Reliability of rapid diagnostic test for diagnosing peripheral and placental malaria in an area of unstable malaria transmission in Eastern Sudan

Diagnostic Pathology

Ishag Adam³  Ahmed M AbdelHalim¹  Salah E Elzaki⁴  Ahmed A Mohmmed²  Gamal K Adam⁵  Awadalla H Kashif¹ 

[1] Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan;Faculty of Medicine, The National Ribat University, P.O. Box 1157, Khartoum, Sudan;Faculty of Medicine, University of Khartoum, Khartoum, Sudan;Tropical Medicine Research Institute, National Centre for Research, Khartoum, Sudan;Faculty of Medicine, University of Gadarif, Gadarif, Sudan

关键词: Pregnancy;    Placental malaria;    Microscopy;    Rapid diagnostic kit;    Plasmodium falciparum;   

Others  :  807239
DOI  :  10.1186/1746-1596-8-59

 received in 2013-02-25, accepted in 2013-04-08,  发布年份 2013

【 摘 要 】

Background

Diagnosing Plasmodium falciparum malaria during pregnancy is a great challenge for clinicians because of the low density of parasites in the peripheral blood and parasite sequestration in the placenta. Nevertheless, few data on the use of malaria rapid diagnostic test (RDT) during pregnancy have been published.

Methods

P. falciparum infections were assessed in 156 febrile pregnant women by microscopic examination of their blood smears and by RDT and polymerase chain reactions (PCR). In addition, 150 women were assessed at the time of delivery by microscopy, RDT, PCR and placental histology investigations. The study was conducted at the Gadarif Hospital, Eastern Sudan. The SD Bioline P. f / P. v (Bio Standard Diagnostics, Gurgaon, Korea) RDT kit was evaluated in this study.

Results

Among the febrile pregnant women, 17 (11.0%), 26 (16.7%) and 18 (11.5%) positive cases of P. falciparum were detected by microscopy, RDT, and PCR, respectively. The sensitivity and specificity of the microscopy was 94.4% and 100%, respectively. The corresponding values for RDT evaluation were 83.3% and 92.0%, as compared with PCR as the gold standard.

While there were no detected cases of malaria by microscopic examination of blood smears, 27 (18.0%), 21(14.0%) and 46 (30.7%) out of the 150 placentae investigated had P. falciparum as determined by RDT, PCR, and histology, respectively. The sensitivity and specificity for RDT was 17.4% and 81.7%, respectively. The corresponding values for PCR were 6.5% and 82.7%, where histology was used as the gold standard.

Conclusions

The RDT kit used in this study has poor performance for peripheral and placental P. falciparum malaria detection in this setting.

Virtual slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1092363465928479 webcite

【 授权许可】

   
2013 Kashif et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]WHO: World Malaria Report 2010. Geneva, Switzerland; 2010. Available: http://www.who.int/malaria/world_malaria_report_2010/worldmalariareport2010.pdf webcite
• [2]Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile FO: Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study. PLoS Med 2010, 7:e1000221.
• [3]Hviid L: The role of Plasmodium falciparum variant surface antigens in protective immunity and vaccine development. Hum Vaccin 2010, 6:84-89.
• [4]Uneke CJ: Diagnosis of Plasmodium falciparum malaria in pregnancy in sub-Saharan Africa: the challenges and public health implications. Parasitol Res 2008, 102:333-342.
• [5]Bánhidy F, Lowry RB, Czeizel AE: Risk and benefit of drug use during pregnancy. Int J Med Sci 2005, 2:100-106.
• [6]World Health Organization (WHO) Guidelines for the treatment of malaria: Geneva. Switzerland: WHO; 2010.
• [7]Moerman F, Lengeler C, Chimumbwa J, Talisuna A, Erhart A, Coosemans M, D’Alessandro U: The contribution of the health-care service to a sound and sustainable malaria-control policy. Lancet Infect Dis 2003, 3:99-102.
• [8]Nkrumah B, Acquah SEK, Ibrahim L, May J, Brattig N, Tannich E, Nguah SB, Adu-Sarkodie Y, Huenger F: Comparative evaluation of two rapid field tests for malaria diagnosis: partec rapid malaria test and binax now malaria rapid diagnostic test. BMC Infect Dis 2011, 11:143-170. BioMed Central Full Text
• [9]Nankabirwa J, Zurovac D, Njogu JN, Rwakimari JB, Counihan H, Snow RW, Tibenderana JK: Malaria misdiagnosis in Uganda–implications for policy change. Malar J 2009, 8:66. BioMed Central Full Text
• [10]McMorrow ML, Masanja MI, Abdulla SM, Kahigwa E, Kachur SP: Challenges in routine implementation and quality control of rapid diagnostic tests for malaria–Rufiji District, Tanzania. Am J Trop Med Hyg 2008, 79:385-390.
• [11]World Health Organization: Results of WHO product testing of malaria rapid diagnostic tests. In Malaria Rapid Diagnostic Test Peformance. Round 1 (2008). Geneva: World Health Organization; 2012.
• [12]Aguilar R, Machevo S, Menéndez C, Bardají A, Nhabomba A, Alonso PL, Mayor A: Comparison of placental blood microscopy and the ICT HRP2 rapid diagnostic test to detect placental malaria. Trans R Soc Trop Med Hyg 2012, 106(9):573-575.
• [13]Dhorda M, Piola P, Nyehangane D, Tumwebaze B, Nalusaji A, Nabasumba C, Turyakira E, McGready R, Ashley E, Guerin PJ, Snounou G: Performance of a histidine-rich protein 2 rapid diagnostic test, Paracheck Pf®, for detection of malaria infections in Ugandan pregnant women. Am J Trop Med Hyg 2012, 86(1):93-95.
• [14]Kattenberg JH, Tahita CM, Versteeg IA, Tinto H, Traoré-Coulibaly M, Schallig HD, Mens PF: Antigen persistence of rapid diagnostic tests in pregnant women in Nanoro, Burkina Faso, and the implications for the diagnosis of malaria in pregnancy. Trop Med Int Health 2012, 17(5):550-557.
• [15]Kyabayinze DJ, Tibenderana JK, Nassali M, Tumwine LK, Riches C, Montague M, Counihan H, Hamade P, Van Geertruyden JP, Meek S: Placental Plasmodium falciparum malaria infection: operational accuracy of HRP2 rapid diagnostic tests in a malaria endemic setting. Malar J 2011, 10:306. BioMed Central Full Text
• [16]Mayor A, Moro L, Aguilar R, Bardají A, Cisteró P, Serra-Casas E, Sigaúque B, Alonso PL, Ordi J, Menéndez C: How hidden can malaria be in pregnant women? Diagnosis by microscopy, placental histology, polymerase chain reaction and detection of histidine-rich protein 2 in plasma. Clin Infect Dis 2012, 54(11):1561-1568.
• [17]Minja DT, Schmiegelow C, Oesterholt M, Magistrado PA, Boström S, John D, Pehrson C, Andersen D, Deloron P, Salanti A, Lemnge M, Luty AJ, Alifrangis M, Theander T, Lusingu JP: Reliability of rapid diagnostic tests in diagnosing pregnancy-associated malaria in north-eastern Tanzania. Malar J 2012, 11:211. BioMed Central Full Text
• [18]Adam I, Elhassan EM, Haggaz AE, Ali AA, Adam GK: A perspective of the epidemiology of malaria and anaemia and their impact on maternal and perinatal outcomes in Sudan. J Infect Dev Ctries 2011, 5(2):83-87.
• [19]Elbashir HM, Salih MM, Elhassan EM, Mohmmed AA, Elbashir MI, Adam I: Polymerase chain reaction and histology in diagnosis of placental malaria in an area of unstable malaria transmission in Central Sudan. Diagn Pathol 2011, 6:128. BioMed Central Full Text
• [20]Elhassan EM, Haggaz AD, Magzoub MM, Adam I: Non-malarial fever among pregnant women in Medani Hospital, Sudan: Diagnostic uncertainty and overtreatment with quinine. Asian Pac J Trop Med 2010, 3:395-398.
• [21]Hassan S-D, Haggaz AE, Mohammed-Elhassan EB, Malik EM, Adam I: Fluorescence microscope (Cyscope) for malaria diagnosis in pregnant women in Medani Hospital, Sudan. Diagn Pathol 2011, 24:6-88.
• [22]Malik EM, Atta HY, Weis M, Lang A, Puta C, Lettenmaier C: Sudan Roll Back Malaria Consultative Mission: Essential Actions to Support the Attainment of the Abuja Targets. Geneva: Roll Back Malaria Partnership; 2004. [Sudan RBM Country Consultative Mission Final Report]
• [23]Adam I, Ali DM, Abdalla A: Artesunate plus Sulfadoxine-pyrimethamine in the treatment of uncomplicated P. falciparum malaria during pregnancy in eastern Sudan. Trans R Soc Trop Med Hyg 2006, 100:632-636.
• [24]Bulmer JN, Rasheed FN, Francis N, Morrison L, Greenwood BM: Placental malaria. I. Pathological classification. Histopathology 1993, 22:211-218.
• [25]Bulmer JN, Rasheed FN, Morrison L, Francis N, Greenwood BM: Placental malaria. II. A semi-quantitative investigation of the pathological features. Histopathology 1993, 22(3):219-225.
• [26]Snounou G, Viriyakosol S, Xhu XP, Jarra W, Pinhero L, Do Rosario VE, Thaithong S, Brown KN: High sensitivity of detection of human malaria parasites by use of nested polymerase chain reaction. Mol Biochem Parasitol 1993, 61:315-320.
• [27]Harper R, Reeves B: Reporting of precision of estimates for diagnostic accuracy: a review. BMJ 1999, 318:1322-1323.
• [28]Osman MM, Nour BY, Sedig MF, De Bes L, Babikir AM, Mohamedani AA, Mens PF: Informed decision-making before changing to RDT: a comparison of microscopy, rapid diagnostic test and molecular techniques for the diagnosis and identification of malaria parasites in Kassala, eastern Sudan. Trop Med Int Health 2010, 15(12):1442-1448.
• [29]Schachterle S, Mtove G, Levens J, Clemens EG, Shi L, Raj A, Munoz B, Reller ME, West S, Dumler SJ, Sullivan D: Prevalence and density related concordance of three diagnostic tests for malaria in hypoendemic Tanzania. J Clin Microbiol 2011, 49:3885-3891.
• [30]Mockenhaupt FP, Bedu-Addo G, von Gaertner C, Boye R, Fricke K, Hannibal I, Karakaya F, Schaller M, Ulmen U, Acquah PA, Dietz E, Eggelte TA, Bienzle U: Detection and clinical manifestation of placental malaria in southern Ghana. Malar J 2006, 5:119. BioMed Central Full Text
• [31]Mockenhaupt FP, Ulmen U, von Gaertner C, Bedu-Addo G, Bienzle U: Diagnosis of placental malaria. J Clin Microbiol 2002, 40:306-308.
• [32]Singer LM, Newman RD, Diarra A, Moran AC, Huber CS, Stennies G, Sirima SB, Konate A, Yameogo M, Sawadogo R, Barnwell JW, Parise ME: Evaluation of a malaria rapid diagnostic test for assessing the burden of malaria during pregnancy. Am J Trop Med Hyg 2004, 70:481-485.
• [33]Kyabayinze DJ, Tibenderana JK, Odong GW, Rwakimari JB, Counihan H: Operational accuracy and comparative persistent antigenicity of HRP2 rapid diagnostic tests for Plasmodium falciparum malaria in a hyperendemic region of Uganda. Malar J 2008, 7:221. BioMed Central Full Text
• [34]Murray CK, Gasser RA Jr, Magill AJ, Miller RS: Update on rapid diagnostic testing for malaria. Clin Microbiol Rev 2008, 21:97-110.
• [35]Salih MM, Mohammed AH, Mohmmed AA, Adam GK, Elbashir MI, Adam I: Monocytes and macrophages and placental malaria infections in an area of unstable malaria transmission in eastern Sudan. Diagn Pathol 2011, 6:83. BioMed Central Full Text
• [36]Adam I, Ahmed S, Mahmoud MH, Yassin MI: Comparison of HemoCue® hemoglobin-meter and automated hematology analyzer in measurement of hemoglobin levels in pregnant women at Khartoum hospital, Sudan. Diagn Pathol 2012, 7:30. BioMed Central Full Text
• [37]Abdelrahman EG, Gasim GI, Musa IR, Elbashir LM, Adam I: Red blood cell distribution width and iron deficiency anemia among pregnant Sudanese women. Diagn Pathol 2012, 7:168. BioMed Central Full Text
• [38]Elmardi KA, Malik EM, Abdelgadir T, Ali SH, Elsyed AH, Mudather MA, Elhassan AH, Adam I: Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan's conditions using artemisinin-based combination therapy and rapid diagnostic test. Malar J 2009, 8:39. BioMed Central Full Text