EVALUATION OF RAPID DIAGNOSTIC TEST, CONVENTIONAL LIGHT MICROSCOPY AND POLYMERASE CHAIN REACTION IN THE DIAGNOSIS OF UNCOMPLICATED Plasmodium falciparum MALARIA IN JOS

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EVALUATION OF RAPID DIAGNOSTIC TEST, CONVENTIONAL LIGHT MICROSCOPY AND POLYMERASE CHAIN REACTION IN THE DIAGNOSIS OF UNCOMPLICATED Plasmodium falciparum MALARIA IN JOS

Abstract

In Nigeria, malaria is responsible for 60% outpatient visits to health facilities, 30% childhood deaths and 11% maternal death. Misdiagnosis leads to wastage of resources, unnecessary exposure to anti-malarials’ toxicity and the creation of selective pressure for drug resistance. This makes fast and accurate diagnosis of malaria a life saving necessity. However, microscopy, which is the gold standard for diagnosis is labourious and time consuming. Therefore, this research set out to compare the performance of SD Bioline rapid diagnostic test (RDT) against microscopy using polymerase chain reaction (PCR) as the reference standard. The RDT was also compared with microscopy. This study was a prospective, cross sectional, hospital based study. Specimens were collected from children and adult patients of both sexes who presented with at least fever and concerning whom a clinical diagnosis of acute uncomplicated malaria had been made. Demographic and clinical data were collected from the patients by means of a structured questionnaire. Specimens were processed for the diagnosis of malaria by RDT, microscopy and PCR.
The prevalence of malaria in this study by PCR was 17%. The sensitivity, specificity, positive and negative predictive values of RDT when compared to PCR was 76.5%, 98.8%, 92.3% and 95.4% respectively. The sensitivity, specificity, positive and negative predictive values of microscopy when compared against PCR was 88.2%, 100%, 100% and 97.7% respectively. When compared against microscopy, RDT showed an overall sensitivity and specificity of 80% and 96% respectively, while corresponding figures at parasite densities of ≥200 parasites/µL were 95.8% and 95.9% respectively. Genotyping the P. falciparum isolates in this study using the GLURP-2 gene revealed that 29.4% of patients whose samples were positive by PCR were infected by one clone of P. falciparum, while 70.6% were infected by two clones of P. falciparum. The performance of nested PCR in this study was better than conventional giemsa stain microscopy which in turn was better than RDT in the diagnosis of uncomplicated P. falciparum malaria in Jos. A patient with clinical features of malaria whose RDT result is positive for P. falciparum should be treated for malaria, while a patient with clinical features of malaria whose RDT result is negative should be re-tested by microscopy.

EVALUATION OF RAPID DIAGNOSTIC TEST, CONVENTIONAL LIGHT MICROSCOPY AND POLYMERASE CHAIN REACTION IN THE DIAGNOSIS OF UNCOMPLICATED Plasmodium falciparum MALARIA IN JOS

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