TY - JOUR
T1 - Is molecular biology the best alternative for diagnosis of malaria to microscopy? A comparison between microscopy, antigen detection and molecular tests in rural Kenya and urban Tanzania
AU - Mens, P.
AU - Spieker, N.
AU - Omar, S.
AU - Heijnen, M.
AU - Schallig, H.
AU - Kager, P. A.
PY - 2007
Y1 - 2007
N2 - OBJECTIVE: To assess the agreement of different diagnostic methods for the diagnosis and confirmation of the clinical suspicion of Plasmodium infection in children in Tanzania and Kenya. METHOD: Blood samples were collected by the finger prick method from 338 children. Blood samples were collected from 338 children with the clinical suspicion of uncomplicated malaria in health clinics in Tanzania and Kenya. The presence of Plasmodium parasites was assessed with microscopy, rapid diagnostic tests (RDTs) and the molecular assays, quantitative nucleic acid sequence based amplification (QT-NASBA) and polymerase chain reaction (PCR). The results were compared and analysed for agreement. RESULTS: There was a high degree of agreement (88.6-100%) between RDTs or molecular tests and microscopy. In rural Kenya, with a high incidence of malaria cases, the correlation coefficient ranged from 0.94 for RDTs to 0.76 for PCR. In urban Tanzania, where there was a low incidence of cases, R for RDTs was 1.0 but only 0.25 for PCR and 0.33 for NASBA. CONCLUSION: Malaria is overestimated if the diagnosis is based solely on clinical signs. Therefore, laboratory confirmation is essential. Microscopy is a reliable method in rural areas where malaria is prevalent, but RDTs offer a good alternative with the advantage that it is an easy and rapid method. Molecular tests are more sensitive but difficult to implement in rural areas. In areas with lower incidence, molecular tests detect a significantly higher number of Plasmodium infections than RDTs or microscopy. Although implementation of molecular tools can be difficult, the prospect of an easy and cheap detection system makes them promising tools for the near future
AB - OBJECTIVE: To assess the agreement of different diagnostic methods for the diagnosis and confirmation of the clinical suspicion of Plasmodium infection in children in Tanzania and Kenya. METHOD: Blood samples were collected by the finger prick method from 338 children. Blood samples were collected from 338 children with the clinical suspicion of uncomplicated malaria in health clinics in Tanzania and Kenya. The presence of Plasmodium parasites was assessed with microscopy, rapid diagnostic tests (RDTs) and the molecular assays, quantitative nucleic acid sequence based amplification (QT-NASBA) and polymerase chain reaction (PCR). The results were compared and analysed for agreement. RESULTS: There was a high degree of agreement (88.6-100%) between RDTs or molecular tests and microscopy. In rural Kenya, with a high incidence of malaria cases, the correlation coefficient ranged from 0.94 for RDTs to 0.76 for PCR. In urban Tanzania, where there was a low incidence of cases, R for RDTs was 1.0 but only 0.25 for PCR and 0.33 for NASBA. CONCLUSION: Malaria is overestimated if the diagnosis is based solely on clinical signs. Therefore, laboratory confirmation is essential. Microscopy is a reliable method in rural areas where malaria is prevalent, but RDTs offer a good alternative with the advantage that it is an easy and rapid method. Molecular tests are more sensitive but difficult to implement in rural areas. In areas with lower incidence, molecular tests detect a significantly higher number of Plasmodium infections than RDTs or microscopy. Although implementation of molecular tools can be difficult, the prospect of an easy and cheap detection system makes them promising tools for the near future
U2 - https://doi.org/10.1111/j.1365-3165.2006.01779.x
DO - https://doi.org/10.1111/j.1365-3165.2006.01779.x
M3 - Article
C2 - 17300631
SN - 1360-2276
VL - 12
SP - 238
EP - 244
JO - Tropical Medicine & International Health
JF - Tropical Medicine & International Health
IS - 2
ER -