BackgroundHematology analyzers display abnormal hematology parameters during malaria infection providing insightful information for suspecting and assessing malaria infection. The goal of this study is to demonstrate the potential of a three part differential hematology analyzer to assess malaria, provide information about the parasitemia, and discuss the importance of combining CRP with hematology parameters to obtain further information about the malaria infection.MethodsThe present study shows the results of a retrospective study involving comparison of raw instrument data from a three part differential hematology analyzer with CRP measurement and corresponding microscopic findings of samples obtained during the monsoon season of years 2018 and 2019 in Mumbai, India. Mann-Whitney U and Krustal-Wallis tests were applied for obtaining statistical significance of hematology parameters and CRP among P. vivax, P. falciparum, dengue and negative samples. ResultsThe study considers 1008 non-malaria febrile cases, 209 P. vivax, 31 P. falciparum positive malaria samples, five cases of mixed species malaria infection, and three co-infection of malaria and dengue. Median values of WBCs, PLTs, PCT and %LYM were lower in malaria and dengue samples compared to negative ones with statistical difference (p < 0.05). Contrary, medians of MCHC, MPV, PDW, and %MON were higher than negative samples. The greatest difference in the analyzer results of malaria and dengue cases was observed in between their medians of CRP levels, which is evidenced by the values of the first quartiles of P. vivax and P. falciparum cases, and the third quartile of dengue cases being 8.6 and 10.4 mg/L, respectively.The parameters with a statistical difference for different levels of parasitemia were WBC, PLT, %MON and CRP. An interfering abnormal peak was observed in the white blood cell histogram, below 37 fl, in malaria infected samples, especially in P. vivax cases, where the height of that peak showed a strong correlation with red blood cells infected predominantly with larger parasitic forms.ConclusionsA three differential part hematology analyzer has the potential to not only trigger malaria diagnosis confirmation but also assess the severity of the infection when CRP is considered.
Background Automated detection of malaria and dengue infection has been actively researched for more than two decades. Although many improvements have been achieved, these solutions remain too expensive for most laboratories and clinics in developing countries. The low range HORIBA Medical Haematology Analyzer, Yumizen H550, now provides dedicated flags ‘vivax malaria’ and ‘dengue fever’ in routine blood testing, developed through machine learning methods, to be used as a screening tool for malaria and dengue fever in endemic areas. This study sought to evaluate the effectiveness of these flags under real clinical conditions. Methods A total of 1420 samples were tested using the Yumizen H550 Haematology Analyzer, including 1339 samples from febrile patients among whom 202 were infected with malaria parasites (Plasmodium vivax only: 182, Plasmodium falciparum only: 18, both: 2), 210 were from febrile dengue infected patients, 3 were from afebrile dengue infected patients and 78 were samples from healthy controls, in an outpatient laboratory clinic in Mumbai, India. Microscopic examination was carried out as the confirmatory reference method for detection of malarial parasite, species identification and assessing parasitaemia based on different stages of parasite life cycle. Rapid diagnostic malarial antigen tests were used for additional confirmation. For dengue infection, NS1 antigen detection by ELISA was used as a diagnostic marker. Results For the automated vivax malaria flag, the original manufacturer’s cut off yielded a sensitivity and specificity of 65.2% and 98.9% respectively with the ROC AUC of 0.9. After optimization of cut-off value, flag performance improved to 72% for sensitivity and 97.9% specificity. Additionally it demonstrated a positive correlation with increasing levels of parasitaemia. For the automated dengue fever flag it yielded a ROC AUC of 0.82 with 79.3% sensitivity and 71.5% specificity. Conclusions The results demonstrate a possibility of the effective use of automated infectious flags for screening vivax malaria and dengue infection in a clinical setting.
Background Hematology analyzers display abnormal parameters during malaria infection providing insightful information for suspecting and assessing malaria infection. The goal of this study is to demonstrate the potential of a three-part differential hematology analyzer to assess malaria, provide information about the parasitemia, and discuss the importance of combining C-reactive protein (CRP) with hematology parameters to obtain further information about the malaria infection. Methods The present study shows the results of a case–control study during the monsoon season of years 2018 and 2019 in Mumbai, India. The study considers 1008 non-malaria febrile cases, 209 P. vivax and 31 P. falciparum positive malaria samples, five cases of mixed P. vivax and P. falciparum infection, and three co-infection cases of P. vivax and dengue. Raw data from the three-part analyzer LC-667G CRP (HORIBA) and the corresponding microscopic findings (golden standard for diagnosis of malaria) were obtained for each sample. Results The medians of platelet counts (PLT) were 102.5, 109.0, and 223.0 × 103/µL, while CRP medians were 67.4, 81.4 and 10.4 mg/L in P. vivax, P. falciparum and control groups respectively (p < 0.001 in Mann–Whitney U tests between malaria and control groups). Compared with negative samples, platelets counting less than 161.5 × 103/µL were observed on malaria patients (OR 19.12, 95% CI 11.89–30.75). Especially in P. vivax cases, an abnormal peak was frequently observed in the white blood cells (WBC) histogram around the 37fL channel. The events counted around that channel showed a linear correlation with the counting of red blood cells infected predominantly with larger parasitic forms. Parameters like CRP (rs = 0.325, p < 0.001), WBC (rs = 0.285, p < 0.001) and PLT (rs = − 0.303, p < 0.001) were correlated with the parasitemia of P. vivax samples. Between the malaria and dengue groups, the highest area under the receiver operating characteristic curve was observed on CRP (0.867, CRP ≥ 26.85 mg/L). Conclusions A three-part differential hematology analyzer has the potential to not only trigger malaria diagnosis confirmation but also assess the severity of the infection when CRP is considered.
BackgroundHematology analyzers display abnormal hematology parameters during malaria infection providing insightful information for suspecting and assessing malaria infection. The goal of this study is to demonstrate the potential of a three part differential hematology analyzer to assess malaria, provide information about the parasitemia, and discuss the importance of combining CRP with hematology parameters to obtain further information about the malaria infection.MethodsThe present study shows the results of a retrospective study involving comparison of raw instrument data from a three part differential hematology analyzer with CRP measurement and corresponding microscopic findings of samples obtained during the monsoon season of years 2018 and 2019 in Mumbai, India. Mann-Whitney U and Krustal-Wallis tests were applied for obtaining statistical significance of hematology parameters and CRP among P. vivax, P. falciparum, dengue and negative samples. ResultsThe study considers 1008 non-malaria febrile cases, 209 P. vivax, 31 P. falciparum positive malaria samples, five cases of mixed species malaria infection, and three co-infection of malaria and dengue. Median values of WBCs, PLTs, PCT and %LYM were lower in malaria and dengue samples compared to negative ones with statistical difference (p < 0.05). Contrary, medians of MCHC, MPV, PDW, and %MON were higher than negative samples. The greatest difference in the analyzer results of malaria and dengue cases was observed in between their medians of CRP levels, which is evidenced by the values of the first quartiles of P. vivax and P. falciparum cases, and the third quartile of dengue cases being 8.6 and 10.4 mg/L, respectively.The parameters with a statistical difference for different levels of parasitemia were WBC, PLT, %MON and CRP. An interfering abnormal peak was observed in the white blood cell histogram, below 37 fl, in malaria infected samples, especially in P. vivax cases, where the height of that peak showed a strong correlation with red blood cells infected predominantly with larger parasitic forms.ConclusionsA three differential part hematology analyzer has the potential to not only trigger malaria diagnosis confirmation but also assess the severity of the infection when CRP is considered.
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