Prevalence and Density-Related Concordance of Three Diagnostic Tests for Malaria in a Region of Tanzania with Hypoendemic Malaria
Open accessAbstract
Accurate malaria diagnosis has dual roles in identification of symptomatic persons for effective malaria treatment and also enumeration of asymptomatic persons who contribute to the epidemiologic determinants of transmission. Three currently used diagnostic tests, microscopy, rapid diagnostic tests (RDTs), and real-time PCR, all have different sensitivities and specificities, which are parasite density dependent. Here, we compare their concordance among 451 febrile episodes in a cohort of 2,058 children and adults followed over 6 months in a region in central Tanzania with hypoendemic malaria. Microscopy, a histidine-rich protein-based RDT, and two different real-time PCR gene probes detected Plasmodium falciparum in 20, 54, 41, and 78 episodes of fever, respectively. They had complete concordance in only 9 episodes. Real-time PCR with an 18S probe was more sensitive than with a mitochondrial probe for cytochrome b despite higher copy numbers of mitochondrial DNA. Both PCR yields were increased 4-fold by glycogen/acetate precipitation with low-speed centrifugation. Duplicate PCR increases low-density malaria detection. RDT had the highest number of unique positives, presumably from persistent antigen despite the absence of parasites, although RDT did not detect 3 parasitemias with over 1,000 parasites/μl. In a latent class analysis, real-time PCR had significantly higher sensitivity than did microscopy or RDT. Agreement between real-time PCR, RDT, and microscopy was highest in March and April, when both the P. falciparum parasite rate and parasite densities are highest. Real-time PCR is more sensitive and specific than RDT and microscopy in low-prevalence, low-parasite-density settings.
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The performance of the RDT kit in the current study is in agreement with Schachterle et al., who showed that RDT kits had high false positive and negative rates in a region of malaria hypoendemicity in Tanzania.
“The performance of the RDT kit for malaria diagnosis used in the current study is in agreement with the findings of Schachterle et al., who showed that RDT kits had high false positive and negative rates in a region of malaria hypoendemicity in Tanzania [29].”
From Reliability of rapid diagnostic test for diagnosing peripheral and placental malaria in an area of unstable malaria transmission in Eastern Sudan (2013) · cites this paper as [29]
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- Authors
- Schachterle, S. E., Mtove, G., Levens, J. P., Clemens, E. G., Shi, L., Raj, A., Munoz, B., Reller, M. E., West, S., Dumler, J. S., Sullivan, D., & and the PRET Project Team
- Affiliations
- Johns Hopkins University (US)
- National Institute for Medical Research (TZ)
- Venue
- Journal of Clinical Microbiology
- Publisher
- American Society for Microbiology
- Published
- 2011-11
- Volume
- 49
- Issue
- 11
- Pages
- 3885-3891
- ISSN
- 0095-1137 (ISSN-L)
- 1098-660X
- PMC
- PMC3209109
- OpenAlex
- W2122437572
- Cited by
- 39
- References
- 9
- Citations by year
- 2026: 1 · 2024: 1 · 2022: 1 · 2021: 2 · 2020: 10 · 2019: 1 · 2018: 3 · 2016: 3 · 2015: 2 · 2014: 5 · 2013: 5 · 2012: 5
- FWCI
- 4.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Microbiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bill and Melinda Gates Foundation
- National Institute of Allergy and Infectious Diseases (U01AI068613)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
- Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
- Keywords
- malaria diagnosis, Plasmodium falciparum, parasite density, diagnostic test concordance, rapid diagnostic tests, microscopy, real-time PCR, latent class analysis, hypoendemic malaria, febrile episodes, asymptomatic malaria, sensitivity and specificity
- MeSH terms
- Adult, Animals, Child, Child, Preschool, Cross-Sectional Studies, Diagnostic Tests, Routine, Humans, Infant, Malaria, Microscopy, Parasitology, Sensitivity and Specificity, Tanzania, Cohort Studies, Prevalence, Endemic Diseases, Molecular Diagnostic Techniques
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