dc.contributor.author | Murungi, Moses | |
dc.contributor.author | Fulton, Travis | |
dc.contributor.author | Reyes, Raquel | |
dc.contributor.author | Matte, Michael | |
dc.contributor.author | Ntaro, Moses | |
dc.contributor.author | Mulogo, Edgar Mugema | |
dc.contributor.author | Nyehangane, Dan | |
dc.contributor.author | Juliano, Jonathan J. | |
dc.contributor.author | Siedner, Mark J. | |
dc.contributor.author | Boum II, Yap | |
dc.contributor.author | Ross M, Boycee | |
dc.date.accessioned | 2021-11-19T13:28:06Z | |
dc.date.available | 2021-11-19T13:28:06Z | |
dc.date.issued | 2017 | |
dc.identifier.citation | Murungi, M., Fulton, T., Reyes, R., Matte, M., Ntaro, M., Mulogo, E., ... & Boyce, R. M. (2017). Improving the specificity of Plasmodium falciparum malaria diagnosis in high-transmission settings with a two-step rapid diagnostic test and microscopy algorithm. Journal of clinical microbiology, 55(5), 1540-1549. | en_US |
dc.identifier.uri | http://ir.must.ac.ug/xmlui/handle/123456789/950 | |
dc.description.abstract | Poor specificity may negatively impact rapid diagnostic test (RDT)-based diagnostic strategies for malaria. We performed real-time PCR on a subset of subjects who had undergone diagnostic testing with a multiple-antigen (histidine-rich protein 2 and pan-lactate dehydrogenase pLDH [HRP2/pLDH]) RDT and microscopy.
We determined the sensitivity and specificity of the RDT in comparison to results of PCR for the detection of Plasmodium falciparum malaria. We developed and evaluated a two-step algorithm utilizing the multiple-antigen RDT to screen patients, followed by confirmatory microscopy for those individuals with HRP2-positive (HRP2_)/ pLDH-negative (pLDH_) results. In total, dried blood spots (DBS) were collected from 276 individuals. There were 124 (44.9%) individuals with an HRP2_/pLDH_ result, 94 (34.1%) with an HRP2_/pLDH_ result, and 58 (21%) with a negative RDT result. The sensitivity and specificity of the RDT compared to results with real-time PCR were 99.4% (95% confidence interval [CI], 95.9 to 100.0%) and 46.7% (95% CI, 37.7 to 55.9%), respectively. Of the 94 HRP2_/pLDH_ results, only 32 (34.0%) and 35 (37.2%)
were positive by microscopy and PCR, respectively. The sensitivity and specificity of the two-step algorithm compared to results with real-time PCR were 95.5% (95% CI, 90.5 to 98.0%) and 91.0% (95% CI, 84.1 to 95.2), respectively. HRP2 antigen bands demonstrated poor specificity for the diagnosis of malaria compared to that of real time PCR in a high-transmission setting.
The most likely explanation for this finding is the persistence of HRP2 antigenemia following treatment of an acute infection. The two-step diagnostic algorithm utilizing microscopy as a confirmatory test for indeterminate HRP2_/pLDH_ results showed significantly improved specificity with little loss of sensitivity in a high-transmission setting. | en_US |
dc.language.iso | en_US | en_US |
dc.publisher | Journal of Clinical Microbiology | en_US |
dc.subject | Plasmodium falciparum | en_US |
dc.subject | Antigen specificity | en_US |
dc.subject | Diagnostics | en_US |
dc.subject | Epidemiology | en_US |
dc.subject | Malaria | en_US |
dc.subject | Rapid tests | en_US |
dc.title | Improving the Specificity of Plasmodium falciparum Malaria Diagnosis in High- Transmission Settings with a Two-Step Rapid Diagnostic Test and Microscopy Algorithm | en_US |
dc.type | Article | en_US |