Improving the Specificity of Plasmodium falciparum Malaria Diagnosis in High-Transmission Settings with a Two-Step Rapid Diagnostic Test and Microscopy Algorithm

ABSTRACT Poor specificity may negatively impact rapid diagnostic test (RDT)-based diagnostic strategies for malaria. We performed real-time PCR on a subset of subjects who had undergone diagnostic testing with a multiple-antigen (histidine-rich protein 2 and pan -lactate dehydrogenase pLDH [HRP2/pLDH]) RDT and microscopy. We determined the sensitivity and specificity of the RDT in comparison to results of PCR for the detection of Plasmodium falciparum malaria. We developed and evaluated a two-step algorithm utilizing the multiple-antigen RDT to screen patients, followed by confirmatory microscopy for those individuals with HRP2-positive (HRP2 + )/pLDH-negative (pLDH − ) results. In total, dried blood spots (DBS) were collected from 276 individuals. There were 124 (44.9%) individuals with an HRP2 + /pLDH + result, 94 (34.1%) with an HRP2 + /pLDH − result, and 58 (21%) with a negative RDT result. The sensitivity and specificity of the RDT compared to results with real-time PCR were 99.4% (95% confidence interval [CI], 95.9 to 100.0%) and 46.7% (95% CI, 37.7 to 55.9%), respectively. Of the 94 HRP2 + /pLDH − results, only 32 (34.0%) and 35 (37.2%) were positive by microscopy and PCR, respectively. The sensitivity and specificity of the two-step algorithm compared to results with real-time PCR were 95.5% (95% CI, 90.5 to 98.0%) and 91.0% (95% CI, 84.1 to 95.2), respectively. HRP2 antigen bands demonstrated poor specificity for the diagnosis of malaria compared to that of real-time PCR in a high-transmission setting. The most likely explanation for this finding is the persistence of HRP2 antigenemia following treatment of an acute infection. The two-step diagnostic algorithm utilizing microscopy as a confirmatory test for indeterminate HRP2 + /pLDH − results showed significantly improved specificity with little loss of sensitivity in a high-transmission setting.

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Comparison of rapid diagnostic test Plasmotec Malaria-3, microscopy, and quantitative real-time PCR for diagnoses of Plasmodium falciparum and Plasmodium vivax infections in Mimika Regency, Papua, Indonesia

Malaria Journal ◽

10.1186/s12936-015-0615-5 ◽

2015 ◽

Vol 14 (1) ◽

Cited By ~ 11

Author(s):

Liony Fransisca ◽

Josef Hari Kusnanto ◽

Tri Baskoro T Satoto ◽

Boni Sebayang ◽

ᅟ Supriyanto ◽

...

Keyword(s):

Plasmodium Falciparum ◽

Plasmodium Vivax ◽

Real Time ◽

Diagnostic Test ◽

Rapid Diagnostic Test ◽

Real Time Pcr ◽

Quantitative Real Time Pcr

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Correlating quantitative real-time PCR to rapid diagnostic test and RNA transcript expression in isolated gametocytemia and asexual parasitemia of Plasmodium falciparum malaria

Tropical Diseases Travel Medicine and Vaccines ◽

10.1186/s40794-015-0008-3 ◽

2015 ◽

Vol 1 (1) ◽

Cited By ~ 2

Author(s):

Rachel Lau ◽

Melissa Phuong ◽

Filip Ralevski ◽

Andrea K. Boggild

Keyword(s):

Plasmodium Falciparum ◽

Real Time ◽

Falciparum Malaria ◽

Diagnostic Test ◽

Rapid Diagnostic Test ◽

Real Time Pcr ◽

Plasmodium Falciparum Malaria ◽

Transcript Expression ◽

Quantitative Real Time Pcr ◽

Rna Transcript

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Is rapid diagnostic test (malaria Pv/Pf Ag card test) reliable in diagnosing malaria

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20175565 ◽

2017 ◽

Vol 5 (1) ◽

pp. 92

Author(s):

Vishruti Gandhi Vishruti Gandhi ◽

Prasad Muley ◽

Niyati Parikh ◽

Hardik Gandhi ◽

Akash Mehta

Keyword(s):

Plasmodium Falciparum ◽

Plasmodium Vivax ◽

Diagnostic Test ◽

Rapid Diagnostic Test ◽

Sensitivity And Specificity ◽

Peripheral Blood Smear ◽

Peripheral Smear ◽

Infected Female ◽

Anopheles Mosquitoes ◽

Smear Examination

Background: Malaria is a protozoan disease transmitted by the bite of infected female anopheles mosquitoes is one of the most important parasitic diseases of human with transmission in 109 countries, affecting more than one billion people worldwide. This study was planned to compare the gold standard i.e. peripheral blood smear examination and the newer rapid diagnostic test (malaria plasmodium falciparum/ plasmodium vivax antigen card) to know the diagnostic accuracy of Rapid Diagnostic Test (RDT) kits. Methods: All the suspected cases of WHO defined malaria between 1month to 18 years of age were enrolled in the study.Results: Out of 96 clinically suspected cases of malaria 63 were confirmed by peripheral smear. The age range of participants ranged from 4 months to 17 years. On peripheral smear examination, out of 96 clinically suspected cases, 37 (38.5%) cases were positive for P. vivax, 23 (23.9%) were positive for P. falciparum and 3 (3.1%) were positive for both parasites by microscopy. Sensitivity and specificity of RDT for Plasmodium Vivax is 92.5% and 96.4% respectively. Sensitivity and specificity of RDT for Plasmodium Falciparum is 96.2% and 90%.Conclusions: The rational use of RDTs as a complement to microscopy might give substantial health benefits through earlier treatment, reduction in morbidity and mortality and more rationalized approach for choosing anti-malarial drugs, which in terms may prevent drug resistance.

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