Malaria Diagnosis Across the International Centers of Excellence for Malaria Research: Platforms, Performance, and Standardization

Abstract

Diagnosis is “the act of identifying a disease, illness, or problem by examining someone or something.” When an individual with acute fever presents for clinical attention, accurate diagnosis leading to specific, prompt treatment often saves lives. As applied to malaria, not only individual patient diagnosis is important but also assessing population-level malaria prevalence using appropriate diagnostic methods is essential for public health purposes. Similarly, identifying (diagnosing) fake antimalarial medications prevents the use of counterfeit drugs that can have disastrous effects. Therefore, accurate diagnosis in broad areas related to malaria is fundamental to improving health-care delivery, informing funding agencies of current malaria situations, and aiding in the prioritization of regional and national control efforts. The International Centers of Excellence for Malaria Research (ICEMR), supported by the U.S. National Institute of Allergy and Infectious Diseases, has collaborated on global efforts to improve malaria diagnostics by working to harmonize and systematize procedures across different regions where endemicity and financial resources vary. In this article, the different diagnostic methods used across each ICEMR are reviewed and challenges are discussed.

Epidemiology of Plasmodium vivax Malaria in Peru

“…Published data from Peru indicate that P. falciparum field isolates commonly lack the pfhrp2 gene (the main target used by previously used RDTs) limiting further the use of some RDTs 66. Another study with RDTs in this region, also showed cross-reactions of P. vivax samples with the Pf-pLDH or PfHRP2 tests; P. falciparum -positive samples with high parasitemias cross-reacted with Pv-pLDH 23. Based on these observations, the ideal RDT to be used in remote areas of the Peruvian Amazon should target Pf-pLDH and Pv-pLDH separately in the same device, with good heat stability and better sensitivity.…”

“…Despite the increasing research conducted in Peru over the past decade on P. vivax malaria epidemiology,17–21 diagnostics,22,23 treatment,12,13,24 vector biology,25–28 and molecular genetics,29–31 several knowledge gaps still need to be addressed to support the Peruvian NMCP, so that malaria transmission hotspots can be readily identified and that the NMCP can more effectively implement strategies that target such areas with effective interventions 32. In this review, the trends in P. vivax incidence are described in relation to major control efforts implemented in Peru over the past 70 years.…”

Malaria Molecular Epidemiology: Lessons from the International Centers of Excellence for Malaria Research Network

“…Diagnostics remain fundamental to molecular epidemiology. Although many specific aspects of malaria diagnostics are discussed separately in this supplement, 5 here we address those issues that relate to disease ecology and transmission dynamics.…”

Evaluation of CareStart™ Malaria HRP2/pLDH (Pf/pan) Combo Test in a malaria low transmission region of Senegal

“…Although with good sensitivity in diagnosing malaria, its reliability relies upon good-quality slide preparation and well-trained staff in parasite detection and differentiation, especially at low parasite densities [ 2 ]. In many peripheral health centres of endemic countries, microscopy is not available [ 3 ] due to limited resources or lack of expertise [ 4 ]. Simpler and rapid methods of identification of parasites may be useful for prompt diagnosis and appropriate treatment especially in peripheral health posts where microscopy is not available [ 5 ].…”

“…Malaria rapid diagnostic tests (RDTs), based on immunochromatographic parasite antigen detection, are of great value in endemic regions. Since 2010, WHO has recommended either RDT or microscopy confirmation of suspected malaria cases before treatment [ 3 ]. However, it remains unclear whether RDTs are useful in field conditions in low transmission areas [ 6 ] since their reliability is limited by the lack of detection of low-density parasitaemia [ 7 ].…”