Detection of Mixed Infections with<i>Plasmodium</i>spp. by PCR, India, 2014

Krishna, Sri; Bharti, Praveen K.; Chandel, Himashu S.; Ahmad, Amreen; Kumar, Rajesh; Singh, Puspendra P.; Singh, Mrigendra P.; Singh, Neeru

doi:10.3201/eid2110.150678

Cited by 57 publications

(49 citation statements)

References 13 publications

(21 reference statements)

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“…This result highlights PCR’s potential for confirming a clinical suspicion of malaria, in spite of being expensive and not available in health centres having limited resources [61]. This study has thus confirmed the importance of PCR-based diagnosis as the norm in future studies concerning P. malariae epidemiology [19, 36, 48, 53]. …”

Section: Discussionsupporting

confidence: 70%

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Plasmodium malariae in the Colombian Amazon region: you don’t diagnose what you don’t suspect

Niño

Cubides

Camargo-Ayala

et al. 2016

Malar J

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BackgroundMalaria is a worldwide public health problem; parasites from the genus Plasmodium spp. are the aetiological agent of this disease. The parasite is mainly diagnosed by microscope-based techniques. However, these have limited sensitivity. Many asymptomatic infections are sub-microscopic and can only be detected by molecular methods. This study was aimed at comparing nested PCR results to those obtained by microscope for diagnosing malaria and to present epidemiological data regarding malaria in Colombia’s Amazon department.MethodsA total of 1392 blood samples (taken by venepuncture) from symptomatic patients in Colombia’s Amazon department were analysed in parallel by thick blood smear (TBS) test and nested PCR for determining Plasmodium spp. infection and identifying infecting species, such as Plasmodium vivax, Plasmodium malariae and/or Plasmodium falciparum. Descriptive statistics were used for comparing the results from both tests regarding detection of the disease, typing infecting species and their prevalence in the study region. Bearing the microscope assay in mind as gold standard, PCR diagnosis performance was evaluated by statistical indicators.ConclusionThe present study revealed great differences between both diagnostic tests, as well as suggesting high P. malariae prevalence from a molecular perspective. This differed profoundly from previous studies in this region of Colombia, usually based on the TBS test, suggesting that diagnosis by conventional techniques could lead to underestimating the prevalence of certain Plasmodium spp. having high circulation in this area. The present results highlight the need for modifying state malaria surveillance schemes for more efficient strategies regarding the detection of this disease in endemic areas. The importance of PCR as a back-up test in cases of low parasitaemia or mixed infection is also highlighted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1629-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 70%

“…Such difference has usually been attributed to the fact that mixed-species infection generally implies the predominance of one species, the others having very few parasite forms [36, 53]; this gives an advantage to PCR as TBS has higher detection thresholds [54]. …”

Section: Discussionmentioning

confidence: 99%

Plasmodium malariae in the Colombian Amazon region: you don’t diagnose what you don’t suspect

Niño

Cubides

Camargo-Ayala

et al. 2016

Malar J

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“…Both vivax and falciparum infections are reported from all parts of India [12, 13]. Sri Lankans visit different parts of India; many visit the northern and eastern states of India for pilgrimages to sites of Buddhist interest often travelling through the southern states.…”

Section: Discussionmentioning

confidence: 99%

Should chemoprophylaxis be a main strategy for preventing re-introduction of malaria in highly receptive areas? Sri Lanka a case in point

Wickremasinghe

Herath

et al. 2017

Malar J

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BackgroundImported malaria cases continue to be reported in Sri Lanka, which was declared ‘malaria-free’ by the World Health Organization in September 2016. Chemoprophylaxis, a recommended strategy for malaria prevention for visitors travelling to malaria-endemic countries from Sri Lanka is available free of charge. The strategy of providing chemoprophylaxis to visitors to a neighbouring malaria-endemic country within the perspective of a country that has successfully eliminated malaria but is highly receptive was assessed, taking Sri Lanka as a case in point.MethodsThe risk of a Sri Lankan national acquiring malaria during a visit to India, a malaria-endemic country, was calculated for the period 2008–2013. The cost of providing prophylaxis for Sri Lankan nationals travelling to India for 1, 2 and 4 weeks was estimated for that same period.ResultsThe risk of a Sri Lankan traveller to India acquiring malaria ranged from 5.25 per 100,000 travellers in 2012 to 13.45 per 100,000 travellers in 2010. If 50% of cases were missed by the Sri Lankan healthcare system, then the risk of acquiring malaria in India among returning Sri Lankans would double. The 95% confidence intervals for both risks are small. As chloroquine is the chemoprophylactic drug recommended for travellers to India by the Anti Malaria Campaign of Sri Lanka, the costs of chemoprophylaxis for travellers for a 1-, 2- and 4-weeks stay in India on average are US$ 41,604, 48,538 and 62,407, respectively. If all Sri Lankan travellers to India are provided with chemoprophylaxis for four weeks, it will comprise 0.65% of the national malaria control programme budget.ConclusionsBased on the low risk of acquiring malaria among Sri Lankan travellers returning from India and the high receptivity in previously malarious areas of the country, chemoprophylaxis should not be considered a major strategy in the prevention of re-introduction. In areas with high receptivity, universal access to quality-assured diagnosis and treatment cannot be compromised at whatever cost.

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“…PCR-based assay has been shown to be more sensitive and specific in the detection and identification of Plasmodium species, and they more readily detect mixed infections [23][24][25][26][27]. They are therefore, useful for epidemiological studies in addition to being an assay of choice in critical situations where confirmatory diagnosis is required.…”

Section: Objectivementioning

confidence: 99%

Molecular investigation of sub-microscopic and mixed Plasmodium species infection in North-Central Nigeria

Oyedeji¹,

Awobode²,

Bassi³

2017

APJTD

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Detection of Mixed Infections withPlasmodiumspp. by PCR, India, 2014

Cited by 57 publications

References 13 publications

Plasmodium malariae in the Colombian Amazon region: you don’t diagnose what you don’t suspect

Plasmodium malariae in the Colombian Amazon region: you don’t diagnose what you don’t suspect

Should chemoprophylaxis be a main strategy for preventing re-introduction of malaria in highly receptive areas? Sri Lanka a case in point

Molecular investigation of sub-microscopic and mixed Plasmodium species infection in North-Central Nigeria

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