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. 2013 Feb;88(2):289-91.
doi: 10.4269/ajtmh.2012.12-0095. Epub 2012 Dec 18.

Prevalence of PCR detectable malaria infection among febrile patients with a negative Plasmodium falciparum specific rapid diagnostic test in Zanzibar

Kimberly A Baltzell  1 , Deler Shakely, Michelle Hsiang, Jordan Kemere, Abdullah Suleiman Ali, Anders Björkman, Andreas Mårtensson, Rahila Omar, Kristina Elfving, Mwinyi Msellem, Berit Aydin-Schmidt, Philip J Rosenthal, Bryan Greenhouse
Affiliations

Prevalence of PCR detectable malaria infection among febrile patients with a negative Plasmodium falciparum specific rapid diagnostic test in Zanzibar

Kimberly A Baltzell et al. Am J Trop Med Hyg. 2013 Feb.

Abstract

We screened for malaria in 594 blood samples from febrile patients who tested negative by a Plasmodium falciparum-specific histidine-rich protein-2-based rapid diagnostic test at 12 health facilities in Zanzibar districts North A and Micheweni, from May to August 2010. Screening was with microscopy, polymerase chain reaction (PCR) targeting the cytochrome b gene (cytbPCR) of the four major human malaria species, and quantitative PCR (qPCR). The prevalence of cytbPCR-detectable malaria infection was 2% (12 of 594), including 8 P. falciparum, 3 Plasmodium malariae, and 1 Plasmodium vivax infections. Microscopy identified 4 of 8 P. falciparum infections. Parasite density as estimated by microscopy or qPCR was > 4,000 parasites/μL in 5 of 8 cytbPCR-detectable P. falciparum infections. The infections that were missed by the rapid diagnostic test represent a particular challenge in malaria elimination settings and highlight the need for more sensitive point-of-care diagnostic tools to improve case detection of all human malaria species in febrile patients.

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