Comparison of Malaria Microscopy and Polymerase Chain Reaction for Identification of Plasmodium in Papua, Indonesia

Abstract

To diagnose malaria, microscopic examination is still considered as the standard tool, but still there are certain reservations. This study aimed to compare the identification of Plasmodium species by microscopy and polymerase chain reaction (PCR). This cross-sectional investigation was carried out in June 2019 until September 2019. Blood samples were taken and examined using microscope and nested PCR. Both results were compared to evaluate the diagnostic performance of microscopy and agreement between both examinations. Only P. vivax and P. falciparum were found in current study. The sensitivity, specificity, PPV, and NPV of the microscopy examination compared to nested PCR for detecting P. vivax, was 91.0%, 97.5%, 96.8%, and 92.8% respectively with κ=0.889; and for P. falciparum, the sensitivity, specificity, PPV and NPV was 62.7%, 95.8%, 88.9%, and 82.7% respectively with κ=0.628. Among all mixed infections, only 12% were identified correctly by microscopy. Microscopy is reliable way for routine diagnostic purposes, to detect single malaria infection. However, it is unreliable to detect mixed malaria infections.