Comparison of PfHRP-2/pLDH RDTs with Light Microscopy in a Low Prevalence Setting in Southeastern Iran, Sistan and Baluchestan: Due to Implementation of Malaria Elimination Program

Abstract

Background: The gold standard for diagnosing malaria in Iran is using light microscopy; however, this method requires equipment, time and skilled microscopists. In some circumstances, rapid diagnostic test (RDTs) can be a proper substitute. Assessing the diagnostic performance of RDT relative to microscopy, for the diagnosis of malaria in Southeastern Iran, Sistan and Baluchestan, was the purpose of this study. Methods: From March to July 2016, which was a peak transmission season in Iran, 318 patients with suspected malaria were taken for a blood sample at the health center in Saravan, in Sistan and Baluchestan Province. The samples were surveyed instantly by light microscopy and RDT. Comparison analysis included: sensitivity, specificity, positive and negative predictive values, and other diagnostic screening performance measures for detecting malaria infections. Results: Of the 318 malaria cases (6.6%), 21 were identified by a microscopy compared to 22 of 318 (6.9%) by RDT. RDT sensitivity and specificity for the diagnosis of malaria were 95.5% (77.2% -99.9%, 95% CI) and 100% (98.8% -100%, 95% CI), respectively, compared to standard microscopy, the sensitivity and specificity for vivax malaria were 100% (79.4-100%, 95% CI) and 99.7% (98.14% -99.99%, 95% CI), and for falciparum malaria: 80% (28.4% -99.5%, 95% CI) and 100% (98.8% -100%, 95% CI). Two tests showed an amazing agreement with a kappa estimation of 0.975. Conclusions:The study proved that the RDT test performs appropriately for the identification of infections with P. falciparum and P. vivax malaria in cross-border malaria. Moreover, the RDT can be a useful instrument for the identification of new clinical cases of malaria in this region.

Performance Comparison of Two Malaria Rapid Diagnostic Test with Real Time Polymerase Chain Reaction and Gold Standard of Microscopy Detection Method

“…This examination is also very prominent, especially in areas where microscopic examination is not available, or it is available but there is no laboratory staff experienced in the examination of blood or some other disadvantage of microscopy examination. Commercially enzyme-based examination tools generally use serological techniques to detect antigens, such as Rapid Diagnostic Tests (RDTs) or Immunochromatography Test (ICT) and Enzyme Linked Immunosorbent Assay (ELISA) 4 , 6 , 7 .…”

Evaluation of Multiplex/Nested Polymerase Chain Reaction and Loop-Mediated Isothermal Amplification for Malaria Diagnosis in Southeastern Iran

“…Therefore, the length of time taken by the technician to examine the sample is important. 1,5,20,[28][29][30] The mn-PCR results were completely similar to the nPCR results, and their sensitivity, specificity, positive predictive value, and negative predictive value were all equal to 100%. These two methods are performed differently, but the same primer is used in both methods.…”

“…Malaria is one of the most serious health problems in many countries, including Iran. 1 According to the latest WHO report, malaria deaths have reduced steadily over the period 2000-2019, from 736,000 in 2000 to 409,000 in 2019. 2 A successful program for malaria elimination is mainly dependent on accurate and effective diagnosis.…”