Abstract
BackgroundThis study aimed at detecting PfHRP2 and pLDH malaria antigens in urine and salivary specimens of suspected malaria patients using RDT kits, and identifying factors influencing the detection of these antigens.MethodsMalaria rapid test kit (SD Bioline RDT kit) was used to detect malaria antigens, PfHRP2 and pLDH, in blood, urine and saliva samples received from patients suspected of malaria. Subsequently, malaria parasitaemia was determined. From the same patients, body temperature readings and haemoglobin concentrations were recorded. Also, micro-haematuria and saliva occult blood were determined. Relative to blood, the sensitivities and the performance of urine and saliva as alternative samples were evaluated.ResultsA total of 706 suspected malaria patients provided all three specimens. Prevalence of malaria by microscopy and RDT was 44.2% and 53.9%, respectively. Compared to blood, the sensitivities of urine and saliva were 35.2% and 57.0% respectively. Haemoglobin concentration < 9.9 g/dL, body temperature > 38.7 °C and occult blood influenced the detection of malaria antigens in both urine and saliva. Furthermore, the antigens were not detected in urine and saliva when parasitaemia was < 60,000 parasites/µL and < 40,000 parasites/µL, respectively.ConclusionSaliva, with or without blood contamination, was found to be more efficient that urine samples. Therefore these non-blood specimens have the potential to be used as non-invasive samples for malaria diagnosis. However, this approach is useful in severe to moderate anaemia, hyperthermia, parasitaemia > 60,000 parasites/µL and samples contaminated with blood.
Highlights
This study aimed at detecting Plasmodium falciparum HISTIDINE-rich protein 2 (PfHRP2) and Plasmodium Lactate dehydrogenase (pLDH) malaria antigens in urine and salivary specimens of suspected malaria patients using Rapid diagnostic test kits (RDT) kits, and identifying factors influencing the detection of these antigens
With the exception of participants recruited from Pokuase Health Centre, over 50% of all participants from other sites were less than 21 years
P. falciparum HRP2 antigens were detected in saliva of malaria patients using ELISA technique, and even though the sensitivity was low (43%) with comparatively long turnaround time [12], this report together with findings in this study showed the potential of a non-invasive approach for malaria diagnosis using saliva
Summary
This study aimed at detecting PfHRP2 and pLDH malaria antigens in urine and salivary specimens of suspected malaria patients using RDT kits, and identifying factors influencing the detection of these antigens. Malaria is one of the highest killer diseases predominant in sub-Saharan Africa (SSA). Invasive phlebotomy can cause adverse effects, such as pain or bruising at the site of puncture, fainting, nerve damage and haematoma [5] in patients. Due to the potential demerits of invasive phlebotomy, diagnosis of diseases based on non-invasive procedures have been suggested and evaluated in some studies [10]. Urine and saliva are the two most popular alternatives to blood for diagnosis of diseases such as malaria [11]. Collection of urine and saliva do not require invasive procedures. It is simple, safe, painless and can be done by individuals with limited training, including patients themselves. No special equipment is needed for collection, and it allows for multiple or serial collections outside of the hospital
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