Evaluation of the OptiMAL Rapid Antigen Test and Species-Specific PCR To Detect Placental Plasmodium falciparum Infection at Delivery
Open accessAbstract
During pregnancy, Plasmodium falciparum infection of the placenta frequently occurs in the absence of parasites in peripheral blood. We investigated the abilities of the OptiMAL rapid immunochromatographic strip test for P. falciparum lactate dehydrogenase and species-specific PCR performed on peripheral blood to detect placental infection or malaria-associated low birth weight. Of 509 Malawian women screened by microscopy, 76 had malaria infection. Among these 509 women, the frequency of peripheral blood parasitemia was low. The OptiMAL test gave positive results in 37 of 171 women tested (one of whom had placental but not peripheral blood parasitemia) and had sensitivities of 71% for peripheral parasitemia and 38% for placental parasitemia compared to the microscopy values. The specificity for peripheral parasitemia was 94%. In 135 women, PCR had sensitivities of 94% for peripheral blood malaria detected by microscopy and 72% for placental infection. In samples examined by PCR, the prevalence of malaria in peripheral blood increased from 26.7% by microscopy to 51.9%. Women with placental malaria and women with malaria in peripheral blood samples by microscopy or OptiMAL testing, but not women with malaria detected only by PCR, had lower-birth-weight babies than did women without malaria by these criteria. Positive results by PCR in the absence of microscopic parasitemia were not associated with low birth weight. Neither OptiMAL nor PCR testing of peripheral blood is adequately sensitive to detect all placental malaria infection, but a positive result by OptiMAL testing identifies women with a high proportion of low-birth-weight babies.
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The OptiMAL test, based on pLDH detection, gave varying results between studies when compared with peripheral blood smears, with sensitivity ranging from 15 to 96.6% and specificity from 90.8 to 98%.
“The OptiMAL test, based on the detection of pLDH, gave varying results between studies when compared with peripheral BS. The sensitivity ranged from 15 to 96.6% and specificity from 90.8 to 98% [10–12].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [10]
In studies using both peripheral and placental blood microscopy as references, RDT sensitivity was lower when compared with placental blood microscopy.
“In studies that used both peripheral and placental blood microscopy as references, RDT sensitivity was lower when compared with placenta blood microscopy [10,13,18].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [10]
Whether applied to peripheral blood or placental blood samples, PCR methods yield positivity rates 20% or more above those of blood smear microscopy.
“Whether applied to peripheral blood or placental blood samples, PCR methods yield positivity rates 20% or more above those of BS microscopy (Tables 3 & 4) [10,14–16,38–46].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [10]
HRP2 or pLDH detected in placental blood has been associated with increased rates of low birthweight in some studies but not in Mozambique.
“HRP2 or pLDH detected in placental blood has been associated with increased rates of LBW in some studies [10,15,53] but not in Mozambique [16].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [10]
In another study, birthweight was associated with positive RDT-pLDH assays but not with positive PCR assays performed on placental blood or peripheral blood.
“In another study, birthweight was associated with positive RDT-pLDH assays but not positive PCR assays performed on placental blood or peripheral blood [10].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [10]
Positive placental blood PCR was associated with an increased rate of low birthweight in one study but not in several others.
“Positive placental blood PCR was associated with an increased rate of LBW in one study [15] but not several others [10,16,53].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [10]
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References 14 · Cited by 65
- Authors
- Mankhambo, L., Kanjala, M., Rudman, S., Lema, V. M., & Rogerson, S. J.
- Affiliations
- University of Malawi (MW)
- Wellcome Trust (GB)
- University of Liverpool (GB)
- Corresponding author
- Rogerson, Stephen J.
- ORCID
- Rogerson, Stephen J.
- Venue
- Journal of Clinical Microbiology
- Publisher
- American Society for Microbiology
- Published
- 2002-01
- Volume
- 40
- Issue
- 1
- Pages
- 155-158
- ISSN
- 0095-1137 (ISSN-L)
- 1098-660X
- PMC
- PMC120134
- OpenAlex
- W2111568165
- Cited by
- 65
- References
- 14
- Citations by year
- 2025: 1 · 2023: 1 · 2021: 1 · 2019: 2 · 2017: 1 · 2016: 1 · 2015: 7 · 2014: 2 · 2013: 4 · 2012: 5
- FWCI
- 3.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Microbiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
- Life Sciences › Immunology and Microbiology › Parasitology › Toxoplasma gondii Research Studies
- Keywords
- placental malaria, Plasmodium falciparum, species-specific PCR, malaria in pregnancy, low birth weight, sensitivity and specificity, Malawi
- MeSH terms
- Adolescent, Adult, Animals, Antigens, Protozoan, Chromatography, Female, Humans, Immunoassay, Infant, Low Birth Weight, Infant, Newborn, L-Lactate Dehydrogenase, Placenta, Placenta Diseases, Plasmodium falciparum, Pregnancy, Species Specificity, Time Factors, Pregnancy Complications, Parasitic, DNA, Protozoan, Polymerase Chain Reaction, Malaria, Falciparum, Delivery, Obstetric
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