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Tiwari AK, Goel S, Singh G, Gahlot PK, Saxena R, Jadhav V, Sethi M. Evaluation of new haematology analyser, XN-31, for malaria detection in blood donors: A single-centre study from India. Vox Sang 2024; 119:556-562. [PMID: 38523360 DOI: 10.1111/vox.13621] [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: 01/17/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND OBJECTIVES Malaria continues to be a significant public health concern in India, with several regions experiencing endemicity and sporadic outbreaks. The prevalence of malaria in blood donors, in India, varies between 0.02% and 0.07%. Common techniques to screen for malaria, in blood donors and patients, include microscopic smear examination and rapid diagnostic tests (RDTs) based on antigen detection. The aim of this study was to evaluate a new fully automated analyser, XN-31, for malaria detection, as compared with current practice of using RDT. MATERIALS AND METHODS Cross-sectional analytical study was conducted to evaluate clinical sensitivity and specificity of new automated analyser XN-31 among blood donors' samples and clinical samples (patients with suspicion of malaria) from outpatient clinic collected over between July 2021 and October 2022. No additional sample was drawn from blood donor or patient. All blood donors and patients' samples were processed by malaria rapid diagnostic test, thick-smear microscopy (MIC) and the haematology analyser XN-31. Any donor blood unit incriminated for malaria was discarded. Laboratory diagnosis using MIC was considered the 'gold standard' in the present study. Clinical sensitivity and specificity of XN-31 were compared with the gold standard. RESULTS Fife thousand and five donor samples and 82 diagnostic samples were evaluated. While the clinical sensitivity and specificity for donor samples were 100%, they were 72.7% and 100% for diagnostic samples. CONCLUSION Automated haematology analysers represent a promising solution, as they can deliver speedy and sensitive donor malaria screening assessments. This method also has the potential to be used for pre-transfusion malaria screening along with haemoglobin estimation.
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Affiliation(s)
- Aseem Kumar Tiwari
- Department of Transfusion Medicine, Medanta-The Medicity, Sector-38, Gurgaon, India
| | - Shalini Goel
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Sector-38, Gurgaon, India
| | - Ganesh Singh
- Department of Transfusion Medicine, Medanta-The Medicity, Sector-38, Gurgaon, India
| | - Pawan Kumar Gahlot
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Sector-38, Gurgaon, India
| | - Renu Saxena
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Sector-38, Gurgaon, India
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Khartabil T, van Schaik RH, Haanstra JR, Koelewijn R, Russcher H, van Hellemond JJ. The fully automated Sysmex XN-31 hematology analyzer can detect bloodstream form Trypanosoma brucei. Diagn Microbiol Infect Dis 2024; 108:116193. [PMID: 38295683 DOI: 10.1016/j.diagmicrobio.2024.116193] [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: 10/26/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND For fully automated detection and quantification of Plasmodium parasites, Sysmex developed the XN-31 hemocytometer. This study investigated whether the XN-31 can also detect and quantify bloodstream form trypanosomes (trypomastigotes). METHODS Axenic cultures of Trypanosoma brucei brucei were used to prepare two dilution series of trypomastigotes in the whole blood of a healthy donor, which were subsequently examined by the XN-31 as well as by microscopic examination of thin and thick blood films. Trypomastigote intactness during the procedures was evaluated by microscopy. RESULTS The XN-31 hemocytometer detected trypomastigotes with a detection limit of 26 trypomastigotes/μL. Scattergram patterns of Trypanosoma and Plasmodium parasites were clearly distinct, but current interpretation settings do not allow the identification of trypomastigotes yet, and therefore, need future refinement. CONCLUSION Proof of concept was provided for an automated fluorescent flow cytometry method that can detect and quantify Plasmodium spp., as well as Trypanosoma brucei trypomastigotes.
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Affiliation(s)
- Tania Khartabil
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Ron Hn van Schaik
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jurgen R Haanstra
- Systems Biology Lab, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Vrije Universiteit Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - Rob Koelewijn
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Henk Russcher
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jaap J van Hellemond
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
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Maturana CR, de Oliveira AD, Nadal S, Bilalli B, Serrat FZ, Soley ME, Igual ES, Bosch M, Lluch AV, Abelló A, López-Codina D, Suñé TP, Clols ES, Joseph-Munné J. Advances and challenges in automated malaria diagnosis using digital microscopy imaging with artificial intelligence tools: A review. Front Microbiol 2022; 13:1006659. [PMID: 36458185 PMCID: PMC9705958 DOI: 10.3389/fmicb.2022.1006659] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/26/2022] [Indexed: 09/03/2023] Open
Abstract
Malaria is an infectious disease caused by parasites of the genus Plasmodium spp. It is transmitted to humans by the bite of an infected female Anopheles mosquito. It is the most common disease in resource-poor settings, with 241 million malaria cases reported in 2020 according to the World Health Organization. Optical microscopy examination of blood smears is the gold standard technique for malaria diagnosis; however, it is a time-consuming method and a well-trained microscopist is needed to perform the microbiological diagnosis. New techniques based on digital imaging analysis by deep learning and artificial intelligence methods are a challenging alternative tool for the diagnosis of infectious diseases. In particular, systems based on Convolutional Neural Networks for image detection of the malaria parasites emulate the microscopy visualization of an expert. Microscope automation provides a fast and low-cost diagnosis, requiring less supervision. Smartphones are a suitable option for microscopic diagnosis, allowing image capture and software identification of parasites. In addition, image analysis techniques could be a fast and optimal solution for the diagnosis of malaria, tuberculosis, or Neglected Tropical Diseases in endemic areas with low resources. The implementation of automated diagnosis by using smartphone applications and new digital imaging technologies in low-income areas is a challenge to achieve. Moreover, automating the movement of the microscope slide and image autofocusing of the samples by hardware implementation would systemize the procedure. These new diagnostic tools would join the global effort to fight against pandemic malaria and other infectious and poverty-related diseases.
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Affiliation(s)
- Carles Rubio Maturana
- Microbiology Department, Vall d’Hebron Research Institute, Vall d’Hebron Hospital Campus, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Allisson Dantas de Oliveira
- Computational Biology and Complex Systems Group, Physics Department, Universitat Politècnica de Catalunya (UPC), Castelldefels, Spain
| | - Sergi Nadal
- Data Base Technologies and Information Group, Engineering Services and Information Systems Department, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Besim Bilalli
- Data Base Technologies and Information Group, Engineering Services and Information Systems Department, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Francesc Zarzuela Serrat
- Microbiology Department, Vall d’Hebron Research Institute, Vall d’Hebron Hospital Campus, Barcelona, Spain
| | - Mateu Espasa Soley
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Clinical Laboratories, Microbiology Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Elena Sulleiro Igual
- Microbiology Department, Vall d’Hebron Research Institute, Vall d’Hebron Hospital Campus, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- CIBERINFEC, ISCIII- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Alberto Abelló
- Data Base Technologies and Information Group, Engineering Services and Information Systems Department, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Daniel López-Codina
- Computational Biology and Complex Systems Group, Physics Department, Universitat Politècnica de Catalunya (UPC), Castelldefels, Spain
| | - Tomàs Pumarola Suñé
- Microbiology Department, Vall d’Hebron Research Institute, Vall d’Hebron Hospital Campus, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elisa Sayrol Clols
- Image Processing Group, Telecommunications and Signal Theory Group, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Joan Joseph-Munné
- Microbiology Department, Vall d’Hebron Research Institute, Vall d’Hebron Hospital Campus, Barcelona, Spain
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Komaki-Yasuda K, Kutsuna S, Kawaguchi M, Kamei M, Uchihashi K, Nakamura K, Nakamoto T, Ohmagari N, Kano S. Clinical performance testing of the automated haematology analyzer XN-31 prototype using whole blood samples from patients with imported malaria in Japan. Malar J 2022; 21:229. [PMID: 35907857 PMCID: PMC9338637 DOI: 10.1186/s12936-022-04247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background The automated haematology analyzer XN-31 prototype (XN-31p) is a new flow cytometry-based device developed to measure the number and the ratio of malaria-infected red blood cells (MI-RBC) with a complete blood count (CBC). The XN-31p can provide results in about one minute and also can simultaneously provide information on the malaria parasite (Plasmodium) species. In this study, clinical testing of the XN-31p was performed using blood samples from patients with imported malaria in Japan. Methods Blood samples were collected from 80 patients who visited the hospital of the National Center for Global Health and Medicine, Tokyo, Japan, for malaria diagnosis from January 2017 to January 2019. The test results by the XN-31p were compared with those by other standard methods, such as microscopic observation, rapid diagnostic tests and the nested PCR. Results Thirty-three patients were diagnosed by the nested PCR as being malaria positive (28 Plasmodium falciparum, 2 Plasmodium vivax, 1 Plasmodium knowlesi, 1 mixed infection of P. falciparum and Plasmodium malariae, and 1 mixed infection of P. falciparum and Plasmodium ovale), and the other 47 were negative. The XN-31p detected 32 patients as “MI-RBC positive”, which almost matched the results by the nested PCR and, in fact, completely matched with the microscopic observations. The ratio of RBCs infected with malaria parasites as determined by the XN-31p showed a high correlation coefficient of more than 0.99 with the parasitaemia counted under microscopic observation. The XN-31p can analyse the size and nucleic acid contents of each cell, and the results were visualized on a two-dimensional cytogram termed the “M scattergram”. Information on species and developmental stages of the parasites could also be predicted from the patterns visualized in the M scattergrams. The XN-31p showed a positive coincidence rate of 0.848 with the nested PCR in discriminating P. falciparum from the other species. Conclusions The XN-31p could rapidly provide instructive information on the ratio of MI-RBC and the infecting Plasmodium species. It was regarded to be of great help for the clinical diagnosis of malaria. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04247-x.
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Affiliation(s)
- Kanako Komaki-Yasuda
- Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center of National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Miki Kawaguchi
- Sysmex Corporation, 4-4-4 Takatsukadai, Nishi-ku, Kobe, 651-2271, Japan
| | - Mina Kamei
- Sysmex Corporation, 4-4-4 Takatsukadai, Nishi-ku, Kobe, 651-2271, Japan
| | - Kinya Uchihashi
- Sysmex Corporation, 4-4-4 Takatsukadai, Nishi-ku, Kobe, 651-2271, Japan
| | - Keiji Nakamura
- Disease Control and Prevention Center of National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Takato Nakamoto
- Disease Control and Prevention Center of National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center of National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Shigeyuki Kano
- Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
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