Clinical Diagnosis Of Malaria Research Articles

Epidemiological Profile of Malaria and Adherence to Treatment in Children under Five

Malaria caused by in Angola is spread throughout the country and is endemic in the 18 provinces, with a higher incidence in the Northern provinces. Treatment is based on combinations of and adherence to drug therapy has an influence on the effectiveness of treatment. The objective of this investigation was to describe the epidemiological profile and treatment adherence of children under five years of age with a clinical diagnosis of malaria

Clinical performance testing of the automated haematology analyzer XN-31 prototype using whole blood samples from patients with imported malaria in Japan

BackgroundThe 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.MethodsBlood 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.ResultsThirty-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.ConclusionsThe 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.

Malaria rapid diagnostic test positivity rate among febrile patients seen at the Paediatric emergency unit of a tertiary care facility

Background: Malaria, a life-threatening parasitic disease transmitted to humans by the female Anopheles mosquito is one of the infectious causes of fever in children. In Nigeria, malaria remains one of the most important health problems, accounting for 25% of infants and 30% of under-five mortalities. The objective of this study was to determine the prevalence of malaria among febrile children presenting at the children's emergency room (CHER) of a tertiary health facility in Abakaliki using a malaria rapid diagnostic test (mRDT).
 Methodology: This was a retrospective study that involved children presenting with fever in CHER over a 3-year period. A total of 1,273 febrile children below 18 years of age were tested with a malaria rapid diagnostic test (mRDT) kit during this period. Medical records of the patients were assessed to retrieve information such as age, gender, and clinical diagnoses. Data were analyzed using SPSS version 25.
 Results: A total of 707 (55.5%) were males and 883 (69.4%) were below 5 years of age. The overall prevalence of malaria by the mRDT test was 26% (n=331). Uncomplicated malaria, 283 (22.2%) was the commonest clinical diagnosis made while the least was malnutrition 3 (0.2%). Children aged 10-<18 years were predominantly affected as mRDT positivity rate was significantly higher in children age group 10-<18 years (40.4% 76/189) than other age groups (X2=44.76, p<0.001). Similarly, the rate was significantly higher (OR 9.625, 95% CI 7.233-12.808, p<0.0001) in children with the clinical diagnosis of malaria (55.2%, 235/426) than those with the clinical diagnosis of other illnesses (11.3%, 96/847), and significantly higher (OR 0.19, 95% CI 0.1186-0.3043, p<0.0001) among those clinically diagnosed with complicated (79.7%, 114/143) than those with uncomplicated malaria (42.8%, 121/283).
 Conclusion: There is a high prevalence of malaria among febrile children presenting at the CHER of Alex Ekwueme Federal University Teaching Hospital Abakaliki. Children age group 10-<18 years were predominantly affected. The use of mRDT should be encouraged both as a screening and diagnostic tool with a protocol such that febrile children who have positive results are confirmed as having malaria while those with negative results are further evaluated with microscopy.

Diagnostic Accuracy of CareStart™ Malaria HRP2 and SD Bioline Pf/PAN for Malaria in Febrile Outpatients in Varying Malaria Transmission Settings in Cameroon

Background: There was an increase in the number of malaria cases in Cameroon in 2018 that could reflect changes in provider practice, despite effective interventions. In this study, we assessed the diagnostic performance of two malaria rapid diagnostic tests (mRDTs) for diagnostic confirmation of suspected cases of malaria in public and private health facilities in two malaria transmission settings in Cameroon. Methods: We evaluated the diagnostic performance of CareStart pf and SD Bioline Pf/PAN mRDT and compared these parameters by RDT type and transmission setting. Nested PCR and blood film microscopy were used as references. The chi square test was used for independent sample comparisons, while the McNemar’s test was used to test for the dependence of categorical data in paired sample testing. A p < 0.05 was considered significant in all comparisons. The R (v.4.0.2) software was used for analyses. Results: A total of 1126 participants consented for the study in the four sites. The diagnostic accuracy of the CareStart Pf mRDT was 0.93.6% (0.911–0.961) in Yaoundé, 0.930% (0.90–0.960) in Ngounso, 0.84% (0.794–0.891) in St Vincent Catholic Hospital Dschang and 0.407 (0.345–0.468) in Dschang district hospital. For SD Bioline Pf/PAN the accuracy was 0.759 (0.738–0.846) for St Vincent Catholic Hospital Dschang and 0.426 (0.372–0.496) for the Dschang district hospital. The accuracy was slightly lower in each case but not statistically different when PCR was considered as the reference. The likelihood ratios of the positive and negative tests were high in the high transmission settings of Yaoundé (10.99 (6.24–19.35)) and Ngounso (14.40 (7.89–26.28)) compared to the low transmission settings of Dschang (0.71 (0.37–1.37)) and St Vincent Catholic hospital (7.37 (4.32−12.59)). There was a high degree of agreement between the tests in Yaoundé (Cohen’s Kappa: 0.85 ± 0.05 (0.7–0.95)) and Ngounso (Cohen’s Kappa: 0.86 ± 0.05 (0.74, 0.97)) and moderate agreement in St Vincent hospital Dschang (k: 0.58 ± 0.06 (0.44–0.71)) and poor agreement in the District Hospital Dschang (Cohen’s Kappa: −0.11 ± 0.05 (−0.21–0.01)). The diagnostic indicators of the SD Bioline Pf/PAN were slightly better than for CareStart Pf mRDT in St Vincent Catholic hospital Dschang, irrespective of the reference test. Conclusions: Publicly procured malaria rapid diagnostic tests in Cameroon have maintained high accuracy (91–94%) in the clinical diagnosis of malaria in high malaria transmission regions of Cameroon, although they failed to reach WHO standards. We observed an exception in the low transmission region of Dschang, West region, where the accuracy tended to be lower and variable between facilities located in this town. These results underscore the importance of the routine monitoring of the quality and performance of malaria RDTs in diverse settings in malaria endemic areas.

Significant symptoms and nonsymptom-related factors for malaria diagnosis in endemic regions of Indonesia

ObjectivesThis study aims to identify significant symptoms and nonsymptom-related factors for malaria diagnosis in endemic regions of Indonesia. MethodsMedical records are collected from patients suffering from malaria and other febrile diseases from public hospitals in endemic regions of Indonesia. Interviews with eight Indonesian medical doctors are conducted. Feature selection and machine learning techniques are used to develop malaria classifiers for identifying significant symptoms and nonsymptom-related factors. ResultsSeven significant symptoms (duration of fever, headache, nausea and vomiting, heartburn, severe symptom, dizziness, and joint pain) and patients’ history of malaria as a nonsymptom-related factor contribute most to malaria diagnosis. As a symptom, fever duration is more significant than temperature or fever for distinguishing malaria from other febrile diseases. Shivering, fever, and sweating (known to indicate malaria presence in Indonesia) are shown to be less significant than other symptoms in endemic regions. ConclusionsThree most suitable malaria classifiers have been developed to identify the significant features that can be used to predict malaria as distinct from other febrile diseases. With extensive experiments on the classifiers, the significant features identified can help medical doctors in the clinical diagnosis of malaria and raise public awareness of significant malaria symptoms at early stages.

Malaria in Pregnancy in Nigeria: A Literature Review

Malaria is caused by the parasite plasmodium which can be spread to humans through the bite of an infected mosquito. Of the five types of plasmodium (P. Falciparium, P.Ovale, P. Malaria, P. Vivax and P. Knowlesi), the plasmodium falciparium is the deadliest and affects the lives of almost 40 per cent of the world’s population with pregnant women and children under-five years of age being the most affected. This mini-review involved the collation of findings from recent studies in regards to the prevalence of malaria infection among pregnant women and infants. A systematic analysis of recent literature on the prevalence of malaria in pregnancy from many authors was carried out and the facts synthesized to make an easy read. From the analysis of literature, Ten Thousand women and 200,000 babies were reported to be dying annually from complications of malaria in pregnancy which recorded a prevalence of 85 per cent in sub-Saharan Africa. More so, Fifty per cent of pregnant women were discovered to be carrying plasmodium falciparium in their placenta without even experiencing malaria signs/ symptoms, and this development was reported to have been responsible for Twenty per cent of stillbirths and 11 per cent of all maternal deaths. Malaria infection is considered a major threat to the lives and well-being of pregnant women and infants. Therefore, stakeholders should ensure that every clinical diagnosis of malaria in pregnancy is confirmed with a laboratory plasmodium falciparium-based diagnosis before the administration of antimalarial drugs. Furthermore there should be a stepping –up on the distribution of insecticide treated nets alongside enlightenment of pregnant women on ways of preventing mosquito bite. Instituting the aforementioned approaches is key to improving the health- seeking behaviour of pregnant women in particular and the wider population in general thus enabling them to stay malaria free throughout the period of pregnancy and infancy.

Clinical malaria and the potential risk of anaemia among preschool-aged children: a population-based study of the 2015\u20132016 Malawi micronutrient survey

BackgroundAnaemia and malaria are common and life-threatening diseases among preschool-aged children in many tropical and subtropical areas, and Malawi is no exception. Accordingly, this study aimed to examine the association of referral clinical malaria with anemia (hemoglobin [Hb] < 110 g/L) in preschool-aged children in Malawi.MethodsUsing cross-sectional data obtained from the 2015–2016 Malawi Micronutrient Survey (MNS), multivariate logistic regression models were constructed using surveylogistic to account for the complex survey design. Blood samples of 1051 children aged 6–59 months were evaluated for malaria (using rapid diagnostic test [RDT] – SD BIOLINE Malaria Ag P.f/Pan test histidine-rich protein (HRP-II)™), Hb (using HemoCue 301), α-1-acid glycoprotein (AGP), and serum ferritin biomarkers (using simple sandwich enzyme-linked immunosorbent assay technique, ELISA) and inherited blood disorders from dry blood samples (DBS) using polymerize chain reaction (PCR). Diagnosis of clinical malaria was made on the basis of fever and a positive rapid diagnostic test (RDT).ResultsOf the 1051 PSC analysed, 29% had anaemia while 24.4% had a referral to the hospital due to malaria. After adjustments for known confounders, PSC with a history of referral clinical malaria had increased odds of being anaemic (adjusted odds ratio [aOR] = 4.63, 95% confidence interval [CI]: 2.90–7.40), P < 0.0001.ConclusionsThis study found that clinical malaria increased the risk of anaemia in PSC. Thus, elimination of malaria-causing parasites from the PSC’s blood should be rapid and complete in order to prevent the progression of uncomplicated malaria to a chronic infection that can lead to the development of malaria-related anaemia.

Ethnobotanical and clinical knowledge of malaria surveys, antiplasmodial effect and cytotoxicity of plants used in traditional medicine in two departments of Congo

For more effective in the treatment of malaria by plants in traditional medicine, a scientific validation on the efficacy and tolerability of the treatments is essential. This study aims firstly to evaluate the knowledge of health tradipractitioners on the pathophysiological manifestations that helped to establish a clinical diagnosis of malaria; secondly to identify the different recipes of the plants used against malaria with a view to select plants to be evaluated for their citotoxicity and antiplasmodial effect. An ethnobotanical and clinical knowledge of malaria surveys have been conducted in Nkayi and Gamboma semi-rural cities. Five plants were selected and submitted to aqueous maceration and sequential maceration using polar croissant solvent system: hexane, dichlorometane (DCM), mix v dichloromethane / v methanol (MeOH) and methanol. Antiplasmodial assay was conducted with D10 sensitive Plasmodium falciparum strain. Cytotoxicity was assessed at Vero cells line. Cassia siamea bark aqueous, hexane and DCM / MeOH extracts, Quassia africana roots aqueous and MeOH extracts, Nauclea latifolia leaves DCM/MeOH, MeOH and roots DCM/MeOH extracts, Rauvolfia vomitoria leaves DCM/MeOH, MeOH extracts are highly active(IC50 < 6,25 μg / ml). Some of these active extracts are completely devoided of the cytotoxicity, others are weakly cytotoxic (44, 09 ± 1, 47 μg / ml ≤ CC50 ≤ 120, 5 ± 1, 94 μg / ml; 14.22 > SI > 19, 28). Many chemical molecules of these plants are responsible for activity.

Simple clinical parameters to diagnose Malaria in Outpatient Department.

Introduction: Malaria is the world's most important parasitic infection which poses major health challenges. Best estimates currently describe the annual global burden of malaria as 300-500 million cases and 1-2 million deaths. Traditionally malaria is diagnosed clinically based upon sign symptoms and clinical examination particularly in remote areas where laboratory facilities are not available. However, no universal criteria exist for clinical diagnosis of malaria and presenting features are highly variable region to region. Therefore, we planned to define the simple parameters based on clinical signs and symptoms that predict malaria without laboratory confirmation of parasitemia.&#x0D; Objective: To determine the sensitivity, specificity and positive predictive values of simple clinical parameters for the diagnosis of malaria without laboratory confirmation of parasitemia.&#x0D; Methodology: This observational study was carried out at pediatric department of Karachi Medical and Dental college and Abassi Shaheed Hospital Karachi during 15 April 2015 to 15 February 2015. Children between 6 months to 5 years, who presented with short duration of fever (less than 7 days) were included in study. The diagnosis of malaria was confirmed on identification of parasite (Plasmodium vivax or Plasmodium falciparum) in blood obtained from finger prick sample for thick and thin film. The patients were divided into two groups (+ve MP cases and -ve MP cases). Focal signs and symptoms, pallor (anemia) and splenomegaly were checked in both groups to assess the sensitivity, specificity and predictive values of these simple clinical parameters and co-related with the presence of malaria parasitemia.&#x0D; Result: Six hundred fifty-seven children were examined. One hundred (15.22%) children out of 657 had malaria confirmed while 84.78% (557 of 657) had illness other than malaria. There were 43 children (43%) with Plasmodium falciparum malaria, 47 children (47%) with Plasmodium vivax malaria and 10 (10%) with mixed infections. Three clinical parameters (No focal features, anemia &amp; splenomegaly) were studied in all febrile patients which were divided into two groups (Malarial parasite +ve and malarial parasite -ve).&#x0D; Conclusion: Few simple clinical findings can lead to reliable clinical diagnosis of malaria with more logical use of antimalarial drugs in children.&#x0D; Key words: Malaria, Anemia, Splenomegaly.

Malaria case management in Zambia: A cross-sectional health facility survey

Misdiagnosis of malaria could lead to the overuse of antimalarials resulting in the progression of underlying illness as well as increased risk of mortality. Misdiagnosis is an important consideration as a significant proportion of febrile illnesses in sub-Saharan Africa are attributable to conditions other than malaria. A health facility survey was carried out for a simple random sample of health facilities across 4 provinces of central Zambia in 2014. Twenty-nine facilities with at least 10 outpatients per day were included in the final sample. A modified service provision assessment questionnaire was used for data collection along with several other instruments. Primary outcomes included the quality and accuracy of diagnostic testing for malaria as well as health worker diagnostic and treatment practices. Laboratory technicians displayed 65.5% sensitivity and 86.0% specificity in performing malaria microscopy. Rapid diagnostic test results as reported by health workers were cross-checked by survey staff revealing 99.8% (95% CI: 98.0%–100.0%) concordance. Overall, 69.5% (177/286) (95% CI [58.8%–78.4%]) of patients were reported as febrile of which 37.0% (68/177) (95% CI [21.0%–56.6%]) had a malaria test requested or conducted by their health worker. Appropriate health worker adherence to recommended malaria case management practices (i.e. requesting/conducting malaria tests for febrile patients and providing appropriate antimalarial treatment for test positive cases or forgoing antimalarial treatment for test negative cases) was 30.5% (57/177) (95% CI [17.1%–48.4%]). Presence of fever (aOR = 10.6; 95% CI [3.6–31.2]) and self-reported headache (aOR = 2.2; 95% CI [1.0–4.9]) were significant factors in explaining health worker practices of requesting or performing malaria tests. Routine practice of IQA activities (aOR = 4.8; 95% CI [1.5–15.1]) and self-reported headache (aOR = 3.3; 95% CI [1.1–10.1])) were both significant predictors of antimalarial drug treatment or prescription among malaria untested patients. Prescriber adherence to malaria diagnostic test results in central Zambia is good, but the overall testing rate of febrile patients was low. Additionally, a number of patients observed during this survey were found to have received a clinical diagnosis of malaria without parasitological confirmation and many patients without test results received antimalarial treatment.

Case Definitions of Clinical Malaria in Children from Three Health Districts in the North Region of Cameroon.

Malaria endemicity in Cameroon greatly varies according to ecological environment. In such conditions, parasitaemia, which is associated with fever, may not always suffice to define an episode of clinical malaria. The evaluation of malaria control intervention strategies mostly consists of identifying cases of clinical malaria and is crucial to promote better diagnosis for accurate measurement of the impact of the intervention. We sought out to define and quantify clinical malaria cases in children from three health districts in the Northern region of Cameroon. A cohort study of 6,195 children aged between 6 and 120 months was carried out during the raining season (July to October) between 2013 and 2014. Differential diagnosis of clinical malaria was performed using the parasite density and axillary temperature. At recruitment, patients with malaria-related symptoms (fever [axillary temperature ≥ 37.5°C], chills, severe malaise, headache, or vomiting) and a malaria positive blood smear were classified under clinical malaria group. The malaria attributable fraction was calculated using logistic regression models. Plasmodium falciparum was responsible for over 91% of infections. Children from Pitoa health district had the highest number of asymptomatic infections (45.60%) compared to those from Garoua and Mayo Oulo. The most suitable cut-off for the association between parasite densities and fever was found among children less than 24 months. Overall, parasite densities that ranged above 3,200 parasites per μl of blood could be used to define the malaria attributable fever cases. In groups of children aged between 24 and 59 months and 60 and 94 months, the optimum cut-off parasite density was 6,400 parasites per μl of blood, while children aged between 95 and 120 months had a cut-off of 800 parasites per μl of blood. In the same ecoepidemiological zone, clinical malaria case definitions are influenced by age and location (health district) and this could be considered when evaluating malaria intervention strategies in endemic areas.

Field evaluation of malaria malachite green loop-mediated isothermal amplification in health posts in Roraima state, Brazil

BackgroundMicroscopic detection of malaria parasites is the standard method for clinical diagnosis of malaria in Brazil. However, malaria epidemiological surveillance studies specifically aimed at the detection of low-density infection and asymptomatic cases will require more sensitive and field-usable tools. The diagnostic accuracy of the colorimetric malachite green, loop-mediated, isothermal amplification (MG-LAMP) assay was evaluated in remote health posts in Roraima state, Brazil.MethodsStudy participants were prospectively enrolled from health posts (healthcare-seeking patients) and from nearby villages (healthy participants) in three different study sites. The MG-LAMP assay and microscopy were performed in the health posts. Two independent readers scored the MG-LAMP tests as positive (blue/green) or negative (clear). Sensitivity and specificity of local microscopy and MG-LAMP were calculated using results of PET-PCR as a reference.ResultsA total of 91 participants were enrolled. There was 100% agreement between the two MG-LAMP readers (Kappa = 1). The overall sensitivity and specificity of MG-LAMP were 90.0% (95% confidence interval (CI) 76.34–97.21%) and 94% (95% CI 83.76–98.77%), respectively. The sensitivity and specificity of local microscopy were 83% (95% CI 67.22–92.66%) and 100% (95% CI 93.02–100.00%), respectively. PET-PCR detected six mixed infections (infection with both Plasmodium falciparum and Plasmodium vivax); two of these were also detected by MG-LAMP and one by microscopy. Microscopy did not detect any Plasmodium infection in the 26 healthy participants; MG-LAMP detected Plasmodium in five of these and PET-PCR assay detected infection in three. Overall, performing the MG-LAMP in this setting did not present any particular challenges.ConclusionMG-LAMP is a sensitive and specific assay that may be useful for the detection of malaria parasites in remote healthcare settings. These findings suggest that it is possible to implement simple molecular tests in facilities with limited resources.

Manifestations of malaria: a clinical experience

Background: Malaria is fast emerging as a number one infectious disease with high morbidity and mortality across the globe. It’s being transmitted across 108 countries containing 3 billion populations (40% of world’s populations) with more than 3 million deaths per year. India is an endemic country for malaria with an estimated 70-100 million1 cases per year. 45-50% of them are due to Plasmodium falciparum (Pf). Pf is responsible for majority of severe and fatal malaria though death due to Plasmodium vivax mono infection have also been reported. Symptoms and sign are highly non-specific in malaria making it more of a clinical diagnosis more than a laboratory diagnosis. Presentation may vary at times and can be quite confusing as malaria is a multisystem disease. Authors’ idea was to study the variable manifestations in confirmed cases of malaria patients at our hospitalMethods: A hospital based cross sectional study was conducted for a period of one year-from 01-08-2015 to 31-07-2016 based on authors’ hospitals records (case sheets with demography profile, clinical features, investigations and treatment outcome).Results: A total of 369 patients positive for malaria parasite were included in the study. 369 were smear positive-219 positive for Plasmodium vivax, 127 were P. falciparum type and 23 were for both. Majority were males (64.50%) and belonged to the age group of 21-50 years (58.84%). They were admitted in post monsoon months (60.43%). Of them 46.44% had classical symptoms of malaria. All the patients had received mainly artemisinin combination therapy (ACT) and 91.87% patients recovered in 7-28 days. The mortality rate was nearly 5.69%.Conclusions: The present study was useful to know the varied manifestations of malaria and hence will be useful in making a clinical diagnosis of malaria.

Comparison of clinical profile between Plasmodium vivax and Plasmodium falciparum malaria in children in tertiary care hospital

Background: The high prevalence of uncomplicated malaria as seen in this study suggests the importance of timely diagnosis and effective treatment and encourages new activities to further decrease complicated malaria cases.Methods: In this study, malaria was diagnosed by conventional thick and thin peripheral smear stained with Leishman stain, examined under oil immersion. The slide was considered negative when there were no parasites in 100 HPF. Rapid diagnostic tests were based on detection of specific plasmodium antigen, LDH (optimal test) for Vivax and HRP2 for falciparum. The mode of presentations like fever, splenomegaly, vomiting, abdominal pain, laboratory investigations and complications were noted. Simple malaria was defined as Plasmodium vivax or Plasmodium falciparum malaria without any complications. All the statistical analysis was done by using SPSS 16 version and in MS Excel. Qualitative variables were expressed as frequencies and percentages. Chi-square was used for examining the categorical data.Results: A total 100 cases of malaria diagnosed by rapid diagnostic test and/or peripheral smear were studied. 69% of the cases were falciparum malaria and 31% of the cases were vivax malaria. Males were more commonly affected than females. Vivax malaria was most common between 5-10 years of age and falciparum malaria was more common in 0-5 years of age. Uncomplicated malaria was seen in 73% of the cases and complicated malaria was seen in 27% of the cases. Incidence of complicated malaria was more common in case of falciparum malaria. Fever, pallor, hepatomegaly and splenomegaly were significant for clinical diagnosis of malaria. Severe anaemia was the most common presentation of complicated malaria followed by jaundice. Cerebral malaria was more common in case of falciparum malaria. Metabolic acidosis and renal failure were more common in falciparum malaria. Hypoglycemia, significant bleeding and shock were more common in falciparum malaria. ARDS was most common in vivax malaria.Conclusions: This study emphasizes the importance of severity of P. Vivax malaria and recommends further studies to establish mortality and severity predictors specific to it.

Evaluating Malaria Prevalence Using Clinical Diagnosis Compared with Microscopy and Rapid Diagnostic Tests in a Tertiary Healthcare Facility in Rivers State, Nigeria.

The World Health Organization's policy on laboratory test of all suspected malaria cases before treatment has not yielded significant effects in several rural areas of Sub-Saharan Africa due to inadequate diagnostic infrastructure, leading to high morbidity and mortality rates. A cross-sectional randomized study was conducted to evaluate the validity of clinical malaria diagnosis through comparison with microscopy and rapid diagnostic test kits (RDTs) using 1000 consenting outpatients of a tertiary hospital in Nigeria. Physicians conducted clinical diagnosis, and blood samples were collected through venous procedure and analyzed for malaria parasites using Giemsa microscopy and RDT kits. Microscopy was considered the diagnostic “gold standard” and all data obtained were statistically analyzed using Chi-square test with a P value <0.05 considered significant. Malaria prevalence values of 20.1%, 43.1%, and 29.7% were obtained for clinical diagnosis, microscopy, and RDTs, respectively (P < 0.05). Values of 47.2%, 95.9%, and 77.8% were obtained for sensitivity, specificity, and diagnostic accuracy, respectively, in clinical diagnosis, while RDTs had sensitivity, specificity, and diagnostic accuracy values of 73.7%, 97.3%, and 88.3%, respectively, when compared to microscopy (P < 0.05). Clinical diagnosed malaria cases should be confirmed with a parasite-based laboratory diagnosis and more qualitative research is needed to explore why clinicians still use clinical diagnosis despite reported cases of its ineffectiveness.

The sensitivity and specificity of a urine based Rapid Diagnostic Test for the diagnosis of plasmodium falciparum in a malaria endemic area in Odisha, India

Background: Rapid and accurate diagnosis is crucial in the treatment of malaria. Rapid Diagnostic Tests (RDTs) using blood have been recommended by the WHO as an acceptable method for the diagnosis of malaria. RDTs provide results quickly, is simple to use and easy to interpret. However, its use requires collection of blood by skin puncture. Hence the aim of the pilot study is to explore the sensitivity and specificity of RDTs using urine (collected non-invasively) for diagnosis of Plasmodium falciparum malaria and to assess the relation between parasite density in blood with HRP-2 Ag detection in urine. Material and Method: All fever cases admitted to Ispat General Hospital (IGH) Rourkela, India, during June 2012-March 2013 with a clinical diagnosis of malaria were examined for the presence of asexual forms of P. falciparum in peripheral blood smears. All smear positive febrile patients who met the eligibility criteria were enrolled. Smear negative fever cases were enrolled as control cases. RDTs were performed using both urine and blood samples by using commercially available blood specific kits. Results: Sixty blood smear positive cases and 51 febrile blood smear negative cases were enrolled. Sensitivity and specificity of RDT urine were 86.67% (95%CI:75.83–93.09) and 94.12% (95%CI:84.08–97.98) respectively whereas those of RDT blood were 91.67% (95% CI: 81.93–96.39) and 98.04% (95% CI 89.7–99.65). The sensitivity of both RDT urine as well as RDT blood were found to be dependent on the level of parasitemia. Conclusion: Results of this study are promising. Larger studies are needed to assess whether RDTs using urine could serve as a practical, reliable method for the detection of P. falciparum in a non-invasive manner where invasive blood taking is less feasible.

Recent Progress in the Development of Diagnostic Tests for Malaria.

The impact of malaria on global health has continually prompted the need to develop effective diagnostic strategies. In malaria endemic regions, routine diagnosis is hampered by technical and infrastructural challenges to laboratories. These laboratories lack standard facilities, expertise or diagnostic supplies; thus, therapy is administered based on clinical or self-diagnosis. There is the need for accurate diagnosis of malaria due to the continuous increase in the cost of medication, and the emergence and spread of drug resistant strains. However, the widely utilized Giemsa-stained microscopy and immunochromatographic tests for malaria are liable to several drawbacks, including inadequate sensitivity and false-positive outcomes. Alternative methods that offer improvements in performance are either expensive, have longer turnaround time or require a level of expertise that makes them unsuitable for point-of-care (POC) applications. These gaps necessitate exploration of more efficient detection techniques with the potential of POC applications, especially in resource-limited settings. This minireview discusses some of the recent trends and new approaches that are seeking to improve the clinical diagnosis of malaria.

Investigating unlicensed retail drug vendors’ preparedness and knowledge about malaria: An exploratory study in rural Uganda

BackgroundDespite major efforts to increase the uptake of preventive measures and timely use of the first line antimalarial treatment artemisinin-based combination therapies (ACT), Uganda continues to fall short of meeting its national malaria control targets. One of the challenges has been scaling up effective measures in rural and remote areas where the unlicensed private retail sector remains the first point of contact and a common source of treatment. The current paper discusses unlicensed vendors’ (1) training related to malaria case management for children aged five and under, and (2) knowledge related to the cause of malaria, preventive measures, common signs, and symptoms, diagnostic procedures, and best treatment options. MethodsA qualitative study using semi-structured interviews was conducted in the rural district of Butaleja, Uganda in 2011. All 88 unlicensed drug outlets enumerated in the study area were visited by six locally recruited research assistants, with one vendor from each outlet invited to participate. The transcripts were analyzed using acceptable qualitative research protocols. ResultsAbout half of the 75 vendors interviewed had received some sort of formal training on malaria at a post-secondary institution, although only 6.7% had qualifications which met licensure requirements. The study found widespread misconceptions relating to the cause, as well as prevention and treatment of malaria. A large majority of the vendors relied primarily on non-specific symptoms and limited physical exams for diagnoses, with less than one-tenth of the vendors recognizing that rapid or microscopic blood testing was necessary to confirm a clinical diagnosis of malaria. While most recognized mosquitoes as the primary vector for malaria, over two-fifths of the vendors held misconceptions about the factors that could increase the risk of malaria, and nearly a third believed that malaria could not be prevented. With respect to acute case management, three-quarters viewed as the best option a medicine other than the government’s first-line antimalarial, artemisinin-based combination therapies (ACT). Almost three-fifths specified quinine as their preferred option, with about one-fifth recommending quinine injection. ConclusionFindings from this study confirm significant gaps in unlicensed vendors’ knowledge related to malaria. With increased utilization of unlicensed drug outlets in rural and remote settings such as Butaleja, findings from this study strongly supports the need to implement strategies to improve the quality of care delivered at these outlet.

VIVAX MALARIA;

Background: The primary health care physician is usually perplexed withregards to selection of initial therapy for patients presenting with fever. Some degrees ofhematological changes do exist in most patients with malaria. How often these changes doexist with malaria in our set up? And whether these changes are due to associated fever oractually resulting because of malaria. Objective: 1-To measure the frequency of abnormalhematological changes in malaria patients in our set up. 2-To compare the hematologicalparameters among subjects with laboratory proven malaria, fever but no malaria diagnosisand healthy controls. Design: Cross-sectional analysis. Place and duration of study: Thisstudy was carried out from May 2010 to Dec- 2010 at department of medicine PNS SHIFA, anddepartments of pathology PNS SHIFA and RAHAT, Karachi. Subjects and methods: Subjectswith history of fever and a clinical suspicion of malaria were recruited from primary physician’sOPD along with healthy age and sex-matched control. First, the frequencies of various abnormalfindings in hematological parameters were measured in subjects diagnosed to have malaria.Later, group-1: [Malaria (Laboratory positive) (n=74)], Group-2: [Fever (Laboratory negative)(n=104)] and group-3: [Age and sex matched controls (n=54)] were evaluated by one wayANOVA followed by post-hoc comparisons for significant differences among groups. Bloodcomplete picture were measured by automated hematology analyzer (Specifications: CELTAC- alpha, MEK-6410 K). Malaria parasite presence was confirmed by both slide examinationtechnique and immune-chromatographic (ICT) testing. Main outcome measures-Hemoglobin,white blood cells (WBC), platelets, PDW, % neutrophil. Results- 21.62 % cases from malariahad anemia, while the occurrence of leucopenia was 62.16%. This leukpenia was associatedwith relative neutrophil excess (63.51%). Thrombocytopenia was the most consistent findingamong our studied subjects (97.30%). The difference between the three groups were significantfor platelets [Group-1, Malaria (Laboratory positive) group= 86.42 (95%CI: 78.43-94.41)][Group 2, Fever (Laboratory negative) group = 192.47 (95%CI: 177.69-207.25)] and (Group-3,Age and sex matched control group=278.89 (95%CI: 254.16-303.62)] {p&lt;0.001}, and WBC[Group-1, Malaria (Laboratory positive) group= 5.55 (95%CI: 5.08-6.01)] [Group 2, Fever(Laboratory negative) group = 6.68 (95%CI: 6.14-7.20)] and (Group-3, Age and sex matchedcontrol group=8.78 (95%CI: 8.01-9.55)] {p&lt;0.001}. The results for % neutrophil and PDW werealso significant, but post-hoc comparison did not show significant differences between groupsthus differentiating a case of malaria from non-malaria fever or control. Conclusion: Malariadue to Plasmodium vivax is associated with thrombocytopenia and leucopenia in our set up.Moreover, the associated hematological parameters including % neutrophil and PDW may helpin augmenting a clinical diagnosis of malaria.

Clinical and Hematological Changes in Childhood Malaria in India

Malaria caused by Plasmodium species is a disease with high morbidity and mortality, especially in children. The changing clinical and blood manifestations of P.falciparum, emerging trends of complications with P.vivax are some of the important issues that merit attention at present in India. The prospective cross- sectional study conducted on 170 patients of malaria in Mumbai aimed at studying the clinico-haematological alterations in the disease. Fever and splenomegaly were critical findings in majority of patients so that they may be used for clinical diagnosis of malaria and early institution of therapy. P.vivax was the predominant species with severe thrombocytopenia however anemia was common in P.falciparum infection.Older children were affected more severely than infants with hematological complications, namely anemia and thrombocytopenia. Anemia and thrombocytopenia were common observations while leucocyte count was normal in most patients. After 48 hours of antimalarial treatment, platelet count improved with restoration to normal in majority of patients while anemia worsened in most cases. There was a negative correlation between platelet count and hyperparasitemia. Despite availability of extensive literature on various manifestations of malaria, the evolving nature of the disease mandates continuous revision of existing data.