Evaluating the potential of using urine and saliva specimens for malaria diagnosis in suspected patients in Ghana

Aninagyei, Enoch; Abraham, Joseph; Atiiga, Paul; Antwi, Shadrach Duodu; Bamfo, Stephen; Acheampong, Desmond Omane

doi:10.1186/s12936-020-03427-x

Cited by 13 publications

(16 citation statements)

References 28 publications

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“…The usefulness of both saliva and urine in the diagnosis of malaria in endemic settings has been documented using sensitive PCR-based approaches to detect P. falciparum infection [23,24], parasite DNA [25] and P. falciparum histidine-rich protein 2 (PfHRP2) antigen [26,27] in samples from human malaria patients. There are however, limited reports evaluating the performance of RDTs in the non-invasive diagnosis of malaria [28,29]. Considering the variability of malaria diagnostic tests in different transmission settings and the need for a rapid test on non-invasive specimen with comparable performance to microscopy for the screening or diagnosis of all participants, this study evaluated the diagnostic performance of a commercially available mRDT on blood, saliva and urine from the same patients at outpatient clinics in the Buea and Tiko health districts of Southwestern Cameroon.…”

Section: Introductionmentioning

confidence: 99%

Comparison of conventional and non-invasive diagnostic tools for detecting Plasmodium falciparum infection in southwestern Cameroon: a cross-sectional study

et al. 2021

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Background Malaria remains a significant health challenge in sub-Saharan Africa, with early diagnosis critical to reducing its morbidity and mortality. Despite the increasing Plasmodium spp. diagnostic capabilities, access to testing is limited in some cases by the almost absolute requirement for blood from potentially infected subjects as the only sample source for all conventional methods. A rapid test on non-invasive specimen with comparable performance to microscopy for the screening or diagnosis of all participants is invaluable. This study sought to compare conventional and non-invasive diagnostic tools for detecting Plasmodium falciparum. Methods This was a cross-sectional study, carried out between March and August 2019 to evaluate and compare the diagnostic performance of a PfHRP2/pLDH-based malaria rapid diagnostic test (mRDT) on patients’ blood, saliva and urine relative to conventional light microscopy and nested PCR at outpatient clinics in the Buea and Tiko health districts of Southwestern Cameroon. The significance of differences in proportions was explored using the Pearson’s χ2 test whereas differences in group means were assessed using analyses of variance. Results A total of 359 individuals of both sexes, aged 1–92 years, were enrolled into the study. Of the 301 individuals tested by light microscopy and mRDTs on blood, saliva and urine, 84 (27.9%), 81 (26.9%), 87 (28.9%) and 107 (35.5%) respectively were positive. However, only 34.3%, 90.5%, 91.4%, 83.9% and 65.4% febrile, light microscopy and mRDT positives on blood, saliva and urine respectively had P. falciparum infection as confirmed by PCR. The sensitivity and specificity of presumptive diagnosis, light microscopy and mRDT on blood, saliva and urine were 86.9% and 19.7%, 77.8% and 96.1%, 75.8% and 96.6%, 74.5% and 93.1%, and 70.7% and 81.8%, respectively. The agreement between mRDT on saliva (k = 0.696) and microscopy (k = 0.766) compared to PCR was good. Conclusion The study highlighted the low performance of presumptive diagnosis, reinforcing the need for parasitological tests prior to antimalarial therapy. The higher PfHRP2/pLDH mRDT parasite detection rates and sensitivity in saliva compared to urine suggests that the former is a practical adjunct to or alternative worth optimising for the routine diagnosis of malaria. Graphic Abstract Flow chart for diagnosis of P. falciparum infection by light microscopy, rapid diagnostic tests and nested PCR.

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Section: Introductionmentioning

confidence: 99%

Comparison of conventional and non-invasive diagnostic tools for detecting Plasmodium falciparum infection in southwestern Cameroon: a cross-sectional study

et al. 2021

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“…We retrieved 1607 records from bibliographic searches. Eighteen studies 14 15 30–45 were included, contributing to a total of 36 data sets included in the systematic review and 30 in the meta-analysis ( figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…For nPCR in saliva for example, 18S rRNA genes, or mitochondrial cytochrome b gene, of Plasmodium falciparum and Plasmodium vivax were targeted and amplified in most of the studies, 30 31 whereas RDT in saliva and urine target Pf HRP2 and pLDH antigens. 14 36 This suggests that the issues faced by blood based RDT tests (regarding Pf HRP detection) are the same for tests conducted on non-invasive sample.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several studies have evaluated the accuracy of diagnosing malaria using PCR, ELISA or rapid diagnostic testing (RDT) on non-invasively collected human specimens such as saliva, urine, faeces and hair. 14 15 The current study aimed to systematically review these studies and performed a meta-analysis to determine the overall diagnostic accuracy of malaria diagnostic tests performed on saliva, urine, faeces and hair.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of malaria diagnostic tests performed on non-invasively collected samples: a systematic review and meta-analysis

et al. 2021

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BackgroundDuring the last decade, many studies have assessed the performance of malaria tests on non-invasively collected specimens, but no systematic review has hitherto estimated the overall performance of these tests. We report here the first meta-analysis estimating the diagnostic performance of malaria diagnostic tests performed on saliva, urine, faeces, skin odour (‘sniff and tell’) and hair, using either microscopy or PCR on blood sample as reference test.MethodsWe searched on PubMed, EMBASE, African Journals Online and Cochrane Infectious Diseases from inception until 19 January 2021 for relevant primary studies. A random effects model was used to estimate the overall performance of various diagnostic methods on different types of specimen.ResultsEighteen studies providing 30 data sets were included in the meta-analysis. The overall sensitivity, specificity and diagnostic OR (DOR) of PCR were 84.5% (95% CI 79.3% to 88.6%), 97.3% (95% CI 95.3% to 98.5%) and 184.9 (95% CI 95.8 to 356.9) in saliva, respectively; 57.4% (95% CI 41.4% to 72.1%), 98.6% (95% CI 97.3% to 99.3%) and 47.2 (95% CI 22.1 to 101.1) in urine, respectively. The overall sensitivity, specificity and DOR of rapid diagnostic test for malaria in urine was 59.8% (95% CI 40.0% to 76.9%), 96.9% (95% CI 91.0% to 99.0%) and 30.8 (95% CI:23.5 to 40.4).ConclusionIn settings where PCR is available, saliva and urine samples should be considered for PCR-based malaria diagnosis only if blood samples cannot be collected. The performance of rapid diagnostic testing in the urine is limited, especially its sensitivity. Malaria testing on non-invasively collected specimen still needs substantial improvement.

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“…Another protein at the surface of the female gametocyte PSSP17,whichis presumably more abundant in saliva samples, was also investigated in Cameroon, Zambia and Sierra Leone with an estimated sensitivity of 83% (95% CI, 61 to 95) in symptomatic patients when compared to PCR as the gold standard [58]. Detection of pfhrp2 in saliva have been reported recently using LFIA, but the sensitivity was only shown to be improved in severe to moderate form of infections with parasitemia >60,000 parasites/μL [59]. Although convenient, pfhrp2-based LFIA could be less useful in detecting asymptomatic infections.…”

Section: Lateral Flow Immunoassay (Lfia)mentioning

confidence: 99%

Progress in Parasite Genomics and Its Application to Current Challenges in Malaria Control

Dieng¹,

Ford²,

Huynh³

et al. 2021

Current Topics and Emerging Issues in Malaria Elimination

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A wide deployment of malaria control tools have significantly reduced malaria morbidity and mortality across Africa. However, in the last five to seven years, there has been a resurgence of malaria in several African countries, raising the questions of whether and why current control mechanisms are failing. Since the first Plasmodium falciparum reference genome was published in 2002, few thousands more representing a broad range of geographical isolates have been sequenced. These advances in parasite genomics have improved our understanding of mutational changes, molecular structure, and genetic mechanisms associated with diagnostic testing, antimalarial resistance, and preventive measures such as vaccine development. In this chapter, we summarize the current progress on: (1) genomic characteristics of P. falciparum; (2) novel biomarkers and revolutionary techniques for diagnosing malaria infections; and (3) current vaccine targets and challenges for developing efficacious and long-lasting malaria vaccines.

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Evaluating the potential of using urine and saliva specimens for malaria diagnosis in suspected patients in Ghana

Cited by 13 publications

References 28 publications

Comparison of conventional and non-invasive diagnostic tools for detecting Plasmodium falciparum infection in southwestern Cameroon: a cross-sectional study

Comparison of conventional and non-invasive diagnostic tools for detecting Plasmodium falciparum infection in southwestern Cameroon: a cross-sectional study

Accuracy of malaria diagnostic tests performed on non-invasively collected samples: a systematic review and meta-analysis

Progress in Parasite Genomics and Its Application to Current Challenges in Malaria Control

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