Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections

Afriyie, Stephen Opoku; Addison, Thomas Kwame; Gebre, Yilekal; Mutala, Abdul-Hakim; Antwi, Kwasi Baako; Abbas, Dawood Ackom; Addo, Kofi Agyapong; Tweneboah, Austine; Ayisi-Boateng, Nana Kwame; Koepfli, Cristian; Badu, Kingsley

doi:10.1186/s12936-023-04506-5

Cited by 32 publications

(17 citation statements)

References 62 publications

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“…Interestingly, malaria could not be detected in any of the study participants, indicating that the implementation of the IPTp–SP recommendation together with other malaria control programmes [ 9 ] have been highly effective in our setting in support of earlier reports [ 15 , 43 ] since all participants had been treated. Although microscopy remains the gold standard for malaria diagnosis, a recent Ghanaian study [ 44 ] has affirmed the superiority of rapid diagnostic test (RDT). Indeed, the accuracy of microscopy is operator-dependent suggesting that a combination with RDT may be more useful, especially in instances of low parasite levels.…”

Section: Discussionmentioning

confidence: 99%

Gestational glucose intolerance among pregnant women at the Cape Coast Teaching Hospital

Kumah,

Agbeno,

Derkyi-Kwarteng

et al. 2024

BMC Pregnancy Childbirth

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Background Malaria in pregnancy can have adverse outcomes if untreated. Both malaria and pregnancy are associated with insulin resistance and diabetes. Although malaria is treated prophylactically with gestational diabetes mellitus (GDM) screened for in pregnancy as part a routine antenatal care, their impacts have not been examined in terms of other forms of dysglycaemia. This cross-sectional study examined insulin resistance and its relationship with dysglycaemia and malaria among pregnant women in the Cape Coast Teaching Hospital (CCTH). Methods Using a structured questionnaire, demographic and clinical information were obtained from 252 pregnant women aged 18–42 years. Weight and height were measured for computation of body mass index (BMI). Measurement of insulin, lipid profile and glucose were taken under fasting conditions followed by oral glucose tolerant test. Insulin resistance and beta-cell function were assessed by the homeostatic model as malaria was diagnosed by microscopy. Results The respective prevalence of GDM, gestational glucose intolerance (GGI) and insulin resistance were 0.8% (2/252), 19.44% (49/252) and 56.75% (143/252). No malaria parasite or dyslipidaemia was detected in any of the participants. Apart from BMI that increased across trimesters, no other measured parameter differed among the participants. Junior High School (JHS) education compared with no formal education increased the odds (AOR: 2.53; CI: 1.12–5.71; P = 0.03) but 2nd trimester of pregnancy compared to the 1st decreased the odds (AOR: 0.32; CI: 0.12–0.81; P = 0.02) of having insulin resistance in the entire sample. In a sub-group analysis across trimesters, pregnant women with JHS education in their 3rd trimester had increased odds (AOR: 4.41; CI: 1.25–15.62; P = 0.02) of having insulin resistance. Conclusion Prevalence of GDM and GGI were 0.8% and 19.44% respectively. The odds of insulin resistance increased in pregnant women with JHS education in the 3rd trimester. Appropriate measures are needed to assuage the diabetogenic risk posed by GGI in our setting.

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Section: Discussionmentioning

confidence: 99%

Gestational glucose intolerance among pregnant women at the Cape Coast Teaching Hospital

Kumah,

Agbeno,

Derkyi-Kwarteng

et al. 2024

BMC Pregnancy Childbirth

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“…Due to the reasons described above, microscopy still remains the reference method for the laboratory diagnosis of malaria, while RDTs represent an important diagnostic aid over more traditional methods and molecular methods are currently used as confirmatory assays. In fact, molecular methods are crucial when the morphological characteristics of the parasites overlap each other, or parasite morphology is altered by drug treatment, in case of mixed infections by different Plasmodium species, incorrect storage of the samples, or when sub-microscopic parasitemia occurs [14,21,71].…”

Section: Molecular Methodsmentioning

confidence: 99%

The Laboratory Diagnosis of Malaria: A Focus on the Diagnostic Assays in Non-Endemic Areas

Calderaro,

Piccolo,

Chezzi

2024

IJMS

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Even if malaria is rare in Europe, it is a medical emergency and programs for its control should ensure both an early diagnosis and a prompt treatment within 24–48 h from the onset of the symptoms. The increasing number of imported malaria cases as well as the risk of the reintroduction of autochthonous cases encouraged laboratories in non-endemic countries to adopt diagnostic methods/algorithms. Microscopy remains the gold standard, but with limitations. Rapid diagnostic tests have greatly expanded the ability to diagnose malaria for rapid results due to simplicity and low cost, but they lack sensitivity and specificity. PCR-based assays provide more relevant information but need well-trained technicians. As reported in the World Health Organization Global Technical Strategy for Malaria 2016–2030, the development of point-of-care testing is important for the improvement of diagnosis with beneficial consequences for prompt/accurate treatment and for preventing the spread of the disease. Despite their limitations, diagnostic methods contribute to the decline of malaria mortality. Recently, evidence suggested that artificial intelligence could be utilized for assisting pathologists in malaria diagnosis.

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“…In Ashanti region of Ghana, transmission of P . falciparum is intense [ 19 ]. Across both sites, we collected 1649 blood samples from febrile patients, and compared diagnosis by miLab to local microscopy, expert microscopy, RDT, and qPCR.…”

Section: Introductionmentioning

confidence: 99%

A digital microscope for the diagnosis of Plasmodium falciparum and Plasmodium vivax, including P. falciparum with hrp2/hrp3 deletion

Ewnetu,

Badu,

Carlier

et al. 2024

PLOS Glob Public Health

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Sensitive and accurate malaria diagnosis is required for case management to accelerate control efforts. Diagnosis is particularly challenging where multiple Plasmodium species are endemic, and where P. falciparum hrp2/3 deletions are frequent. The Noul miLab is a fully automated portable digital microscope that prepares a blood film from a droplet of blood, followed by staining and detection of parasites by an algorithm. Infected red blood cells are displayed on the screen of the instrument. Time-to-result is approximately 20 minutes, with less than two minutes hands-on time. We evaluated the miLab among 659 suspected malaria patients in Gondar, Ethiopia, where P. falciparum and P. vivax are endemic, and the frequency of hrp2/3 deletions is high, and 991 patients in Ghana, where P. falciparum transmission is intense. Across both countries combined, the sensitivity of the miLab for P. falciparum was 94.3% at densities >200 parasites/μL by qPCR, and 83% at densities >20 parasites/μL. The miLab was more sensitive than local microscopy, and comparable to RDT. In Ethiopia, the miLab diagnosed 51/52 (98.1%) of P. falciparum infections with hrp2 deletion at densities >20 parasites/μL. Specificity of the miLab was 94.0%. For P. vivax diagnosis in Ethiopia, the sensitivity of the miLab was 97.0% at densities >200 parasites/μL (RDT: 76.8%, microscopy: 67.0%), 93.9% at densities >20 parasites/μL, and specificity was 97.6%. In Ethiopia, where P. falciparum and P. vivax were frequent, the miLab assigned the wrong species to 15/195 mono-infections at densities >20 parasites/μL by qPCR, and identified only 5/18 mixed-species infections correctly. In conclusion, the miLab was more sensitive than microscopy and thus is a valuable addition to the toolkit for malaria diagnosis, particularly for areas with high frequencies of hrp2/3 deletions.

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Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections

Cited by 32 publications

References 62 publications

Gestational glucose intolerance among pregnant women at the Cape Coast Teaching Hospital

Gestational glucose intolerance among pregnant women at the Cape Coast Teaching Hospital

The Laboratory Diagnosis of Malaria: A Focus on the Diagnostic Assays in Non-Endemic Areas

A digital microscope for the diagnosis of Plasmodium falciparum and Plasmodium vivax, including P. falciparum with hrp2/hrp3 deletion

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