Acridine Orange Diagnosis of Plasmodium falciparum: Evaluation after Experimental Infection

Gary W. LongCenter for Vaccine Research, School of Hygiene and Public Health, Johns Hopkins University, Malaria Program, Naval Medical Research Institute, National Naval Medical Center, Department of Immunology, Walter Reed Army Institute for Research, Baltimore, Maryland

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Trevor R. JonesCenter for Vaccine Research, School of Hygiene and Public Health, Johns Hopkins University, Malaria Program, Naval Medical Research Institute, National Naval Medical Center, Department of Immunology, Walter Reed Army Institute for Research, Baltimore, Maryland

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Leland S. RickmanCenter for Vaccine Research, School of Hygiene and Public Health, Johns Hopkins University, Malaria Program, Naval Medical Research Institute, National Naval Medical Center, Department of Immunology, Walter Reed Army Institute for Research, Baltimore, Maryland

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Lou FriesCenter for Vaccine Research, School of Hygiene and Public Health, Johns Hopkins University, Malaria Program, Naval Medical Research Institute, National Naval Medical Center, Department of Immunology, Walter Reed Army Institute for Research, Baltimore, Maryland

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James EganCenter for Vaccine Research, School of Hygiene and Public Health, Johns Hopkins University, Malaria Program, Naval Medical Research Institute, National Naval Medical Center, Department of Immunology, Walter Reed Army Institute for Research, Baltimore, Maryland

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Bruce WelldeCenter for Vaccine Research, School of Hygiene and Public Health, Johns Hopkins University, Malaria Program, Naval Medical Research Institute, National Naval Medical Center, Department of Immunology, Walter Reed Army Institute for Research, Baltimore, Maryland

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Stephen L. HoffmanCenter for Vaccine Research, School of Hygiene and Public Health, Johns Hopkins University, Malaria Program, Naval Medical Research Institute, National Naval Medical Center, Department of Immunology, Walter Reed Army Institute for Research, Baltimore, Maryland

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The value and role of the acridine orange/microhematocrit tube method (quantitative buffy coat [QBC®] analysis) in the diagnosis of malaria remains controversial. To establish the true sensitivity of this test in comparison with the thick blood film, we studied 49 subjects who were experimentally infected with Plasmodium falciparum in 10 malaria vaccine and infectivity trials. Diagnosis was made by the acridine orange staining method 1–3 days earlier than by the thick blood film in 23 subjects (47%) and at the same time as the thick blood film in 20. On the other hand, diagnosis was made by thick blood film earlier than by the acridine orange staining method in six individuals. There were no false positive results using acridine orange among 584 specimens studied. Diagnosis was made using acridine orange at a parasitemia of less than 11 parasites/µl of blood in 65% of cases. Where available, the acridine orange assay is clearly preferable in terms of speed and accuracy to the thick blood film for diagnosis with parasitemias of less than 150/µl of blood, and perhaps as important, for ruling out infection with P. falciparum in a symptomatic patient.

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