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A COMPARISON OF RAPID DIAGNOSTIC TESTING (BY PLASMODIUM LACTATE DEHYDROGENASE), AND QUANTITATIVE BUFFY COAT TECHNIQUE
Ifeanyi Kanayo Ifeorah1, Biobele J Brown2, Olugbemiro O Sodeinde3
1Nigerian Air Force; Nigerian Air Force Hospital, Bill Clinton Drive Abuja, Nigeria.
Insights
The Plasmodium lactate dehydrogenase (pLDH) rapid diagnostic test (RDT) and Quantitative Buffy Coat (QBC) test showed good performance for malaria diagnosis in Nigerian children. Both tests are recommended for malaria-endemic areas.
Area of Science:
- Tropical Medicine
- Diagnostic Microbiology
- Public Health
Background:
- Malaria control relies on early and rapid diagnosis, as emphasized by the World Health Organization (WHO).
- This study evaluated the diagnostic accuracy of two common methods: the Quantitative Buffy Coat (QBC) test and the Plasmodium lactate dehydrogenase (pLDH) rapid diagnostic test (RDT).
- Microscopy was used as the gold standard for comparison.
Purpose of the Study:
- To compare the diagnostic performance of the QBC test and pLDH RDT against microscopy for malaria detection.
- To assess the utility of these rapid diagnostic tests in a clinical setting in Nigeria.
Main Methods:
- The study included 370 febrile children aged 0-5 years at University College Hospital, Ibadan, Nigeria.
- Blood samples were analyzed using Giemsa-stained thick blood films (microscopy), QBC, and pLDH RDT.
- Diagnostic accuracy metrics (sensitivity, specificity, PPV, NPV) were calculated for QBC and RDT against microscopy.
Main Results:
- Microscopy identified 21% (78/370) malaria parasite (MP) positive cases.
- The QBC test showed 70.5% sensitivity and 92.1% specificity.
- The pLDH RDT demonstrated 84.2% sensitivity and 95.2% specificity, with no significant difference in sensitivity compared to QBC.
Conclusions:
- Both QBC and pLDH RDT performed well in diagnosing malaria in the study population.
- Malaria rapid diagnostic tests are valuable tools in malaria-endemic areas, aiding in timely and appropriate treatment decisions.
- RDTs can help prevent unnecessary antimalarial drug administration.
Background:
The World Health Organization (WHO) considers early and rapid diagnosis as one of the strategies to control malaria. This study compared the performance of Quantitative Buffy Coat (QBC) test and the Plasmodium lactate dehydrogenase (pLDH) rapid diagnostic test (RDT) with microscopy as the gold standard.
Materials And Methods:
The study involved children ages 0-5 years who presented with a history of fever at the University College Hospital, Ibadan, Nigeria. Blood was collected from each patient and used for RDT, QBC and Giemsa-stained blood films for malaria parasites (MP). Results of QBC and RDT were compared with microscopy results for the diagnosis of malaria.
Results:
A total of 370 cases (194 boys and 176 girls) were studied giving a male: female ratio of 1.1:1. Of the 370 cases tested using Giemsa-stained thick blood films for MP, 78 (21 %) were positive. For the QBC test, 78 (21%) of the cases were positive with sensitivity, specificity, positive and negative predictive values of 70.5 %, 92.1%, 70.5 % and 92.1 % respectively. Seventy-six (20%) of the cases were positive by RDT with sensitivity, specificity, positive and negative predictive values of 84.2 %, 95.2 %, 82.1 %, and 95.9 % respectively. There was no significant difference in the sensitivity of QBC compared with the RDT.
Conclusion:
Both the QBC and the pfLDH (RDT) performed reasonably well in this study Malaria rapid diagnostic tests are recommended in malaria endemic clinical settings to avoid unnecessary antimalarial treatment. List of Abbreviations: AO: Acridine orange, AIDS: Acquired immunodeficiency syndrome, ACT: Artemisinin-based combination therapy, CM:Cerebral malaria, BCP:Benzothiocarboxypurine, DDT:Dichloro-diphenyl-trichloroethane, DNA:DeoxyriboNucleic Acid, ELAM-1: Endothelial leukocyte adhesion molecule, G6PD: Glucose-6-Phosphate Dehydrogenase, HIV: Human immuno deficiency virus, HRP 2: Histidine Rich Protein 2, ICAM -1: Inter cellular adhesion molecule1, ICER: Incremental cost effectiveness ratio, IL-1: Interleukin -1, IFN-g: Interferon-gamma, IgG: Immunoglobulin G, MP: Malaria parasite, NADP: Oxidised Nicotinamide Adenine Dinucleotide Phosphate, NADPH: Reduced Nicotinamide Adenine Dinucleotide Phosphate, PCV: Packed Cell Volume (haematocrit), P. falciparum: Plasmodium falciparum, PLDH: Plasmodium lactate dehydrogenase, PCR: Polymerase Chain Reaction, PPV: Positive predictive value, QBC: Quantitative Buffy Coat examination, TNF: Tumour necrosis factor, NPV: Negative predictive value, RDT: Rapid diagnostic test, SP: Sulphadoxine -Pyrimethamine, SMA: Severe malarial anaemia, UM: Uncomplicated malaria, USA:United States of America, VCAM-1: Vascular cell adhesion molecule, WBC: White Blood Cell, WHO: World Health Organization.
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