Volume 84, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The technical capability of different methods to diagnose in maternal peripheral blood, placenta, and umbilical cord blood has not been assessed in Colombia and seldom explored in other malaria-endemic regions. We designed a study to compare the technical and the operational-economical performances of light microscopy (LM), nested polymerase chain reaction (nPCR), and histopathology (HP). In maternal blood, LM had 41% sensitivity and 100% specificity and in placental blood, 35% and 100%, respectively, compared with nPCR. In placental tissue, LM had 33% sensitivity and 95% specificity; and nPCR 47% and 77%, respectively; compared with HP. Light microscopy had the best operational-economical qualification. We concluded that nPCR and HP performed better compared with LM, but field implementation of these two techniques remains a problem. Therefore, LM is recommended as the gold standard for diagnosis of gestational malaria and placental blood infection in the field.


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  1. López-Antuñano F, López-Antuñano FJ, Schmunis G, , 1988. Diagnóstico microscópico de los parásitos de la malaria en la sangre. , eds. Diagnóstico de malaria. Washington DC, WHO-PAHO, 3950.
  2. Makler M, Palmer C, Ager A, , 1998. A review of practical techniques for the diagnosis of malaria. Ann Trop Med Parasitol 92: 419433.[Crossref]
  3. PAHO, 1996. Pan American Health Organization. Malaria in the Americas. PAHO Bull 17: 118.
  4. Blair S, Carmona-Fonseca J, Piñeros J, Ríos A, Álvarez T, Álvarez G, Tobón A, , 2006. Therapeutic efficacy test in malaria falciparum in Antioquia, Colombia. Malar J 5: 14.[Crossref]
  5. Carmona-Fonseca J, Álvarez G, Blair S, , 2006. Plasmodium vivax malaria: treatment of primany attacks with primaquine, in three different doses, and a fixed dose of chloroquine, Antioquia, Colombia, 2003–2004. Biomedica 26: 353365.[Crossref]
  6. Castañeda A, , 1990. Niveles de Parasitemia por Plasmodium falciparum y Algunos Factores Relacionados. Urabá Bajo Cauca, Departamento de Antioquia; 1988–1989. Tesis de Grado. Medellín (Colombia): Universidad de Anioquia, Medellín (Colombia).
  7. Graffeo R, Masucci L, Bugli F, Damiano F, Pinnetti C, Federico G, Fadda G, , 2008. Multiple malaria infection in a pregnant woman from Nigeria: detection by multiplex PCR. New Microbiol 31: 565567.
  8. WHO, 2009. World Health Organization. Malaria Rapid Diagnostic Test Performance: Results of WHO Product Testing of Malaria RDTs: Round 1 (2008). Geneva: WHO.
  9. Pava Z, Echeverry D, Díaz G, Murillo C, , 2010. Large variation in detection of histidine-rich protein 2 in Plasmodium falciparum isolates from Colombia. Am J Trop Med Hyg 83: 834837.[Crossref]
  10. Gamboa D, Ho M, Bendezu J, Torres K, Chiodini P, Barnwell J, Incardona S, Perkins M, Bell D, McCarthy J, Cheng Q, , 2010. A large proportion of P. falciparum isolates in the Amazon region of Peru lack pfhrp2 and pfhrp3: implications for malaria rapid diagnostic tests. PLoS ONE 5: e8091.[Crossref]
  11. Snounou G, Viriyakosol S, Zhu X, Jarra W, Pinheiro L, Do Rosario V, Thaithong S, Brown K, , 1993. High sensitivity of detection of human malaria parasites by the use of nested polymerase chain reaction. Mol Biochem Parasitol 61: 315320.[Crossref]
  12. Perandin F, Manca N, Calderaro A, Piccolo G, Galati L, Ricci L, Medici M, Arcangeletti M, Snounou G, Dettori G, Chezzi C, , 2004. Development of a real-time PCR assay for detection of Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale for routine clinical diagnosis. J Clin Microbiol 42: 12141219.[Crossref]
  13. Lucchi N, Demas A, Narayanan J, Sumari D, Kabanywanyi A, Kachur S, Barnwell J, Udhayakumar V, , 2010. Real-time fluorescence loop mediated isothermal amplification for the diagnosis of malaria. PLoS One 5: e13733.[Crossref]
  14. Han E, Watanabe R, Sattabongkot J, Khuntirat B, Sirichaisinthop J, Iriko H, Jin L, Takeo S, Tsuboi T, , 2007. Detection of four Plasmodium species by genus- and species-specific Loop-Mediated Isothermal Amplification for clinical diagnosis. J Clin Microbiol 45: 25212528.[Crossref]
  15. Paris D, Imwong M, Faiz A, Hasan M, Yunus E, Silamut K, Lee S, Day N, Dondorp A, , 2007. Loop-mediated isothermal PCR (LAMP) for the diagnosis of falciparum malaria. Am J Trop Med Hyg 77: 972976.
  16. Poon L, Wong B, Ma E, Chan Q, Chow L, Abeyewickreme W, Tangpukdee N, Yuen K, Guan Y, Looareesuwan S, Peiris J, , 2006. Sensitive and inexpensive molecular test for falciparum malaria: detecting Plasmodium falciparum DNA directly from heat-treated blood by loop-mediated isothermal amplification. Clin Chem 52: 303306.[Crossref]
  17. Snounou G, , 2007. Rapid, sensitive and cheap molecular diagnosis of malaria: is microscopy on the way out? Future Microbiol 2: 477480.[Crossref]
  18. Rogerson S, Mkundika P, Kanjala M, , 2003. Diagnosis of Plasmodium falciparum malaria at delivery: comparison of blood film preparation methods and of blood films with histology. J Clin Microbiol 41: 13701374.[Crossref]
  19. Bulmer J, Rasheed F, Francis N, Morrison L, Greenwoods B, , 1993. Placental malaria. I. Pathological classification. Histopathology 22: 211218.[Crossref]
  20. Bulmer J, Rasheed F, Morrison L, Francis N, Greenwood B, , 1993. Placental malaria. II. A semi-quantitative investigation of the pathological features. Histopathology 22: 219225.[Crossref]
  21. Rogerson S, Pollina E, Getachew A, Tadesse E, Lema V, Molyneux M, , 2003. Placental monocyte infiltrates in response to Plasmodium falciparum malaria infection and their association with adverse pregnancy outcomes. Am J Trop Med Hyg 68: 115119.
  22. Uneke C, , 2008. Diagnosis of Plasmodium falciparum malaria in pregnancy in sub-Saharan Africa: the challenges and public health implications. Parasitol Res 102: 333342.[Crossref]
  23. Grobusch M, Hänscheid T, Göbels K, Slevogt H, Zoller T, Rögler G, Teichmann D, , 2003. Comparison of three antigen detection tests for diagnosis and follow-up of falciparum malaria in travellers returning to Berlin, Germany. Parasitol Res 89: 354357.
  24. Iqbal J, Khalid N, Hira P, , 2002. Comparison of two commercial assays with expert microscopy for confirmation of symptomatically diagnosed malaria. J Clin Microbiol 40: 46754678.[Crossref]
  25. Londoño B, Carmona J, Blair S, , 2002. Comparación de los métodos Optimal y gota gruesa para el diagnóstico de malaria en una zona endémica sin epidemia. Biomedica 22: 466475.[Crossref]
  26. Montoya A, Menco J, Osorio N, Zuluaga M, Duque J, Torres G, Restrepo M, , 2008. Concordance between thick blood smear, immunochromatography and polymerase chain reaction for malaria diagnosis. Biomedica 28: 252261.[Crossref]
  27. Pabón A, Alvarez G, Yánez J, Céspedes C, Rodríguez Y, Restrepo A, Blair S, , 2007. Evaluation of ICT malaria immunochromatograpic Binax NOW ICT Pf/Pv test for rapid diagnosis of malaria in a Columbian endemic area. Biomedica 27: 225235.[Crossref]
  28. Playford E, Walker J, , 2002. Evaluation of the ICT malaria Pf/Pv and the OptiMAL rapid diagnostic tests for malaria in febrile returned travellers. J Clin Microbiol 40: 41664171.[Crossref]
  29. Hanscheid T, , 1999. Diagnosis of malaria: a review of alternatives to conventional microscopy. Clin Lab Haematol 21: 235245.[Crossref]
  30. Jaimes F, , 2007. Pruebas diagnósticas: uso e interpretación. Acta Med Colomb 32: 2933.
  31. Pita Fernández S, Pértegas Díaz S, , 2003. Diagnostic tests. Cad Aten Primaria 10: 120124. Available at: http://www.fisterra.com/mbe/investiga/pruebas_diagnosticas/pruebas_diagnosticas122.pdf. Accessed December 13, 2009.
  32. Hernández J, , 2003. Cost-effectiveness of laboratory testing. Arch Pathol Lab Med 127: 440445.
  33. Carmona-Fonseca J, , 2003. La malaria en Colombia, Antioquia y las zonas de Urabá y Bajo Cauca: panorama para interpretar la falla terapéutica antimalárica. Parte 1. Iatreia 16: 299318.
  34. Carmona-Fonseca J, , 2004. La malaria en Colombia, Antioquia y las zonas de Urabá y Bajo Cauca: panorama para interpretar la falla terapéutica antimalárica. Parte 2. Iatreia. 17: 3453.
  35. Carmona-Fonseca J, Maestre A, , 2009. Incidencia de la malaria gestacional, congénita y placentaria en Urabá (Antioquia, Colombia), 2005–2007. Rev Colomb Obstet Ginecol 60: 1226.
  36. García C, Moreno L, García H, Moreno L, Cano F, García H, , 1994. Evaluación de pruebas diagnósticas. , eds. Epidemiología clínica. Second edition. México DF: Editorial Interamericana S.A; 159162.
  37. Martínez-Bencardino C, , 1984. Muestreo. Bogotá: Ecoe, 4547.
  38. Landeta J, , 1999. The Delphi Method: A Technique for the Uncertainty Estimate. Barcelona: Ariel.
  39. Lagerberg R, , 2008. Malaria in pregnancy: a literature review. J Midwifery Womens Health 53: 209215.[Crossref]
  40. Adegnika A, Verweij J, Agnandji S, Chai S, Breitling L, Ramharter M, Frolich M, Issifou S, Kremsner P, Yazdanbakhsh M, , 2006. Microscopic and sub-microscopic Plasmodium falciparum infection, but not inflammation caused by infection, is associated with low birth weight. Am J Trop Med Hyg 75: 798803.
  41. Walker-Abbey A, Djokam R, Eno A, Leke R, Titanji V, Fogako J, Sama G, Thuita L, Beardslee E, Snounou G, Zhou A, Taylor D, , 2005. Malaria in pregnant Cameroonian women: the effect of age and gravidity on submicroscopic and mixed-species infections and multiple parasite genotypes. Am J Trop Med Hyg 72: 229235.
  42. Färnert A, , 2008. Plasmodium falciparum population dynamics: only snapshots in time? Trends Parasitol 24: 340344.[Crossref]
  43. Färnert A, Lebbad M, Faraja L, Rooth I, , 2008. Extensive dynamics of Plasmodium falciparum densities, stages and genotyping profiles. Malar J 2: 241.[Crossref]
  44. Beck S, Mockenhaupt F, Bienzle U, Eggelte T, Thompson W, Stark K, , 2001. Multiplicity of Plasmodium falciparum infection in pregnancy. Am J Trop Med Hyg 65: 631636.
  45. Arango E, Maestre A, Carmona-Fonseca J, , 2010. Effect of submicroscopic or polyclonal Plasmodium falciparum infection on mother and gestation product: systematic review. Rev bras epidemiol 13: 373386.[Crossref]
  46. Ndao M, , 2009. Diagnosis of parasitic diseases: old and new approaches. Interdiscip Perspect Infect Dis 2009: 278246.
  47. Abraira V, , 2006. Bias in studies of diagnostic tests. Semergen 32: 2426.[Crossref]

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  • Received : 09 Sep 2010
  • Accepted : 11 Feb 2011

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