Volume 88, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We screened for malaria in 594 blood samples from febrile patients who tested negative by a -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 gene (PCR) of the four major human malaria species, and quantitative PCR (qPCR). The prevalence of PCR-detectable malaria infection was 2% (12 of 594), including 8 , 3 and 1 infections. Microscopy identified 4 of 8 infections. Parasite density as estimated by microscopy or qPCR was > 4,000 parasites/μL in 5 of 8 PCR-detectable 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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  1. Mårtensson A, Stromberg J, Sisowath C, Msellem MI, Gil JP, Montgomery SM, Olliaro P, Ali AS, Björkman A, , 2005. Efficacy of artesunate plus amodiaquine versus that of artemether-lumefantrine for the treatment of uncomplicated childhood Plasmodium falciparum malaria in Zanzibar, Tanzania. Clin Infect Dis 41: 10791086.[Crossref] [Google Scholar]
  2. Zanzibar Ministry of Health and Social Welfare, 2009. Malaria Early Epidemic Detection System First Biannual Report. Zanzibar Malaria Control Programme: Zanzibar Ministry of Health and Social Welfare. [Google Scholar]
  3. Breman JG, Mills A, Snow RW, Mulligan JA, Lengeler C, Mendis K, Sharp B, Morel C, Marchesini P, White NJ, Steketee RW, Doumbo OK, Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, , 2006. Chapter 21. Conquering Malaria. , eds. Disease Control Priorities in Developing Countries. Second edition. Washington, DC: The International Bank for Reconstruction and Development/The World Bank Group.[Crossref] [Google Scholar]
  4. Msellem MI, Mårtensson A, Rotllant G, Bhattarai A, Stromberg J, Kahigwa E, Garcia M, Petzold M, Olumese P, Ali A, Björkman A, , 2009. Influence of rapid malaria diagnostic tests on treatment and health outcome in fever patients, Zanzibar: a crossover validation study. PLoS Med 6: e1000070.[Crossref] [Google Scholar]
  5. Mboera LE, Fanello CI, Malima RC, Talbert A, Fogliati P, Bobbio F, Molteni F, , 2006. Comparison of the Paracheck-Pf test with microscopy, for the confirmation of Plasmodium falciparum malaria in Tanzania. Ann Trop Med Parasitol 100: 115122.[Crossref] [Google Scholar]
  6. WHO World Health Organization and UNICEF, 2008. Integrated Management of Childhood Illnesses. , ed. IMCI Chart Booklet: WHO. [Google Scholar]
  7. Hsiang ML, , 2010. PCR-based pooling of dried blood spots for detection of malaria parasites: optimization and application to a cohort of Ugandan children. J Clin Microbiol 10: 35393543.[Crossref] [Google Scholar]
  8. Steenkeste N, Incardona S, Chy S, Duval L, Ekala MT, Lim P, Hewitt S, Sochantha T, Socheat D, Rogier C, Mercereau-Puijalon O, Fandeur T, Ariey F, , 2009. Towards high-throughput molecular detection of Plasmodium: new approaches and molecular markers. Malar J 8: 86.[Crossref] [Google Scholar]
  9. Steenkeste N, Rogers WO, Okell L, Jeanne I, Incardona S, Duval L, Chy S, Hewitt S, Chou M, Socheat D, Babin FX, Ariey F, Rogier C, , 2010. Sub-microscopic malaria cases and mixed malaria infection in a remote area of high malaria endemicity in Rattanakiri province, Cambodia: implication for malaria elimination. Malar J 9: 108.[Crossref] [Google Scholar]
  10. Beshir KB, Hallett RL, Eziefula AC, Bailey R, Watson J, Wright SG, Chiodini PL, Polley SD, Sutherland CJ, , 2010. Measuring the efficacy of anti-malarial drugs in vivo: quantitative PCR measurement of parasite clearance. Malar J 9: 312.[Crossref] [Google Scholar]
  11. Warhurst DC, Williams JE, , 1996. ACP Broadsheet no 148. July 1996. Laboratory diagnosis of malaria. J Clin Pathol 49: 533538.[Crossref] [Google Scholar]
  12. McMorrow ML, Aidoo M, Kachur SP, , 2011. Malaria rapid diagnostic tests in elimination settings–can they find the last parasite? Clin Microbiol Infect 17: 16241631.[Crossref] [Google Scholar]
  13. Baker J, Ho MF, Pelecanos A, Gatton M, Chen N, Abdullah S, Albertini S, Albertina A, Ariey F, Barnwell J, Bell D, Cunningham J, Djalle D, Echeverry DF, Gamboa D, Hii J, Kyaw MP, Luchavez J, Membi C, Menard D, Murillo C, Nhem S, Ogutu B, Onyor P, Oyibo W, Wang SQ, McCarthy J, Cheng Q, , 2010. Global sequence variation in the histidine-rich proteins 2 and 3 of Plasmodium falciparum: implications for the performance of malaria rapid diagnostic tests. Malar J 9: 129.[Crossref] [Google Scholar]
  14. Gamboa D, Ho MF, Bendezu J, Torres K, Chiodini PL, Barnwell JW, 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] [Google Scholar]
  15. Baker J, Gatton ML, Peters J, Ho MF, McCarthy JS, Cheng Q, , 2011. Transcription and expression of Plasmodium falciparum histidine-rich proteins in different stages and strains: implications for rapid diagnostic tests. PLoS ONE 6: e22593.[Crossref] [Google Scholar]
  16. Koita OA, Doumbo OK, Ouattara A, Tall LK, Konaré A, Diakité M, Diallo M, Sagara I, Masinde GL, Doumbo SN, Dolo A, Tounkara A, Traoré I, Krogstad DJ, , 2012. False-negative rapid diagnostic tests for malaria and deletion of the histidine-rich repeat region of the hrp2 gene. Am J Trop Med Hyg 86: 194198.[Crossref] [Google Scholar]

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  • Received : 10 Feb 2012
  • Accepted : 01 Oct 2012
  • Published online : 06 Feb 2013

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