Abstract

Rapid and specific diagnosis of malaria remains one of the main strategies to fight the disease. The diagnosis is made primarily by the simple and low-cost thick drop technique, considered the gold standard test. However, the requirement for good quality microscopes and well-trained personnel often lead to inaccurate diagnosis, especially in cases of mixed infections or low parasitemia. Although PCR-based tests can help in these situations, this technique requires large and sensitive equipments, being unsuitable for point of care (POC) settings. A myriad of POC diagnostic tests have being developed in the last years, relying on molecular methods but also on novel strategies. New platforms, miniaturization techniques, and multiplexing possibilities promise great potential to improve disease diagnostics through fast and accurate detection of cases, even at remote places. Here, we will address the main POC strategies developed for the diagnosis of malaria, highlighting their strengths and weakness as POC applications.

Highlights

  • Malaria is one of the deadliest diseases of poverty

  • The sensitivity of the optical microscopy technique using the thick drop method is50–500 parasites/μL, many factors may interfere with the results found in the thick drop technique, such as the quality of the microscope, the quality of the available staining reagents, and the skill of the technician

  • While microscopy remains the gold standard, being the mainstay of parasite-based diagnosis, its characteristics are inadequate for ensuring good sensitivity and specificity of malaria diagnosis in the field, adversely affecting health outcomes and optimal use of resources

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Summary

Introduction

Malaria is one of the deadliest diseases of poverty. It is estimated that malaria causes 228 million illnesses and 405 thousands deaths each year. The appearance of antimalarial resistant parasites including artemisinin derivatives pose a major public health threat [3] Drugs such as the artemisinin-derivatives are more expensive, leading to an increased demand for patient evaluation by accurate diagnostic tests before treatment [4–6]. According to the World Health Organization (WHO) guidelines, the useful diagnostic tool at the point of care (POC) is defined by some characteristics It should be low cost, deliver sensitive and accurate results in as little time as possible, run on a portable instrument (ideally, should be instrument-free), require minimal external power, require minimal training before use, and not require refrigerated reagent storage and transportation. We will review the status of the diagnostic technologies that have been used for malaria detection at POC conditions, discussing their main advantages and disadvantages in the POC context

Smear microscopy
Polymerase chain reaction (PCR)
Isothermal amplification methods
Microfluidics and other new technologies
DNA-based capture molecules
Non-invasive samples and detection methods
The nucleic acid extraction problem
Advantages and disadvantages for POC settings
Costs and cost effectiveness
Findings
Conclusion
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