Laboratory Diagnosis of Malaria: Conventional and Rapid Diagnostic Methods

Abstract

Context.—The global control of malaria is more challenging than that of many other infectious diseases: malaria is vector borne, it is caused by 5 species of Plasmodium with different geographic distributions, infection is widespread in many regions, drug resistance is common, and the disease overlaps clinically with other infectious diseases. Therefore, malaria control programs, in addition to diagnosis and testing, must also target limiting spread of the disease through vector control. Although malaria control efforts have been successful in some regions, malaria remains one of the most important causes of death in sub-Saharan Africa, particularly in women and children. Objective.—To review the current literature regarding diagnostic methods available to detect clinical malaria, with an emphasis on comparing the strengths and limitations of each method. Data Sources.—Current World Health Organization malaria control report and other information, recent meta-analyses of diagnostic tests, primary literature concerning the performance characteristics of different tests, and primary literature concerning how diagnostic tests are used in daily practice. Conclusions.—The most commonly used method for identifying cases of malaria remains microscopic examination of peripheral blood, but there is growing use of malaria rapid diagnostic tests in many regions. One of the most important findings in the recent literature is that despite the widespread use of diagnostic tests, treatment is too often based on clinical findings rather than on results of diagnostic tests.

A Review of Plasmodium coatneyi–Macaque Models of Severe Malaria

“…Although the World Health Organization suggests that microscopic slide evaluation in cases of malaria is at best 75% effective based on a range of clinical, geographic, and species-specific factors, microscopy has significant advantages over other diagnostic modalities that may be more accurate. 119 The benefits of microscopy for malaria diagnosis are linked to the geography and epidemiology of the various plasmodial diseases. Falciparum malaria is endemic circumferentially along the equator and extends significant distances to the north and south but still covers a large swath of the poorer and less developed portions of the planet.…”

Malaria, enfermedad tropical de múltiples métodos diagnósticos

“…Existen diferentes pruebas entre las que se encuentran: métodos microscópicos como la gota gruesa y extendido de sangre periférica; métodos moleculares como: reacción en cadena de la polimerasa (PCR); prueba rápida de diagnóstico de malaria (PDR) y pruebas serológicas. Las diferencias son dadas por la sensibilidad y especificidad que presenta cada método diagnóstico, ver tabla 1 [27]. El gold standard es la gota gruesa, el cual permite la cuantificación y diferenciación de las especies de Plasmodium [27].…”

“…Las diferencias son dadas por la sensibilidad y especificidad que presenta cada método diagnóstico, ver tabla 1 [27]. El gold standard es la gota gruesa, el cual permite la cuantificación y diferenciación de las especies de Plasmodium [27].…”

Rapid diagnostic test versus microscopy in the diagnosis of acute malaria in a district hospital in Enugu state, Southeast Nigeria

“…13 The advantages of microscopy in the diagnosis of malaria, includes its ability to identify the infecting species and determine the magnitude of parasitaemia, its usefulness for serial examinations to monitor the efficacy of therapy, and its comparative affordability. 16 However, the shortcomings of microscopic diagnosis of malaria include that it is labourintensive, time-consuming, requires expertise and its relatively low sensitivity at low parasite level, making it unsuitable for high through-put-use and species determination at low parasite density.…”

“…Plasmodium histidine-rich protein 2 [HRP 2] which is specific to P. falciparum and Plasmodium spp lactose dehydrogenase [pLDH], which may be species specific or pan-specific) in blood flowing along a membrane containing specific anti-malaria antibodies. 1,16 The advantages of RDT over the traditional microscopy in the diagnosis of malaria consists in its simplicity, ease of use by non-laboratory technicians/technologists, greatly reduced time of diagnosis and its availability in limited resource settings. However, the disadvantages of RDTs include the occasional occurrence of false positive results (especially in persisting HRP 2 antigenaemia, in crossreactivity with auto antibodies such as rheumatoid factor), its lower sensitivity compared to reference microscopy, its inability to determine infection with other species of plasmodium (P. ovale, P. malariae, P. knowlesi), its inability to quantify the parasites and the probability of a prozone effect occurring with HRP 2-based RDTs.…”