Sachin Kale, MD (Pathology).

Malaria Diagnosis

Approaches

Clinical

Microsopy

RDTs

Microscopy

Microscopy

Sensitive5 – 10 parasites/ul100 parasites/ul (in field conditions.) InformativeSpecies Inexpensive

Microscopy

Permanent recordQuality control

DisadvantagesLabour intensiveExacting

Nikon Coolpix 3700Vision 2000Camera mode: ManualWhite Balance: AutoSize: 1024x780

Conflict of Interest Statement: No association with any of above brands.

Photomicrography

Vivax

Falciparum

Vivax

Falciparum

Rapid Diagnstic Tests

Antigens

HRP-2p-LDH

Suspected cases

RDT/PS

+ve -ve

P.f

Severe

T/t

Uncomplicated

T/t

High Suspicion

T/t, excludeOther diseases

Other diseases,Review/refer

Low Susp

Species-specific PCR diagnosis of malaria

5 parasites or less/ul Species identified

Other Approaches

Quantitative buffy coat Fluorescence Microscopy Sensitivity: 41 to 93 % (0.002%

parasitemia)

Specificity: 93%(P.f) No species identification

Ancillary Tests

Hb, PCV Blood glucose WBC, Platelet Count Coagulation tests; FDPs, Fibrinogen Urine for free Hb Blood Urea/ Creatinine Urine Protein G6PD

Poor Prognosis

Heavy parasitemia >5% RBCPresence Malarial pigment, schizonts and

mature trophsWBC > 12,000/cmmCreatinine: > 2.9 mg/dlBUN: 128 mg/dlPCV: < 20%, Hb: < 7.0 gm/dlBlood glucose: < 40Riased transaminases

Iqbal et al. (J. Clin. Microbiol. 39:3644–3646. ) looked at pLDH detection compared to microscopy and PCR in 550 immigrants from malaria-endemic areas who were entering Kuwait, where malaria is not endemic. They concluded that for parasite levels of >100 parasites/µl , the sensitivity obtained for OptiMAL was 97%. However, because half of the samples with <50 parasites/µl detected by microscopy were not detected, the authors recommended that the test should be used with great caution and should not replace conventional microscopy in the diagnosis of malaria.

Diagnostic and Prognostic Utility of Rapid Strip(Optimal and Paracheck) Versus Conventional SmearMicroscopy in Adult Patients of Acute,Uncomplicated P. falciparum Malaria in Mumbai, IndiaNJ Gogtay*, SS Dalvi**, D Rajgor***, AR Chogle#, DR Karnad+++, M Ramdas+, U Aigal##,NA Kshirsagar++

Thrombocytopenia in malariaPatel U, Gandhi G, Friedman S, Niranjan S.

The study found the sensitivity of platelet count for diagnosing malaria was 100%, and the specificity was 70%.

The negative predictive value was 100% and the positive predictive valve was 86%.

J Natl Med Assoc. 2004 Sep;96(9):1212-4

Clinical Microbiology Reviews, January 2002, p. 66-78, Vol. 15, No. 1

References

Treatment of Malria www.cdc.gov The use of Malaria Rapid Diagnstic Tests. WHO, Roll Back Malaria

REPORT OF A JOINT WHO/USAID INFORMAL CONSULTATION

25–27 OCTOBER 1999 New Perspectives Malaria Diagnosis

http://japi.org/August2003/O-762.pdf?malaria

Clinical Microbiology Reviews,

January 2002, p. 66-78, Vol. 15, No. 1

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