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. 2023 Mar 28;22(1):110.
doi: 10.1186/s12936-023-04538-x.

PET-PCR reveals low parasitaemia and submicroscopic malarial infections in Honduran Moskitia

Gabriela Matamoros  1 , Denis Escobar  1 , Alejandra Pinto  1 , Delmy Serrano  2 , Eliška Ksandrová  1 , Nicole Grimaldi  1 , Gabriel Juárez-Fontecha  1 , Marcela Moncada  1 , Hugo O Valdivia  3 , Gustavo Fontecha  4
Affiliations

PET-PCR reveals low parasitaemia and submicroscopic malarial infections in Honduran Moskitia

Gabriela Matamoros et al. Malar J. .

Abstract

Background: Malaria remains a main parasitic disease of humans. Although the largest number of cases is reported in the African region, there are still endemic foci in the Americas. Central America reported 36,000 malaria cases in 2020, which represents 5.5% of cases in the Americas and 0.015% of cases globally. Most malaria infections in Central America are reported in La Moskitia, shared by Honduras and Nicaragua. In the Honduran Moskitia, less than 800 cases were registered in 2020, considering it an area of low endemicity. In low endemicity settings, the number of submicroscopic and asymptomatic infections tends to increase, leaving many cases undetected and untreated. These reservoirs challenge national malaria elimination programmes. This study aimed to assess the diagnostic performance of Light Microscopy (LM), a nested PCR test and a photoinduced electron transfer polymerase chain reaction (PET-PCR) in a population of febrile patients from La Moskitia.

Methods: A total of 309 febrile participants were recruited using a passive surveillance approach at the Puerto Lempira hospital. Blood samples were analysed by LM, nested PCR, and PET-PCR. Diagnostic performance including sensitivity, specificity, negative and positive predictive values, kappa index, accuracy, and ROC analysis was evaluated. The parasitaemia of the positive samples was quantified by both LM and PET-PCR.

Results: The overall prevalence of malaria was 19.1% by LM, 27.8% by nPCR, and 31.1% by PET-PCR. The sensitivity of LM was 67.4% compared to nPCR, and the sensitivity of LM and nPCR was 59.6% and 80.8%, respectively, compared to PET-PCR. LM showed a kappa index of 0.67, with a moderate level of agreement. Forty positive cases by PET-PCR were not detected by LM.

Conclusions: This study demonstrated that LM is unable to detect parasitaemia at low levels and that there is a high degree of submicroscopic infections in the Honduran Moskitia.

Keywords: Honduras; Nested PCR; PET-PCR; Parasitaemia; Plasmodium species; Submicroscopic malaria.

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Conflict of interest statement

Some authors of this manuscript are military service members and employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S.C. §105 provides that copyright protection under this title is not available for any work of the United States Government. Title 17 U.S.C. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.

Figures

Fig. 1
Fig. 1
Number of malaria cases per year in Honduras, 2000, 2010–2021
Fig. 2
Fig. 2
Map of Honduras shows in green the Gracias a Dios department (La Moskitia region) and the municipalities where the participants resided
Fig. 3
Fig. 3
Schematic flow chart showing the number of participants and diagnostic tests
Fig. 4
Fig. 4
ROC curves for light microscopy and nested PCR compared with PET-PCR. Nested PCR showed an AUC of 89% and LM an AUC of 79.8%
See this image and copyright information in PMC

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