Diagnosis Of Falciparum Malaria Research Articles

High Frequency of Clinically Significant Bacteremia in Adults Hospitalized With Falciparum Malaria.

Background. African children with severe falciparum malaria commonly have concomitant Gram-negative bacteremia, but co-infection has been thought to be relatively rare in adult malaria. Methods. Adults with a diagnosis of falciparum malaria hospitalized at 4 tertiary referral hospitals in Myanmar had blood cultures collected at admission. The frequency of concomitant bacteremia and the clinical characteristics of the patients, with and without bacteremia, were explored. Results. Of 67 adults hospitalized with falciparum malaria, 9 (13% [95% confidence interval, 5.3%-21.6%]) were also bacteremic on admission, 7 (78%) with Gram-negative enteric organisms (Escherichia coli [n = 3], typhoidal Salmonella species [n = 3], nontyphoidal Salmonella [n = 1]). Bacteremic adults had more severe disease (median Respiratory Coma Acidosis Malaria [RCAM] score 3; interquartile range [IQR], 1-4) than those without bacteremia (median RCAM score 1; IQR, 1-2) and had a higher frequency of acute kidney injury (50% vs 16%, P = .03). Although 35 (52%) were at high risk of death (RCAM score ≥2), all 67 patients in the study survived, 51 (76%) of whom received empirical antibiotics on admission. Conclusions. Bacteremia was relatively frequent in adults hospitalized with falciparum malaria in Myanmar. Like children in high transmission settings, bacteremic adults in this low transmission setting were sicker than nonbacteremic adults, and were often difficult to identify at presentation. Empirical antibiotics may also be appropriate in adults hospitalized with falciparum malaria in low transmission settings, until bacterial infection is excluded.

Epidemiological Aspects and Foeto-Maternal Complications of Malaria at N’Djamena Mother and Child Hospital (Chad)

Background: Malaria contributes very significantly to maternal and fetal mortality. The severity of malaria in pregnancy is thought to be due to general impaired immunity plus a diminution of acquired immunity to malaria in endemic areas. Chad since 2008 imposed the politics of exemption from payment of emergencies cares fees and the distribution of malaria preventing drugs for pregnant women and child. Few prior studies focused on fetal and maternal complications of malaria in this country. Objective: increase combat both malaria and foeto-maternal complications, improve maternal and perinatal health and curb the spread of this preventable infectious disease. Material and method: This was a prospective and descriptive survey of six months (from April 15th 2014 to October 15th 2014) about epidemiological aspects and foeto-maternal complications of malaria at N’Djamena mother and child hospital. All women pregnant women admitted for symptomatic or asymptomatic malaria during this survey period were included. Malaria diagnosis had involved identifying malaria parasites or antigens/ products in patient blood. Data were analyzed using SPSS17.0. Chi-square (X2) test (p<0.05) was used to compare variables. Results: We recorded 155 patients admitted for malaria among 1065 patients, giving and incidence of 14.55%. The majority of pregnant women, 65% (101/155) hadn’t attended ante natal consultation. Three quarters (¾) of patients didn’t receive malaria ‘preventive treatment during pregnancy (khi²=103; p=001). Seventyeight patients (50.3%) declared using insecticide-treated bed nets. Rapid diagnostic test was use first and the conventional microscopic diagnosis by staining thin and thick peripheral blood smears later. The majority (141/155 i.e. 90.97%) had had positive malaria rapid test. The microscopic examination of stained blood films using Giemsa showed Plasmodium falciparum malaria diagnosis in 80.64%. Quinine and artesunate were used for curative treatment. More than ¾ of patients (n=120/155 i.e. 77.4%) received quinine. Eighteen per cent 18% (n=28/155) of patients presented anaemia, the outcome of malaria infection was fatal for one patient giving a death rate of 0.65%. Among fetal complications, we registered 15.48 %( n=24/155) of low birth weight and 10.3 %( n=16/155) premature delivery. Conclusion: Malaria remains a frequent infectious disease during pregnancy. Sensitizations for antenatal consultations are useful to improve malaria ‘management.

Alternative Malaria Diagnostic Tools: Evaluation of Plasmodium falciparum Detection along ThailandÂ’s Border by Loop-Mediated Isothermal Amplification (LAMP) and Immunochromatographic Test (ICT)

Introduction: Thailand has a national goal to eliminate malaria from 80 percent of the country by 2020. However, malaria-endemic areas still exist along the forested Thailand’s borders. An accurate and prompt diagnosis is the key to effective disease management. This aim of this study was to evaluate the application of LAMP as an alternative tool for falciparum malaria diagnosis of clinical suspicion of plasmodium infection in the border area, compared to those of ICT and microscopy using nested PCR as the reference detection method. Materials and Methods: One hundred and four of blood samples were obtained from patients who were diagnosed malaria positive by clinical diagnosis or subjected to suffering from malaria as observed from clinical history. The primer set used for LAMP was designed on the basis of nucleotide sequence of 18S rRNA plasmodium gene and the ICT test was performed with the parasite lactate dehydrogease (pLDH) antigen-based lateral flow test. Results: The LAMP assay has the highest agreement with the reference method (99.04%, κ=0.98) with a sensitivity (95%CI) of 98.59% (95.85-100.00) comparable to ICT and microscopy. Moreover, LAMP showed specificity 100% compared with 100% of ICT and 96.97% (91.12-100.00%) microscopy. Negative predictive value of LAMP and ICT were 97.06% and 82.50% respectively. Conclusion: LAMP is useful and more reliable for specific diagnosis in border regions where malaria is endemic but individuals are asymptomatic and hence that LAMP could be the preferred method in resource-limited laboratories to progress towards malaria elimination in Thailand.

Low sensitivity of malaria rapid diagnostic tests stored at room temperature in the Brazilian Amazon Region

In remote areas of the Amazon Region, diagnosis of malaria by microscopy is practically impossible. This study aimed to evaluate the performance of two rapid diagnostic tests (RDTs) targeting different malaria antigens stored at room temperature in the Brazilian Amazon Region. Performance of the OptiMal Pf/Pan test and ICT-Now Pf/Pan test was analyzed retrospectively in 1,627 and 1,602 blood samples, respectively. Tests were performed over a 15-month period. Kits were stored at room temperature in five community health centres located in the Brazilian Amazon Region. RDT results were compared with thick blood smear (TBS) results to determine sensitivity, specificity, and accuracy of the RDT. The sensitivities of the OptiMal Pf/Pan test were 79.7% for Plasmodium falciparum malaria diagnosis and 85.7% for non-P. falciparum infections. The results showed a crude agreement of 88.5% for P. falciparum, and 88.3% for non-P. falciparum infections (Kappa index = 0.74 and 0.75, respectively). For the ICT-Now Pf/Pan test (CI 95%), the sensitivities were 87.9% for P. falciparum malaria diagnosis and 72.5% for non-P. falciparum infection. Crude agreement between the ICT-Now Pf/Pan test and TBS was 91.4% for P. falciparum and 79.7% for non-P. falciparum infection. The Kappa index was 0.81 and 0.59 for the final diagnosis of P. falciparum and non-P. falciparum, respectively. Higher levels of parasitaemia were associated with higher crude agreement between RDT and TBS. The sensitivities of RDTs stored at room temperature over a 15-month period and performed in field conditions were lower than those previously reported.

Evaluation of the Performances of Two Rapid Diagnostic Tests (Cyscope®mini and Paracheck-Pf®) in the Diagnosis of Malaria among Febrile Children in Southwest Nigeria

Objective: The aim of this study was to test the diagnostic performances of Cyscope®mini and Paracheck-Pf® for Plasmodium falciparum relative to microscopy. Subjects and Methods: 209 children aged 6 months to 12 years presenting with symptoms suggestive of malaria were enrolled at the University College Hospital, Ibadan, Nigeria, within a period of 6 months. Malaria parasites were identified in capillary blood samples using Cyscope®mini (parasite DNA-based fluorescence microscope) and Paracheck-Pf® (an HRP-II-based test) with microscopy of Giemsa-stained thick blood films as reference gold standard. The overall performances were calculated using OpenEpi version 2.3 statistical package. 209 samples were performed for Cyscope®mini and light microscopy while 140 samples were done by Paracheck-Pf®. Results: The prevalence of malaria parasitaemia by light microscopy was 22.0% (46/209), while those of Cyscope®mini and Paracheck-Pf® were 85.2% (178/209) and 32.1% (45/140), respectively. Parasite density ranged from 40 to 203,883/µl. Cyscope®mini and Paracheck-Pf® had sensitivities of 91.3 and 86.21%, respectively. The respective specificities were 16.56 and 81.98% for Cyscope®mini and Paracheck-Pf® with diagnostic accuracies of 33.01 and 82.86%. The diagnostic performances of the two rapid diagnostic tests were significantly different. Conclusion: Paracheck-Pf® performed better than Cyscope®mini for diagnosis of falciparum malaria and will be a good diagnostic tool for field studies.

Insuficiência renal associada a infecção por Plasmodium falciparum.

Plasmodium falciparum infection may be a cause of acute renal failure (ARF). Whereas renal failure appears to be a common complication of severe malaria in adults, it seldom occurs in children. The authors report a case of a previously healthy 9-year-old child, who was admitted with fever, vomits, diarrhoea, jaundice and obnubilation of consciencious. The results of laboratory tests performed confirmed the diagnosis of falciparum malaria. At the 2nd day of hospitalization she was in ARF and dialysis was necessary. We admitted that the probable underlying factors leading to this complication were: intravascular haemolysis, volume depletion, hypotension and hyperparasitaemia. Despite the presence of predictive factors of bad outcome the evolution was favourable with gradual recuperation of renal function.

Serious and Fatal Illness Associated with Falciparum and Vivax Malaria among Patients Admitted to Hospital at West Sumba in Eastern Indonesia

Records of 3,449 patients admitted to Karitas Hospital at Waitabula in eastern Indonesia with microscopy-confirmed malaria through 2008 and 2009 were systematically reviewed. Falciparum, vivax, and mixed species malaria occurred among 1,541, 1,837, and 71 admissions, respectively. Among these, 400 (26%), 199 (11%), and 15 (21%) had serious illness. Fatalities occurred in 46 (12%), 18 (9%), and 2 (13%) of these patients, respectively. Although patients with a diagnosis of falciparum malaria were more likely to have serious illness compared with those with vivax malaria (odds ratio [OR] = 2.9; 95% confidence interval [CI]: 2.4–3.5), this diagnosis nonetheless was associated with 32% of serious illness and 27% of fatalities. Among the seriously ill with a diagnosis of falciparum or vivax malaria, no significant difference in risk of death occurred (OR = 1.3; 95% CI: 0.7–2.5). Serious and fatal illness was predominantly anemia or altered mental state syndromes among patients with either of the species diagnoses. Plasmodium vivax was associated with a substantial share of the burden of morbidity and mortality caused by malaria in this hypo- to meso-endemic community.

Severe disease in children hospitalized with a diagnosis of Plasmodium vivax in south-eastern Pakistan

BackgroundInfection by Plasmodium vivax has been considered rarely threatening to life, but recent studies challenge this notion. This study documented the frequency and character of severe illness in paediatric patients admitted to a hospital in south-eastern Pakistan with a laboratory-confirmed diagnosis of vivax malaria.MethodsAn observational study of all 180 paediatric patients admitted with any diagnosis of malaria during 2010 was conducted: 128 P. vivax; 48 Plasmodium falciparum; and four mixed infections of these species. Patients were classified as having severe illness with any of the following indicators: Glascow coma scale <11; ≥2 convulsions; haemoglobin <5g/dL; thrombocytes <50,000/mL; blood glucose <45mg%; >70 breaths/min; or intravenous anti-malarial therapy. Additionally, 64 patients with a diagnosis of vivax malaria were treated during 2009, and the 21 of these having severe illness were included in analyses of the frequency and character of severe illness with that diagnosis.ResultsDuring 2010, 39 (31%) or 37 (77%) patients with a diagnosis of P. vivax or P. falciparum were classified as having severe disease. Including the 2009 records of 64 patients having vivax malaria, a total of 60 (31%) patients with severe illness and a diagnosis of P. vivax were available. Altered mental status (Glascow coma scale score <11; or ≥2 convulsions) dominated at 54% of the 83 indicators of severe illness manifest among the patients with vivax malaria, as was true among the 37 children with a diagnosis of falciparum malaria and being severely ill; 58% of the 72 indicators of severe disease documented among them. No statistically significant difference appeared in frequencies of any other severe disease indicators between patients diagnosed with vivax or falciparum malaria. Despite such similarities, a diagnosis of falciparum malaria nonetheless came with 3.8-fold (95% CI = 1.8-8.1) higher risk of presenting with severe illness, and 8.0-fold (95% CI = 2.1-31) greater likelihood of presenting with three or more severe disease indicators. Two patients did not survive hospitalization, one each with a diagnosis of falciparum or vivax malaria.ConclusionsVivax malaria caused a substantial burden of potentially life-threatening morbidity on a paediatric ward in a hospital in south-eastern Pakistan.

How Do We Best Diagnose Malaria in Africa?

How Do We Best Diagnose Malaria in Africa?

Effectiveness of Immunochromatographic Test in the Diagnosis of Falciparum Malaria

Introduction : Various diagnostic tools are used to confirm diagnosis of different types of malaria. Immunochromatographic test for Plasmodium falciparum (ICT malaria Pf) is one of them. Objective: Aim of this prospective study was to find out a rapid, effective and easy tool for the diagnosis of malaria for the hilly area of Bangladesh. Method: A prospective study was conducted at hilly area of Bangladesh over a period of 7 months. Clinically suspected 50 cases of malaria of both sexes of different age group were included in the study. Blood samples were collected and simultaneously microscopic examination of Leishman's stain film and ICT malaria Pf were done. Results were compared using standard method. Result: The mean age of the patients was 29.9±18 years and 49 were male. Among the 19 parasitaemic cases, 16 (84.2%) cases were Plasmodium falciparum positive, 02 (10.5%) cases were Plasmodium vivax positive and 01 (5.3%) was mixed infection. The degree of parasitaemia (malarial parasite count /cmm) ranges form 2000/cmm to 30,000/cmm with the mean 10,395±8,444/cmm. Among the 19 microscopically positive cases, 16 (84.2%) cases were ICT positive and 03 (15.8%) cases were ICT negative. The sensitivity of ICT for Pf in this study was 94.1% and the specificity of ICT for Pf was 100%. The positive predictive value (PPV) and negative predictive value (NPV) were 100% and 97.1% respectively Conclusion: The study revealed that the "ICT Malaria Pf has a very important role in the diagnosis of Plasmodium malaria. The sensitivity and specificity are approx 100% and very rapid in action. Key words: Falciparum malaria; Immunochromatographic test; Hilly area of Bangladesh DOI: http://dx.doi.org/10.3329/jafmc.v7i1.8624 JAFMC Bangladesh. Vol 7, No 1 (June) 2011; 31-33

Evaluation of a PfHRP2 and a pLDH-based Rapid Diagnostic Test for the Diagnosis of Severe Malaria in 2 Populations of African Children

Rapid diagnostic tests (RDTs) now play an important role in the diagnosis of falciparum malaria in many countries where the disease is endemic. Although these tests have been extensively evaluated in uncomplicated falciparum malaria, reliable data on their performance for diagnosing potentially lethal severe malaria is lacking. We compared a Plasmodium falciparum histidine-rich-protein2 (PfHRP₂)-based RDT and a Plasmodium lactate dehydrogenase (pLDH)-based RDT with routine microscopy of a peripheral blood slide and expert microscopy as a reference standard for the diagnosis of severe malaria in 1898 children who presented with severe febrile illness at 2 centers in Mozambique and Tanzania. The overall sensitivity, specificity, positive predictive value, and negative predictive values of the PfHRP₂-based test were 94.0%, 70.9%, 85.4%, and 86.8%, respectively, and for the pLDH-based test, the values were 88.0%, 88.3%, 93.2%, and 80.3%, respectively. At parasite counts < 1000 parasites/μL (n = 173), sensitivity of the pLDH-based test was low (45.7%), compared with that of the PfHRP₂-based test (69.9%). Both RDTs performed better than did the routine slide reading in a clinical laboratory as assessed in 1 of the centers. The evaluated PfHRP2-based RDT is an acceptable alternative to routine microscopy for diagnosing severe malaria in African children and performed better than did the evaluated pLDH-based RDT.

Newer versus conventional methods in the diagnosis of malaria : A comparison

Background: This study attempts to evaluate and compare the efficacy of polymerase chain reaction (PCR) and quantitative buffy coat (QBC) assay with conventional Giemsa stained peripheral blood smear (PBS) examination in the diagnosis of malaria. Methods: The study was conducted on 50 cases of smear positive malaria (group 1), 50 cases of clinically suspected malaria (group 2) and 15 healthy controls. All were subjected to Giemsa stain slide examination both thick and thin smear, QBC assay and PCR. PBS examination by Giemsa stain was taken as gold standard. Result: In this study the overall sensitivity and positive predictive value (PPV) of QBC assay in group 1 was 100% and that of PCR was 60% and 100% respectively. In group 2 the sensitivity, specificity, PPV and NPV of QBC assay was 100% and that of PCR was 71%, 100%, 100% and 73% respectively as compared to the gold standard. All the 15 healthy controls were negative by all the three assays showing 100% specificity. Conclusion: QBC assay was an excellent alternative to the conventional method as it is rapid and less time consuming and can directly demonstrate the parasite. Utility of PCR lies in species-specific diagnosis of falciparum malaria especially when there is a high degree of clinical suspicion and the report is negative by the other two methods.

Comparison of different methods for delayed post-mortem diagnosis of falciparum malaria

BackgroundBetween 10,000 and 12,000 cases of imported malaria are notified in the European Union each year. Despite an excellent health care system, fatalities do occur. In case of advanced autolysis, the post-mortem diagnostic is impaired. Quicker diagnosis could be achieved by using rapid diagnostic malaria tests.MethodsIn order to evaluate different methods for the post-mortem diagnosis of Plasmodium falciparum malaria in non-immunes, a study was performed on the basis of forensic autopsies of corpses examined at variable intervals after death in five cases of fatal malaria (with an interval of four hours to five days), and in 20 cases of deaths unrelated to malaria. Detection of parasite DNA by PCR and an immunochromatographic test (ICT) based upon the detection of P. falciparum histidine-rich protein 2 (PfHRP2) were compared with the results of microscopic examination of smears from cadaveric blood, histopathological findings, and autopsy results.ResultsIn all cases of fatal malaria, post-mortem findings were unsuspicious for the final diagnosis, and autoptic investigations, including histopathology, were only performed because of additional information by police officers and neighbours. Macroscopic findings during autopsy were unspecific. Histopathology confirmed sequestration of erythrocytes and pigment in macrophages in most organs in four patients (not evaluable in one patient due to autolysis). Microscopy of cadaveric blood smears revealed remnants of intraerythrocytic parasites, and was compromised or impossible due to autolysis in two cases. PCR and ICT performed with cadaveric blood were positive in all malaria patients and negative in all controls.ConclusionIn non-immune fatalities with unclear anamnesis, ICT can be recommended as a sensitive and specific tool for post-mortem malaria diagnosis, which is easier and faster than microscopy, and also applicable when microscopic examination is impossible due to autolysis. PCR is more expensive and time-consuming, but may be used as confirmatory test. In highly endemic areas where asymptomatic parasitaemia is common, confirmation of the diagnosis of malaria as the cause of death has to rely on histopathological findings.

Initial characterization of Pf62, a novel protein of Plasmodium falciparum identified by immunoscreening

In order to find new antigens from Plasmodium falciparum, a complementary DNA (cDNA) library was constructed and screened. The study of expression library of P. falciparum was performed in an attempt to identify new antigens that could have potential relevance for the falciparum-malaria diagnosis and/or protection. Between the positive clones detected (ring erythrocyte surface antigen, merozoite erythrocyte surface antigen, RHOP H3, CSP, LSA), a new gene that correspond to a new protein (Pf62) was isolated and characterized. This antigen was useful for the diagnosis of malaria in enzyme-linked immunosorbent assay tests. The cDNA corresponding to this antigen and structure of the gene were characterized. Pf62 is a single copy gene that contains one exon. The Pf62 cDNA has an open reading frame of 1,599 nucleotides that code for a putative protein of 532 amino acids with a predicted molecular mass of 62 kDa. The polypeptide contains in the central section two regions of repeats of 21 and 19 amino acids, respectively. The localization of the Pf62 protein was performed by immunoblot, indirect immunofluorescence assay and immunoelectron microscopy. Pf62 is localized in the cytoplasm of the parasite and also on the surface of the infected erythrocyte. Serologic assays by using synthetic peptides designed from different antigenic regions of the Pf62 protein resulted in acceptable data of sensitivity and specificity in symptomatic malaria patients.

Paracheck Pf® compared with microscopy for diagnosis of &lt;i&gt;Plasmodium falciparum&lt;/i&gt; malaria among children in Tanga City, north-eastern Tanzania

Malaria is a major public health problem particularly in rural Sub-Saharan Africa. In most urban areas, malaria transmission intensity is low thus monitoring trends using reliable tools is crucial to provide vital information for future management of the disease. Rapid diagnostic tests (RDT) such as Paracheck Pf are now increasingly adopted for Plasmodium falciparum malaria diagnosis and are advantageous and cost effective alternative to microscopy. This cross sectional survey was carried out during June 2005 to determine the prevalence of malaria in an urban setting and compare microscopy diagnosis versus Paracheck Pf for detecting Plasmodium falciparum. Blood samples from a total of 301 children (< 10 years) attending outpatient clinic at Makorora Health Centre, in Tanga, Tanzania were examined for the presence of malaria. Twenty-nine (9.6%) of the children were positive to malaria by microscopy while 30 (10.0%) were positive by Paracheck test. Three out of 30 positive cases detected by Paracheck were negative by microscopy; thus considered to be false positive results. For the 271 Paracheck Pf negative cases, 2 were positive by microscopy; yielding 2 false negative results. Paracheck Pf sensitivity and specificity were 93.1% and 98.9%, respectively. P. falciparum was the only malarial species observed among the 29 microscopy positive cases. The prevalence of anaemia among the children was 53.16%. These findings indicate a low prevalence of malaria in Tanga City and that Paracheck Pf can be an effective tool for malaria diagnosis.

Loop-Mediated Isothermal PCR (LAMP) for the Diagnosis of Falciparum Malaria

A recently described loop-mediated isothermal polymerase chain reaction (LAMP) for molecular detection of Plasmodium falciparum was compared with microscopy, PfHRP2-based rapid diagnostic test (RDT), and nested polymerase chain reaction (PCR) as the "gold standard" in 115 Bangladeshi in-patients with fever. DNA extraction for LAMP was conducted by conventional methods or simple heating of the sample; test results were either assessed visually or by gel electrophoresis. Conventional DNA extraction followed by gel electrophoresis had the highest agreement with the reference method (81.7%, kappa = 0.64), with a sensitivity (95% CI) of 76.1% (68.3-83.9%), comparable to RDT and microscopy, but a specificity of 89.6% (84.0-95.2%) compared with 100% for RDT and microscopy. DNA extraction by heat treatment deteriorated specificity to unacceptable levels. LAMP enables molecular diagnosis of falciparum malaria in settings with limited technical resources but will need further optimization. The results are in contrast with a higher accuracy reported in an earlier study comparing LAMP with a non-validated PCR method.

Utilization of Nucleotide Probes in PCR‐ELISA Procedure for the Quantitative Determination of Plasmodium Falciparum DNA in Malaria

The research work reported herein is the development of a simple and specific quantitative procedure for the determination of P. falciparum DNA in malaria that involves the direct detection of the highly 42‐kDa conserved C‐terminal regiopn of P. falciparum merozoite surface protein gene (MSP1 42 gene). This procedure entails the amplification of the MSP1 42 gene by using the PCR technique in the presence of digoxigenin‐11‐dUTP and the synthesis of the specific biotin label nucleotide probes directed to the MSP1 42 gene. These specific probes are then used in the Enzyme Linked Immunosorbent Assay (ELISA) for the quantitative determination of the MSP1 42 gene which leads to the quantitative determination of P. falciparum DNA in malaria for quantitative diagnostic purpose. The P. falciparum malaria diagnostic results obtained from a small number of 18 whole blood samples show that the present quantitative PCR‐ELISA procedure allows the quantitative determination of P. falciparum DNA in malaria with a sensitivity and specificity over to those of the current standard microscopic examination. This quantitative PCR‐ELISA procedure is not only important for quantitative P. falciparum malaria diagnosis but also useful for monitoring the efficacy of any existing anti‐malarial drug as well as for testing the efficacy of any malaria vaccine.

Diagnosis of &lt;i&gt;Plasmodium falciparum&lt;/i&gt; malaria in children using the immuno-chromatographic diagnostic technique

Background: Children under five years of age constitute the “at risk” population for fatal complications of P. falciparum malaria infection. Early diagnosis and prompt treatment are key features in the current Roll Back Malaria Programme.Objective: To assess the diagnostic performance of the Immunochromatographic test (ICT) in the rapid diagnosis of falciparum malaria infection in children aged less than five years with a presumptive clinical diagnosis of malaria.Method: This prospective study was conducted at the Children Emergency Room of the Lagos University Teaching Hospital between January and October 2001. Febrile children aged less than five years and were suspected to have malaria, were enrolled. Blood samples from all patients were tested using the ICT-Malaria P f Ò test kit as well as the conventional blood film microscopy after Giemsa staining. Results: The results showed that the diagnosis of falciparum malaria was achieved within eight minutes using the ICT-Malaria P f Ò test kit. The sensitivity of the test kit was 69.6 percent while the specificity was 98.4 percent. However, among patients with severe malaria, the ICT had a sensitivity of 90.3 percent. The test kit was unable to detect antigenaemia at parasite density below 400/ml. An increase in body temperature was associated with higher rate of ICT test positivity.Conclusion: The low sensitivity of the ICT technique obtained in this study makes it a poor screening tool for the routine diagnosis of falciparum malaria in children aged 0-5yrs. It may be useful in the rapid diagnosis of suspected severe malaria in febrile children. The high cost of the test kit is likely to prove a major limitation to its widespread use. Nigerian Journal of Paediatrics Vol. 31(3) 2004: 71-78

EVALUATION OF THE POLYMERASE CHAIN REACTION ANALYSIS FOR DIAGNOSIS OF FALCIPARUM MALARIA IN DELHI, INDIA

Plasmodium falciparum infections are frequently fatal if untreated and hence need to be diagnosed and treated early. Malaria diagnosis, with conventional Giemsa staining as a gold standard, has had several limitations. New rapid and accurate methods are needed for diagnosis. In this study, polymerase chain reaction (PCR) analysis specific for diagnosis of P. falciparum was evaluated. For the study, blood samples were collected from 310 patients suspected of having malaria. PCR analysis for P. falciparum from venous blood and at the same time Giemsa staining of thick and thin blood smears was done. A total of 160 (51.6 %) samples were positive for malarial parasite of which 63 (39.4 %) were positive for P. falciparum by Giemsa staining while 61 (38.1 %) were positive for P. falciparum by PCR analysis. Giemsa staining was time consuming, laborious and may give poor results in cases with low parasitaemia. The PCR analysis for P. falciparum was able to detect 3 cases of low parasitaemia missed initially on Giemsa staining, was 96.8 % sensitive, 100% specific but was very costly, needed a lot of practice and standardization and was time consuming. PCR analysis can be used to supplement the conventional Giemsa staining for reliable diagnosis of falciparum malaria especially in cases with low parasitaemia.

Evaluation of the polymerase chain reaction analysis for diagnosis of falciparum malaria in Delhi, India

Plasmodium falciparum infections are frequently fatal if untreated and hence need to be diagnosed and treated early. Malaria diagnosis, with conventional Giemsa staining as a gold standard, has had several limitations. New rapid and accurate methods are needed for diagnosis. In this study, polymerase chain reaction (PCR) analysis specific for diagnosis of P. falciparum was evaluated. For the study, blood samples were collected from 310 patients suspected of having malaria. PCR analysis for P. falciparum from venous blood and at the same time Giemsa staining of thick and thin blood smears was done. A total of 160 (51.6 %) samples were positive for malarial parasite of which 63 (39.4 %) were positive for P. falciparum by Giemsa staining while 61 (38.1 %) were positive for P. falciparum by PCR analysis. Giemsa staining was time consuming, laborious and may give poor results in cases with low parasitaemia. The PCR analysis for P. falciparum was able to detect 3 cases of low parasitaemia missed initially on Giemsa staining, was 96.8 % sensitive, 100% specific but was very costly, needed a lot of practice and standardization and was time consuming. PCR analysis can be used to supplement the conventional Giemsa staining for reliable diagnosis of falciparum malaria especially in cases with low parasitaemia.