Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections
Abstract Background The World Health Organization recommends parasitological confirmation of all suspected malaria cases by microscopy or rapid diagnostic tests (RDTs) before treatment. These conventional tools are widely used for point-of-care diagnosis in spite of their poor sensitivity at low par...
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ftdoajarticles:oai:doaj.org/article:489805d2d63f4f968e73cfa2c2a5240e 2023-05-15T15:13:07+02:00 Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections Stephen Opoku Afriyie Thomas Kwame Addison Yilekal Gebre Abdul-Hakim Mutala Kwasi Baako Antwi Dawood Ackom Abbas Kofi Agyapong Addo Austine Tweneboah Nana Kwame Ayisi-Boateng Cristian Koepfli Kingsley Badu 2023-03-01T00:00:00Z https://doi.org/10.1186/s12936-023-04506-5 https://doaj.org/article/489805d2d63f4f968e73cfa2c2a5240e EN eng BMC https://doi.org/10.1186/s12936-023-04506-5 https://doaj.org/toc/1475-2875 doi:10.1186/s12936-023-04506-5 1475-2875 https://doaj.org/article/489805d2d63f4f968e73cfa2c2a5240e Malaria Journal, Vol 22, Iss 1, Pp 1-11 (2023) Malaria Microscopy Rapid diagnostic test varATS qPCR Sensitivity Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2023 ftdoajarticles https://doi.org/10.1186/s12936-023-04506-5 2023-03-26T01:33:52Z Abstract Background The World Health Organization recommends parasitological confirmation of all suspected malaria cases by microscopy or rapid diagnostic tests (RDTs) before treatment. These conventional tools are widely used for point-of-care diagnosis in spite of their poor sensitivity at low parasite density. Previous studies in Ghana have compared microscopy and RDT using standard 18S rRNA PCR as reference with varying outcomes. However, how these conventional tools compare with ultrasensitive varATS qPCR has not been studied. This study, therefore, sought to investigate the clinical performance of microscopy and RDT assuming highly sensitive varATS qPCR as gold standard. Methods 1040 suspected malaria patients were recruited from two primary health care centers in the Ashanti Region of Ghana and tested for malaria by microscopy, RDT, and varATS qPCR. The sensitivity, specificity, and predictive values were assessed using varATS qPCR as gold standard. Results Parasite prevalence was 17.5%, 24.5%, and 42.1% by microscopy, RDT, and varATS qPCR respectively. Using varATS qPCR as the standard, RDT was more sensitive (55.7% vs 39.3%), equally specific (98.2% vs 98.3%), and reported higher positive (95.7% vs 94.5%) and negative predictive values (75.3% vs 69.0%) than microscopy. Consequently, RDT recorded better diagnostic agreement (kappa = 0.571) with varATS qPCR than microscopy (kappa = 0.409) for clinical detection of malaria. Conclusions RDT outperformed microscopy for the diagnosis of Plasmodium falciparum malaria in the study. However, both tests missed over 40% of infections that were detected by varATS qPCR. Novel tools are needed to ensure prompt diagnosis of all clinical malaria cases. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Malaria Journal 22 1 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Malaria Microscopy Rapid diagnostic test varATS qPCR Sensitivity Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
spellingShingle |
Malaria Microscopy Rapid diagnostic test varATS qPCR Sensitivity Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Stephen Opoku Afriyie Thomas Kwame Addison Yilekal Gebre Abdul-Hakim Mutala Kwasi Baako Antwi Dawood Ackom Abbas Kofi Agyapong Addo Austine Tweneboah Nana Kwame Ayisi-Boateng Cristian Koepfli Kingsley Badu Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections |
topic_facet |
Malaria Microscopy Rapid diagnostic test varATS qPCR Sensitivity Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
Abstract Background The World Health Organization recommends parasitological confirmation of all suspected malaria cases by microscopy or rapid diagnostic tests (RDTs) before treatment. These conventional tools are widely used for point-of-care diagnosis in spite of their poor sensitivity at low parasite density. Previous studies in Ghana have compared microscopy and RDT using standard 18S rRNA PCR as reference with varying outcomes. However, how these conventional tools compare with ultrasensitive varATS qPCR has not been studied. This study, therefore, sought to investigate the clinical performance of microscopy and RDT assuming highly sensitive varATS qPCR as gold standard. Methods 1040 suspected malaria patients were recruited from two primary health care centers in the Ashanti Region of Ghana and tested for malaria by microscopy, RDT, and varATS qPCR. The sensitivity, specificity, and predictive values were assessed using varATS qPCR as gold standard. Results Parasite prevalence was 17.5%, 24.5%, and 42.1% by microscopy, RDT, and varATS qPCR respectively. Using varATS qPCR as the standard, RDT was more sensitive (55.7% vs 39.3%), equally specific (98.2% vs 98.3%), and reported higher positive (95.7% vs 94.5%) and negative predictive values (75.3% vs 69.0%) than microscopy. Consequently, RDT recorded better diagnostic agreement (kappa = 0.571) with varATS qPCR than microscopy (kappa = 0.409) for clinical detection of malaria. Conclusions RDT outperformed microscopy for the diagnosis of Plasmodium falciparum malaria in the study. However, both tests missed over 40% of infections that were detected by varATS qPCR. Novel tools are needed to ensure prompt diagnosis of all clinical malaria cases. |
format |
Article in Journal/Newspaper |
author |
Stephen Opoku Afriyie Thomas Kwame Addison Yilekal Gebre Abdul-Hakim Mutala Kwasi Baako Antwi Dawood Ackom Abbas Kofi Agyapong Addo Austine Tweneboah Nana Kwame Ayisi-Boateng Cristian Koepfli Kingsley Badu |
author_facet |
Stephen Opoku Afriyie Thomas Kwame Addison Yilekal Gebre Abdul-Hakim Mutala Kwasi Baako Antwi Dawood Ackom Abbas Kofi Agyapong Addo Austine Tweneboah Nana Kwame Ayisi-Boateng Cristian Koepfli Kingsley Badu |
author_sort |
Stephen Opoku Afriyie |
title |
Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections |
title_short |
Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections |
title_full |
Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections |
title_fullStr |
Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections |
title_full_unstemmed |
Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections |
title_sort |
accuracy of diagnosis among clinical malaria patients: comparing microscopy, rdt and a highly sensitive quantitative pcr looking at the implications for submicroscopic infections |
publisher |
BMC |
publishDate |
2023 |
url |
https://doi.org/10.1186/s12936-023-04506-5 https://doaj.org/article/489805d2d63f4f968e73cfa2c2a5240e |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Malaria Journal, Vol 22, Iss 1, Pp 1-11 (2023) |
op_relation |
https://doi.org/10.1186/s12936-023-04506-5 https://doaj.org/toc/1475-2875 doi:10.1186/s12936-023-04506-5 1475-2875 https://doaj.org/article/489805d2d63f4f968e73cfa2c2a5240e |
op_doi |
https://doi.org/10.1186/s12936-023-04506-5 |
container_title |
Malaria Journal |
container_volume |
22 |
container_issue |
1 |
_version_ |
1766343718380503040 |