Diagnostic Accuracy of Rapid Diagnostic Kits Test for Diagnosis of Malaria

Objective: To assess the diagnostic accuracy of rapid diagnostic kits test for diagnosis of malaria taking microscopy as gold standard Methodology: A total of 375 cases with age range 18-65 years of either gender as suspected for malaria were included in the study. We excluded all those cases already taking anti-malarial drugs. The study was conducted at Chughtais Lahore Lab, Lahore. Required blood sample were obtained following aseptic measures. Malaria RDT SD Bioline Malaria Antigen Pf/Pan (Catalogue No. 05FK60, Standard Diagnostics Inc, Hagal-Dong, Korea, from now on referred as “SD RDT”) was used. Patients were labeled as positive or negative on the basis of reports from hematology department assessed by microscopy and patients were labeled as positive or negative Results: The mean age of the patients was 41.84±13.44 years, male to female ratio of the patients was 1.01:1. The sensitivity, specificity, and diagnostic accuracy of the RDT for diagnosing malaria was 96.79%, 96.28% and 96.53% respectively taking microscopy as gold standard Conclusion: Rapid diagnostic kits is very useful reliable test with high diagnostic accuracy for diagnosis of malaria taking microscopy as gold standard Keywords: Microscopy, Rapid Diagnostic kits, Malaria,

Evaluating laboratory screening tests for malaria on blood donors candidates to reduce the risk of transfusion-transmitted malaria in an endemic area of Indonesia

BACKGROUND Laboratory screening of blood donors for malaria has not been routinely performed in Indonesia. Current policy and practice simply exclude donors based on a history of active clinical malaria. This study was aimed to evaluate laboratory screening tests for malaria among blood donors in an endemic area of Indonesia. METHODS The study was conducted on 550 consecutive blood samples withdrawn from volunteer donors at the Red Cross Blood Transfusion Unit in Ambon city using microscopic and rapid diagnostic tests for antigen as well as for antibody. Furthermore, 248 of those 550 samples were also tested for the presence of malaria DNA using 18S rRNA marker. Statistical analysis was done descriptively using SPSS software version 15 (SPSS Inc., USA). RESULTS The overall malaria positivity rate among the donors was 4.5% (25/550). None of the specimens tested using microscopy or rapid test for malaria antigen assay were positive. However 22 (4.0%) samples were positive for malaria antibody against Plasmodium falciparum; while 3 (1.2%) were positive by PCR. CONCLUSIONS Laboratory testing for blood donors may be used to prevent transfusiontransmitted malaria in an endemic area of Indonesia.

DISTRIBUTION OF PLASMODIUM PARASITES CAUSING MALARIA AMONG LOCAL CHICKENS IN SALAHUDDIN PROVINCE , IRAQ.

This study included two stages, the first one was as epidemiological study of malaria in the local chickens of variuos areas in Salahuddin province the infection rate was 3.16 % out of 433 samples taken. There was different blood stages of the parasite which are represented by trophzoites, schizonts and to less extent gametocytes. The second stage was the experimental study,which showed the ability of induction of infection (subinoculation technique). Prepatent period was represented by the presence of trophozoites m schizonts and gametocytes. The most important clinical signs was partial paralysis , dullness and emaciation. The pathological changes showed congestion and enlargement of liver and spleen. congestion of brain with absence of exo-erythrocytic mild lymphocytosis in the infected group. it was concluded the ability of diagnosis of avian malaria using human malaria antigen by the indirect fluorescence antibody technique.

Postoperative Pernicious Malarial Crisis in Patient Coming Back from an Endemic Area

The case of a young Moroccan doctor who spent Four months in Congo as part of an international humanitarian military mission; he underwent surgery under spinal anesthesia for an anal fissure a week after being returned to Morocco, In the seventh-day postoperative period, acute renal failure with anuria set in, justifying the patient's transfer to an intensive care unit. Upon admission, on the eighth postoperative day, one day after readmission to the emergency room and was put on triple antibiotic therapy ,and liquid resuscitation was carried out immediately by infusion of saline isotonic solution and due to the non-improvement of the hemodynamic state after volume repletion, a vasoactive support was rapidly introduced at the initial dose of 0.2 ug / kg / min, the intravenous quinine was not immediately introduced in the emergency room because the initial thick, thin film and malaria blood smear carried out on admission were negative and the postoperative clinical context argued in favor of bacterial septic shock. A sepsis context not ruled out (blood cultures performed); a surgical revision the morning of his admission to the intensive care by under umbilical laparotomy, didn’t showed an intra-abdominal collection. Parallelly a thick film (30% of parasitized red blood cells) revealing P. falciparum, and blood smear were performed again and came back positive after a positive malaria antigen detection of specific IgMs in the indirect immunofluorescence, confirming the diagnosis. The mode of infection; is associated with the end of chemoprophylaxis rigorously followed up till Finally, the possibility of pernicious malaria aggravating the initial acute renal failure and hipocalcemia is also discussed.

Considerations for quality assurance of multiplex malaria antigen detection assays with large sample sets

Multiplex assays for malaria antigen detection can gather data from large sample sets, but considerations for the consistency and quality assurance (QA) of mass testing lack evaluation. We present a QA framework for a study occurring November 2019 to March 2020 involving 504 assay plates detecting four Plasmodium antigens: pan-Plasmodium aldolase and lactate dehydrogenase (LDH), histidine-rich protein 2 (HRP2), P. vivax LDH (PvLDH). Controls on each plate included buffer blank, antigen negative blood, and 4-point positive dilution curve. The blank and negative blood provided consistently low signal for all targets except for pAldolase, which showed variability. Positive curve signals decreased throughout the 5-month study duration but retained a coefficient of variation (CV) of < 5%, with the exception of HRP2 in month 5 (CV of 11%). Regression fittings for inter-plate control signals provided mean and standard deviations (SDs), and of 504 assay plates, 6 (1.2%) violated the acceptable deviation limits and were repeated. For the 40,272 human blood samples assayed in this study, of 161,088 potential data points (each sample × 4 antigens), 160,641 (99.7%) successfully passed quality checks. The QA framework presented here can be utilized to ensure quality of laboratory antigen detection for large sample sets.

Malaria Infection and Risk for Endemic Burkitt Lymphoma: A Systematic Review and Meta-Analysis

Background: Malaria infection is reportedly linked to endemic Burkitt lymphoma (eBL) in malaria-endemic areas. This study aimed to pool the overall risk (or odds) of eBL among children with previous or concurrent malaria infection. Methods: We searched PubMed, Web of Science, Scopus, and reference lists of publications for potentially relevant studies on malaria infection and eBL. The quality of the included studies was assessed using the Joanna Briggs Institute for case-control studies. Random-effects meta-analysis was used to summarize whether the odds of eBL can be increased by (1) malaria infection or (2) elevated titer of IgGs to malaria antigen. The level of heterogeneity was evaluated using Cochran’s Q statistic and I2. The individual study data, pooled odds, and confidence interval (CI) were illustrated using the forest plot. Publication bias was assessed using funnel plots and Egger’s test. Results: Ten studies were included, reporting the number of malaria cases in eBL and non-eBL (5 studied malaria infection and the odds of eBL; five studied the burden of IgGs to malarial antigens and the odds of eBL). According to the meta-analysis results, the odds of eBL was not increased by malaria infection (p = 0.562, OR: 0.87, 95% CI: 0.54–1.39, I2: 93.5%, malaria in eBL: 604/1506 cases, malaria in non-eBL: 2117/4549 cases) and the elevated titer of IgGs to malaria antigen (p = 0.051, OR: 1.50, 95% CI: 1.00–2.25, I2: 89%, increased IgG titer in eBL: 1059/1736 cases, increased IgG titer in non-eBL: 847/1722 cases). In meta-regression analysis, sex was not a confounding factor for the effect size of malaria infection and eBL (p = 0.10) and that of increased IgGs and eBL (p = 0.80). Conclusions: Malaria infection and IgG titer elevation did not increase the risk for eBL among children. However, the included studies, which are only few, do not generally agree on this point. Therefore, the risk for eBL in children diagnosed with malaria should be investigated further by longitudinal studies to confirm our evidence-based approach.

Abnormal WBC Scattergrams by Sysmex XN550, A Supplementary Diagnostic Tool for Malaria to the Conventional Methods

Background: In India, malaria has a major impact on health system. It is usually diagnosed based on symptomatology, parasite detection in the peripheral smear (PS) or rapid diagnostic tests (RDT) such as malaria antigen test (MAT). Detection of malaria by MAT is considered as the gold standard. A rapid, cost effective screening of malaria can be done with the automated analyzers. The present study was undertaken to assess the efficacy of WBC scattergram generated by Sysmex XN 550 hematology analyzer to diagnose malaria. Methods: A prospective study was conducted over a period of 4 months from August to November 2019, after obtaining institutional ethical clearance. All cases diagnosed as Plasmodium vivax / Plasmodium falciparum infections on malaria antigen test (MAT) were included. Their hemogram and WBC scattergrams obtained from Sysmex XN 550 were studied. Thick & thin Smears were made and stained with Leishman’s stain for microscopy. Results: A total of 101 cases were diagnosed as malaria positive by MAT and thick smear. Ninety-seven were positive by Leishman’s stain. Abnormal scattergrams were 81 out of 101 malaria positive cases. The commonest pattern was double neutrophil zone (n=22) followed by double neutrophil with less space between neutrophil and eosinophil (n=17). An abnormal event on X axis was observed in 16 patients. Gray zone and double eosinophil areas were observed in 11 and 4 cases respectively. The sensitivity of the analyzer was found to be 80.19%. Conclusion: Scattergram of automated haematology analyser (Sysmex XN 550) has good sensitivity, which can be increased to a better level if combined with thrombocytopenia and symptomatology of the patients.

Optical Density Optimization of Malaria Pan Rapid Diagnostic Test Strips for Improved Test Zone Band Intensity

For the last few decades, the immunochromatographic assay has been used for the rapid detection of biological markers in infectious diseases in humans and animals The assay, also known as lateral flow assay, is utilized for the detection of antigen or antibody in human infectious diseases. There are a series of steps involved in the development of these immuno-chromatographic test kits, from gold nano colloids preparation to nitrocellulose membrane coating (NCM). These tests are mostly used for qualitative assays by a visual interpretation of results. For the interpretation of the results, the color intensity of the test zone is therefore very significant. Herein, the study was performed on a malaria antigen test kit. Several studies have reported the use of gold nanoparticles (AuNPs) with varying diameters and its binding with various concentrations of protein in order to optimize tests. However, none of these studies have reported how to fix (improve) test zone band intensity (color), if different sized AuNPs were synthesized during a reaction and when conjugated equally with same amount of protein. Herein, different AuNPs with average diameter ranging from 10 nm to 50 nm were prepared and conjugated equally with protein concentration of 150 µg/mL with KD = 1.0 × 10−3. Afterwards, the developed kits’ test zone band intensity for all different sizes AuNPs was fixed to the same band level (high) by utilization of an ultraviolet-visible spectrophotometer. The study found that the same optical density (OD) has the same test zone band intensity irrespective of AuNP size. This study also illustrates the use of absorption maxima (λ max) techniques to characterize AuNPs and to prevent wastage of protein while developing immunochromatographic test kits.

Combination of Serological, Antigen Detection, and DNA Data for Plasmodium falciparum Provides Robust Geospatial Estimates for Malaria Transmission in Haiti

Microscopy is the gold standard for malaria epidemiology, but laboratory and point-of-care (POC) tests detecting parasite antigen, DNA, and human antibodies against malaria have expanded this capacity. The island nation of Haiti is endemic for Plasmodium falciparum (Pf) malaria, though at a low national prevalence and heterogenous geospatial distribution. In 2015 and 2016, serosurveys were performed of children (ages 6–7 years) sampled in schools in Saut d’Eau commune (n = 1,230) and Grand Anse department (n = 1,664) of Haiti. Children received malaria antigen rapid diagnostic test and provided a filter paper blood sample for further laboratory analysis of the Pf histidine-rich protein 2 (HRP2) antigen, Pf DNA, and anti-Pf IgG antibodies. Prevalence of Pf infection ranged from 0.0–16.7% in 53 Saut d’Eau schools, and 0.0–23.8% in 56 Grand Anse schools. Anti-Pf antibody carriage exceeded 80% of students in some schools from both study sites. Geospatial prediction ellipses were created to indicate clustering of positive tests within the survey areas and overlay of all prediction ellipses for the different types of data revealed regions with high likelihood of active and ongoing Pf malaria transmission. The geospatial utilization of different types of Pf data can provide high confidence for spatial epidemiology of the parasite.