Abstract
Quantification of parasite density is an important component in the diagnosis of malaria infection. The accuracy of this estimation varies according to the method used. The aim of this study was to assess the agreement between the parasite density values obtained with the assumed value of 8,000 cells/μL and the automated WBC count. Moreover, the same comparative analysis was carried out for other assumed values of WBCs. The study was carried out in Brazil with 403 malaria patients who were infected in different endemic areas of the Brazilian Amazon. The use of a fixed WBC count of 8,000 cells/μL to quantify parasite density in malaria patients led to overestimated parasitemia and resulted in low reliability when compared to the automated WBC count. Assumed values ranging between 5,000 and 6,000 cells/μL, and 5,500 cells/μL in particular, showed higher reliability and more similar values of parasite density when compared between the 2 methods. The findings show that assumed WBC count of 5,500 cells/μL could lead to a more accurate estimation of parasite density for malaria patients in this endemic region.
Highlights
Microscopic examination of blood collected from patients infected with Plasmodium is still the most commonly used method to diagnose and estimate parasite density in malaria infections, owing to its low cost and simplicity of implementation
The accuracy of this estimation varies according to the method used; it is higher with quantification by real-time polymerase chain reaction (PCR) analysis of circulating Plasmodium DNA in a known volume of blood and lower for parasite quantification by microscopy of blood smears [2]
The use of a fixed white blood cells (WBC) count of 8,000 cells/mL to quantify parasite density in malaria patients from endemic regions of the Brazilian Amazon led to overestimated parasitemia and resulted in low reliability when compared to the automated WBC count
Summary
Microscopic examination of blood collected from patients infected with Plasmodium is still the most commonly used method to diagnose and estimate parasite density in malaria infections, owing to its low cost and simplicity of implementation. Quantification of parasite density is an important component in the diagnosis of malaria infection, as it helps to define the severity of the disease, assess the therapeutic response in vivo, and explore the effectiveness of new antimalarial drugs [1] The accuracy of this estimation varies according to the method used; it is higher with quantification by real-time polymerase chain reaction (PCR) analysis of circulating Plasmodium DNA in a known volume of blood and lower for parasite quantification by microscopy of blood smears [2]. In order to achieve this, the use of an automated WBC count in infected patients is necessary This allows a more accurate estimation of parasite density when compared to the method that assumes a fixed value of 8,000 cells/mL. An assumed value of 8,000 cells/mL has been considered as an alternative for the quantification of parasitemia in patients infected with malaria in this region
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