Sachin Kale, MD (Pathology).

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Malaria Diagnosis

• Sachin Kale, MD (Pathology).

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Approaches

• Clinical
• Microsopy
• RDTs

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Microscopy
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Microscopy

• Sensitive
• 5 10 parasites/ul
• 100 parasites/ul (in field conditions.)
• Informative
• Species
• Inexpensive

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Microscopy

• Permanent record
• Quality control
• Disadvantages
• Labour intensive
• Exacting

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Photomicrography

• Nikon Coolpix 3700
• Vision 2000
• Camera mode Manual
• White Balance Auto
• Size 1024x780
• Conflict of Interest Statement No association
  with any of above brands.

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Vivax
Falciparum
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Vivax
Falciparum
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Rapid Diagnstic Tests
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Antigens

• HRP-2
• p-LDH

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Suspected cases
RDT/PS
ve
-ve
Low Susp
High Suspicion
P.f
Severe
Uncomplicated
T/t, exclude Other diseases
T/t
T/t
Other diseases, Review/refer
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Species-specific PCR diagnosis of malaria

• 5 parasites or less/ul
• Species identified

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Other Approaches

• Quantitative buffy coat
• Fluorescence Microscopy
• Sensitivity 41 to 93 (0.002 parasitemia)
• Specificity 93(P.f)
• No species identification

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Ancillary Tests

• Hb, PCV
• Blood glucose
• WBC, Platelet Count
• Coagulation tests FDPs, Fibrinogen
• Urine for free Hb
• Blood Urea/ Creatinine
• Urine Protein
• G6PD

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Poor Prognosis

• Heavy parasitemia gt5 RBC
• Presence Malarial pigment, schizonts and mature
  trophs
• WBC gt 12,000/cmm
• Creatinine gt 2.9 mg/dl
• BUN 128 mg/dl
• PCV lt 20, Hb lt 7.0 gm/dl
• Blood glucose lt 40
• Riased transaminases

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• Iqbal et al. (J. Clin. Microbiol. 3936443646. )
  looked at pLDH detection compared to microscopy
  and PCR in 550 immigrants from malaria-endemic
  areas who were entering Kuwait, where malaria is
  not endemic. They concluded that for parasite
  levels of gt100 parasites/µl , the sensitivity
  obtained for OptiMAL was 97. However, because
  half of the samples with lt50 parasites/µl
  detected by microscopy were not detected, the
  authors recommended that the test should be used
  with great caution and should not replace
  conventional microscopy in the diagnosis of
  malaria.

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Diagnostic and Prognostic Utility of Rapid
Strip (Optimal and Paracheck) Versus Conventional
Smear Microscopy in Adult Patients of
Acute, Uncomplicated P. falciparum Malaria in
Mumbai, India NJ Gogtay, SS Dalvi, D
Rajgor, AR Chogle, DR Karnad, M Ramdas, U
Aigal, NA Kshirsagar
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• Thrombocytopenia in malaria
• Patel U, Gandhi G, Friedman S, Niranjan S.
• The study found the sensitivity of platelet count
  for diagnosing malaria was 100, and the
  specificity was 70.
• The negative predictive value was 100 and the
  positive predictive valve was 86.
• J Natl Med Assoc. 2004 Sep96(9)1212-4

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Clinical Microbiology Reviews, January 2002, p.
66-78, Vol. 15, No. 1
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References

• Treatment of Malria www.cdc.gov
• The use of Malaria Rapid Diagnstic Tests. WHO,
  Roll Back Malaria
• REPORT OF A JOINT WHO/USAID INFORMAL CONSULTATION
• 2527 OCTOBER 1999 New Perspectives Malaria
  Diagnosis
• http//japi.org/August2003/O-762.pdf?malaria
• Clinical Microbiology Reviews,
• January 2002, p. 66-78, Vol. 15, No. 1

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Thank You !

• Visit us at
• www.geocities.com/kalepathlab
• http//kalepathlab.tripod.com
• Phone [phone] and 9823244033