, shock, acute respiratory distress syndrome (ARDS) and multiple-organ dysfunction syndrome (MODS) were similar in both groups. The mortality rate of around 20% was similar in severe P. vivax and P. falciparum mono-infection. Risk of mortality in vivax malaria was highest in patients with ARDS followed by MODS and shock. CONCLUSION Increased morbidity owing to P. vivax malaria was observed and risk of mortality was highest in patients with ARDS and MODS.
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Affiliation(s)
- Rajni Sharma
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
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Gonçalves L, Subtil A, de Oliveira MR, do Rosário V, Lee PW, Shaio MF. Bayesian Latent Class Models in malaria diagnosis. PLoS One 2012; 7:e40633. [PMID: 22844405 PMCID: PMC3402519 DOI: 10.1371/journal.pone.0040633] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 06/11/2012] [Indexed: 11/21/2022] Open
Abstract
Aims The main focus of this study is to illustrate the importance of the statistical analysis in the evaluation of the accuracy of malaria diagnostic tests, without admitting a reference test, exploring a dataset (3317) collected in São Tomé and Príncipe. Methods Bayesian Latent Class Models (without and with constraints) are used to estimate the malaria infection prevalence, together with sensitivities, specificities, and predictive values of three diagnostic tests (RDT, Microscopy and PCR), in four subpopulations simultaneously based on a stratified analysis by age groups (, 5 years old) and fever status (febrile, afebrile). Results In the afebrile individuals with at least five years old, the posterior mean of the malaria infection prevalence is 3.2% with a highest posterior density interval of [2.3–4.1]. The other three subpopulations (febrile 5 years, afebrile or febrile children less than 5 years) present a higher prevalence around 10.3% [8.8–11.7]. In afebrile children under-five years old, the sensitivity of microscopy is 50.5% [37.7–63.2]. In children under-five, the estimated sensitivities/specificities of RDT are 95.4% [90.3–99.5]/93.8% [91.6–96.0] – afebrile – and 94.1% [87.5–99.4]/97.5% [95.5–99.3] – febrile. In individuals with at least five years old are 96.0% [91.5–99.7]/98.7% [98.1–99.2] – afebrile – and 97.9% [95.3–99.8]/97.7% [96.6–98.6] – febrile. The PCR yields the most reliable results in four subpopulations. Conclusions The utility of this RDT in the field seems to be relevant. However, in all subpopulations, data provide enough evidence to suggest caution with the positive predictive values of the RDT. Microscopy has poor sensitivity compared to the other tests, particularly, in the afebrile children less than 5 years. This type of findings reveals the danger of statistical analysis based on microscopy as a reference test. Bayesian Latent Class Models provide a powerful tool to evaluate malaria diagnostic tests, taking into account different groups of interest.
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Affiliation(s)
- Luzia Gonçalves
- CEAUL and Unidade de Saúde Pública Internacional e Bioestatística, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
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Narayanasamy K, Chery L, Basu A, Duraisingh MT, Escalante A, Fowble J, Guler JL, Herricks T, Kumar A, Majumder P, Maki J, Mascarenhas A, Rodrigues J, Roy B, Sen S, Shastri J, Smith J, Valecha N, White J, Rathod PK. Malaria evolution in South Asia: knowledge for control and elimination. Acta Trop 2012; 121:256-66. [PMID: 22266213 PMCID: PMC3894252 DOI: 10.1016/j.actatropica.2012.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 01/04/2012] [Accepted: 01/05/2012] [Indexed: 11/16/2022]
Abstract
The study of malaria parasites on the Indian subcontinent should help us understand unexpected disease outbreaks and unpredictable disease presentations from Plasmodium falciparum and Plasmodium vivax infections. The Malaria Evolution in South Asia (MESA) research program is one of ten International Centers of Excellence for Malaria Research (ICEMR) sponsored by the US National Institutes of Health. In this second of two reviews, we describe why population structures of Plasmodia in India will be characterized and how we will determine their consequences on disease presentation, outcome and patterns. Specific projects will determine if genetic diversity, possibly driven by parasites with higher genetic plasticity, plays a role in changing epidemiology, pathogenesis, vector competence of parasite populations and whether innate human genetic traits protect Indians from malaria today. Deep local clinical knowledge of malaria in India will be supplemented by basic scientists who bring new research tools. Such tools will include whole genome sequencing and analysis methods; in vitro assays to measure genome plasticity, RBC cytoadhesion, invasion, and deformability; mosquito infectivity assays to evaluate changing parasite-vector compatibilities; and host genetics to understand protective traits in Indian populations. The MESA-ICEMR study sites span diagonally across India and include a mixture of very urban and rural hospitals, each with very different disease patterns and patient populations. Research partnerships include government-associated research institutes, private medical schools, city and state government hospitals, and hospitals with industry ties. Between 2012 and 2017, in addition to developing clinical research and basic science infrastructure at new clinical sites, our training workshops will engage new scientists and clinicians throughout South Asia in the malaria research field.
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Affiliation(s)
| | - Laura Chery
- Department of Chemistry, University of Washington, Seattle, WA, USA
| | - Analabha Basu
- National Institute of Biomedical Genomics, Kalyani, West Bengal, India
| | | | | | - Joseph Fowble
- Department of Chemistry, University of Washington, Seattle, WA, USA
| | | | | | - Ashwani Kumar
- National Institute of Malaria Research (ICMR), Panaji, Goa, India
| | - Partha Majumder
- National Institute of Biomedical Genomics, Kalyani, West Bengal, India
| | - Jennifer Maki
- Department of Chemistry, University of Washington, Seattle, WA, USA
| | | | | | - Bikram Roy
- National Institute of Biomedical Genomics, Kalyani, West Bengal, India
| | - Somdutta Sen
- SphaeraPharma Research and Development, Manesar, Haryana, India
| | - Jayanthi Shastri
- Kasturba Hospital for Infectious Diseases, Mumbai, Maharashtra, India
- Topiwala Medical College & BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Joseph Smith
- Seattle Biomedical Research Institute, Seattle, WA, USA
| | - Neena Valecha
- National Institute of Malaria Research (ICMR), New Delhi, India
| | - John White
- Department of Chemistry, University of Washington, Seattle, WA, USA
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Shukla M, Singh N, Singh MP. Spleen rates and infant parasite rates as surveillance tool for malaria control in remote hard to reach areas of central India. Malar J 2011; 10:381. [PMID: 22185197 PMCID: PMC3258211 DOI: 10.1186/1475-2875-10-381] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/21/2011] [Indexed: 11/29/2022] Open
Abstract
Background Malaria due to both Plasmodium falciparum and Plasmodium vivax is a major public health problem in India. The quantification of malaria transmission for the classification of malaria risk has long been a concern for epidemiologists. Results are presented from 30 cross-sectional surveys which measured spleen rates (SR) and infant parasite rates (IPR) in the forested districts of Madhya Pradesh during malaria outbreaks to assess whether both IPR and SR can still be used as indicators of malaria endemicity as spleen examination has lost much of its value as an epidemiological indicator in areas where anti-malarials drugs are widely used. Methods Rapid fever surveys were carried out from door to door and all suspected malaria cases in the entire population of a village were screened for malaria parasites on the basis of clinical symptoms such as fever, chill, rigor, headache and body ache etc. Children between 2 and 9 years were examined for enlarged spleen according to Hacketts method. Finger prick blood smears were collected from all children with enlarged spleen with or without fever after obtaining written informed consent following institutional ethical guidelines. Infants less than 1 year were also screened for malaria with or without fever. Results Since malaria is local and focal, in some areas the outbreak waned quickly in few months and in some areas continued for 3 to 4 years. The analysis of trend revealed that when IPR decline over the years as a result of malaria intervention measures, SR also decline. In case splenomegaly continues without diminution in size, it is probably due to recrudescence or relapse, although it is not possible to separate malaria parasite species on the basis of SR. Conclusion Both the tools are of immense value in evaluating and assessing the malaria situation especially in remote areas where sophisticated molecular and serological techniques are difficult to establish. Therefore, in forested areas malaria surveillance system will require adoption of multiple approaches that have proven effective now or in the past.
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Affiliation(s)
- Manmohan Shukla
- National Institute of Malaria Research, Field Station, Jabalpur 482003, Madhya Pradesh, India
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Malaria and National Vector Borne Disease Control Programme. Indian J Pediatr 2011; 78:1527-35. [PMID: 21909781 DOI: 10.1007/s12098-011-0554-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 08/02/2011] [Indexed: 10/17/2022]
Abstract
Malaria is a major vector borne disease in India with significant morbidity and mortality. The official figure of 1.5 million cases annually is a gross under-estimation of the true incidence and the actual figures are estimated to be 10-100 times higher. The National Vector Borne Disease Control Programme (NVBDCP) directorate is the main body responsible for malaria control in India. Newer strategies including insecticide treated bednets, longlasting insecticidal bednets and rapid diagnostic tests have been used for malaria control in the last decade. Global assistance has come from the World Bank and Global fund in the form of Enhanced Malaria Control Programme(EMCP) and Intensified Malaria Control Programme(IMCP) respectively. Despite years of concerted global and national efforts, control of malaria continues to be a challenge. The emergence of drug resistance to anti-malarial drugs has been a major hurdle in its control. The NVBDCP has formulated new treatment guidelines for malaria in 2010 which recommend artemisinin based combination therapy (ACT) as the first-line drugs for P. falciparum malaria in the country. The article discusses the recent national drug policy for malaria and the rationale for its use.
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Ishengoma DS, Francis F, Mmbando BP, Lusingu JPA, Magistrado P, Alifrangis M, Theander TG, Bygbjerg IC, Lemnge MM. Accuracy of malaria rapid diagnostic tests in community studies and their impact on treatment of malaria in an area with declining malaria burden in north-eastern Tanzania. Malar J 2011; 10:176. [PMID: 21703016 PMCID: PMC3145609 DOI: 10.1186/1475-2875-10-176] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 06/26/2011] [Indexed: 11/29/2022] Open
Abstract
Background Despite some problems related to accuracy and applicability of malaria rapid diagnostic tests (RDTs), they are currently the best option in areas with limited laboratory services for improving case management through parasitological diagnosis and reducing over-treatment. This study was conducted in areas with declining malaria burden to assess; 1) the accuracy of RDTs when used at different community settings, 2) the impact of using RDTs on anti-malarial dispensing by community-owned resource persons (CORPs) and 3) adherence of CORPs to treatment guidelines by providing treatment based on RDT results. Methods Data were obtained from: 1) a longitudinal study of passive case detection of fevers using CORPs in six villages in Korogwe; and 2) cross-sectional surveys (CSS) in six villages of Korogwe and Muheza districts, north-eastern, Tanzania. Performance of RDTs was compared with microscopy as a gold standard, and factors affecting their accuracy were explored using a multivariate logistic regression model. Results Overall sensitivity and specificity of RDTs in the longitudinal study (of 23,793 febrile cases; 18,154 with microscopy and RDTs results) were 88.6% and 88.2%, respectively. In the CSS, the sensitivity was significantly lower (63.4%; χ2 = 367.7, p < 0.001), while the specificity was significantly higher (94.3%; χ2 = 143.1, p < 0.001) when compared to the longitudinal study. As determinants of sensitivity of RDTs in both studies, parasite density of < 200 asexual parasites/μl was significantly associated with high risk of false negative RDTs (OR≥16.60, p < 0.001), while the risk of false negative test was significantly lower among cases with fever (axillary temperature ≥37.5°C) (OR ≤ 0.63, p ≤ 0.027). The risk of false positive RDT (as a determinant of specificity) was significantly higher in cases with fever compared to afebrile cases (OR≥2.40, p < 0.001). Using RDTs reduced anti-malarials dispensing from 98.9% to 32.1% in cases aged ≥5 years. Conclusion Although RDTs had low sensitivity and specificity, which varied widely depending on fever and parasite density, using RDTs reduced over-treatment with anti-malarials significantly. Thus, with declining malaria prevalence, RDTs will potentially identify majority of febrile cases with parasites and lead to improved management of malaria and non-malaria fevers.
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Affiliation(s)
- Deus S Ishengoma
- National Institute for Medical Research, Tanga Medical Research Centre, P.O. Box 5004, Tanga, Tanzania.
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Alam MS, Mohon AN, Mustafa S, Khan WA, Islam N, Karim MJ, Khanum H, Sullivan DJ, Haque R. Real-time PCR assay and rapid diagnostic tests for the diagnosis of clinically suspected malaria patients in Bangladesh. Malar J 2011; 10:175. [PMID: 21703009 PMCID: PMC3145608 DOI: 10.1186/1475-2875-10-175] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 06/26/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than 95% of total malaria cases in Bangladesh are reported from the 13 high endemic districts. Plasmodium falciparum and Plasmodium vivax are the two most abundant malaria parasites in the country. To improve the detection and management of malaria patients, the National Malaria Control Programme (NMCP) has been using rapid diagnostic test (RDT) in the endemic areas. A study was conducted to establish a SYBR Green-based modified real-time PCR assay as a gold standard to evaluate the performance of four commercially-available malaria RDTs, along with the classical gold standard- microscopy. METHODS Blood samples were collected from 338 febrile patients referred for the diagnosis of malaria by the attending physician at MatirangaUpazila Health Complex (UHC) from May 2009 to August 2010. Paracheck RDT and microscopy were performed at the UHC. The blood samples were preserved in EDTA tubes. A SYBR Green-based real-time PCR assay was performed and evaluated. The performances of the remaining three RDTs (Falcivax, Onsite Pf and Onsite Pf/Pv) were also evaluated against microscopy and real-time PCR using the stored blood samples. RESULT In total, 338 febrile patients were enrolled in the study. Malaria parasites were detected in 189 (55.9%) and 188 (55.6%) patients by microscopy and real-time PCR respectively. Among the RDTs, the highest sensitivity for the detection of P. falciparum (including mixed infection) was obtained by Paracheck [98.8%, 95% confidence interval (CI) 95.8-99.9] and Falcivax (97.6%, 95% CI 94.1-99.4) compared to microscopy and real-time PCR respectively. Paracheck and Onsite Pf/Pv gave the highest specificity (98.8%, 95% CI 95.7-99.9) compared to microscopy and Onsite Pf/Pv (98.8, 95% CI 95.8-99.9) compared to real-time PCR respectively for the detection of P. falciparum. On the other hand Falcivax and Onsite Pf/Pv had equal sensitivity (90.5%, 95% CI 69.6-98.8) and almost 100% specificity compared to microscopy for the detection of P. vivax. However, compared to real-time PCR assay RDTs and microscopy gave low sensitivity (76.9%, 95% CI 56.4-91) in detecting of P. vivax although a very high specificity was obtained (99-100%). CONCLUSION The results of this study suggest that the SYBR Green-based real-time PCR assay could be used as an alternative gold standard method in a reference setting. Commercially-available RDTs used in the study are quite sensitive and specific in detecting P. falciparum, although their sensitivity in detecting P. vivax was not satisfactory compared to the real-time PCR assay.
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