Abstract:
BACKGROUND:Malaria is a major world health issue and its continued burden is due, in part, to difficulties in the diagnosis of the illness. The World Health Organization recommends confirmatory testing using microscopy-based techniques or rapid diagnostic tests (RDT) for all cases of suspected malaria. In regions where Plasmodium species are indigenous, there are multiple etiologies of fever leading to misdiagnoses, especially in populations where HIV is prevalent and children. To determine the frequency of malaria infection in febrile patients over an 8-month period at the Regional Hospital in Bamenda, Cameroon, we evaluated the clinical efficacy of the Flourescence and Staining Technology (FAST) Malaria stain and ParaLens AdvanceTM microscopy system (FM) and compared it with conventional bright field microscopy and Giemsa stain (GS). METHODS:Peripheral blood samples from 522 patients with a clinical diagnosis of "suspected malaria" were evaluated using GS and FM methods. A nested PCR assay was the gold standard to compare the two methods. PCR positivity, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. RESULTS:Four hundred ninety nine samples were included in the final analysis. Of these, 30 were positive via PCR (6.01%) with a mean PPV of 19.62% and 27.99% for GS and FM, respectively. The mean NPV was 95.01% and 95.28% for GS and FM, respectively. Sensitivity was 26.67% in both groups and specificity was 92.78% and 96.21% for GS and FM, respectively. An increased level of diagnostic discrepancy was observed between technicians based upon skill level using GS, which was not seen with FM. CONCLUSIONS:The frequency of malarial infections confirmed via PCR among patients presenting with fever and other symptoms of malaria was dramatically lower than that anticipated based upon physicians' clinical suspicions. A correlation between technician skill and accuracy of malaria diagnosis using GS was observed that was less pronounced using FM. Additionally, FM increased the specificity and improved the PPV, suggesting this relatively low cost approach could be useful in resource-limited environments. Anecdotally, physicians were reluctant to not treat all patients symptomatically before results were known and in spite of a negative microscopic diagnosis, highlighting the need for further physician education to avoid this practice of overtreatment. A larger study in an area with a known high prevalence is being planned to compare the two microscopy methods against available RDTs.
journal_name
Infect Dis Povertyjournal_title
Infectious diseases of povertyauthors
Parsel SM,Gustafson SA,Friedlander E,Shnyra AA,Adegbulu AJ,Liu Y,Parrish NM,Jamal SA,Lofthus E,Ayuk L,Awasom C,Henry CJ,McArthur CPdoi
10.1186/s40249-017-0251-0subject
Has Abstractpub_date
2017-04-04 00:00:00pages
32issue
1eissn
2095-5162issn
2049-9957pii
10.1186/s40249-017-0251-0journal_volume
6pub_type
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章
doi:10.1186/s40249-016-0175-0
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journal_title:Infectious diseases of poverty
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journal_title:Infectious diseases of poverty
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journal_title:Infectious diseases of poverty
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章
doi:10.1186/2049-9957-3-16
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journal_title:Infectious diseases of poverty
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doi:10.1186/s40249-019-0555-3
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journal_title:Infectious diseases of poverty
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章,多中心研究
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journal_title:Infectious diseases of poverty
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journal_title:Infectious diseases of poverty
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章
doi:10.1186/s40249-018-0472-x
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journal_title:Infectious diseases of poverty
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journal_title:Infectious diseases of poverty
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章,评审
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更新日期:2017-10-25 00:00:00
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journal_title:Infectious diseases of poverty
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pub_type: 信件
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章
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journal_title:Infectious diseases of poverty
pub_type: 社论
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journal_title:Infectious diseases of poverty
pub_type: 历史文章,杂志文章,meta分析
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pub_type: 杂志文章
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章
doi:10.1186/2049-9957-2-3
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章,已发布勘误
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更新日期:2018-04-20 00:00:00
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journal_title:Infectious diseases of poverty
pub_type: 杂志文章
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更新日期:2012-10-25 00:00:00