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Prevalence and density-related concordance of three diagnostic tests for malaria in a region of Tanzania with hypoendemic malaria.

Publication ,  Journal Article
Schachterle, SE; Mtove, G; Levens, JP; Clemens, EG; Shi, L; Raj, A; Munoz, B; Reller, ME; West, S; Dumler, JS; Sullivan, D; PRET Project Team,
Published in: J Clin Microbiol
November 2011

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.

Duke Scholars

Published In

J Clin Microbiol

DOI

EISSN

1098-660X

Publication Date

November 2011

Volume

49

Issue

11

Start / End Page

3885 / 3891

Location

United States

Related Subject Headings

  • Tanzania
  • Sensitivity and Specificity
  • Prevalence
  • Parasitology
  • Molecular Diagnostic Techniques
  • Microscopy
  • Microbiology
  • Malaria
  • Infant
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Schachterle, S. E., Mtove, G., Levens, J. P., Clemens, E. G., Shi, L., Raj, A., … PRET Project Team, . (2011). Prevalence and density-related concordance of three diagnostic tests for malaria in a region of Tanzania with hypoendemic malaria. J Clin Microbiol, 49(11), 3885–3891. https://doi.org/10.1128/JCM.01157-11
Schachterle, Stephen E., George Mtove, Joshua P. Levens, Emily G. Clemens, Lirong Shi, Amirita Raj, Beatrice Munoz, et al. “Prevalence and density-related concordance of three diagnostic tests for malaria in a region of Tanzania with hypoendemic malaria.J Clin Microbiol 49, no. 11 (November 2011): 3885–91. https://doi.org/10.1128/JCM.01157-11.
Schachterle SE, Mtove G, Levens JP, Clemens EG, Shi L, Raj A, et al. Prevalence and density-related concordance of three diagnostic tests for malaria in a region of Tanzania with hypoendemic malaria. J Clin Microbiol. 2011 Nov;49(11):3885–91.
Schachterle, Stephen E., et al. “Prevalence and density-related concordance of three diagnostic tests for malaria in a region of Tanzania with hypoendemic malaria.J Clin Microbiol, vol. 49, no. 11, Nov. 2011, pp. 3885–91. Pubmed, doi:10.1128/JCM.01157-11.
Schachterle SE, Mtove G, Levens JP, Clemens EG, Shi L, Raj A, Munoz B, Reller ME, West S, Dumler JS, Sullivan D, PRET Project Team. Prevalence and density-related concordance of three diagnostic tests for malaria in a region of Tanzania with hypoendemic malaria. J Clin Microbiol. 2011 Nov;49(11):3885–3891.

Published In

J Clin Microbiol

DOI

EISSN

1098-660X

Publication Date

November 2011

Volume

49

Issue

11

Start / End Page

3885 / 3891

Location

United States

Related Subject Headings

  • Tanzania
  • Sensitivity and Specificity
  • Prevalence
  • Parasitology
  • Molecular Diagnostic Techniques
  • Microscopy
  • Microbiology
  • Malaria
  • Infant
  • Humans