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Clinical practice: the diagnosis of imported malaria in children.

Maltha J, Jacobs J - Eur. J. Pediatr. (2011)

Bottom Line: Molecular methods in reference settings are an adjunct for species differentiation.They do not provide information about parasite density and should be used as an adjunct (and not a substitute) to microscopy.In case of persistent suspicion and negative microscopy results, repeat testing every 8-12 h for at least three consecutive samplings is recommended.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Health, Medicine and Life Sciences (FHML), Maastricht, The Netherlands. j.maltha@student.maastrichtuniversity.nl

ABSTRACT
The present paper reviews the diagnosis of imported malaria in children. Malaria is caused by a parasite called Plasmodium and occurs in over 100 countries worldwide. Children account for 10-15% of all patients with imported malaria and are at risk to develop severe and life-threatening complications especially when infected with Plasmodium falciparum. Case-fatality ratios vary between 0.2% and 0.4%. Children visiting friends and relatives in malaria endemic areas and immigrants and refugees account for the vast majority of cases. Symptoms are non-specific and delayed infections (more than 3 months after return from an endemic country) may occur. Microscopic analysis of the thick blood film is the cornerstone of laboratory diagnosis. For pragmatic reasons, EDTA-anticoagulated blood is accepted, provided that slides are prepared within 1 h after collection. Information about the Plasmodium species (in particular P. falciparum versus the non-falciparum species) and the parasite density is essential for patient management. Molecular methods in reference settings are an adjunct for species differentiation. Signals generated by automated hematology analyzers may trigger the diagnosis of malaria in non-suspected cases. Malaria rapid diagnostic tests are reliable in the diagnosis of P. falciparum but not for the detection of the non-falciparum species. They do not provide information about parasite density and should be used as an adjunct (and not a substitute) to microscopy. In case of persistent suspicion and negative microscopy results, repeat testing every 8-12 h for at least three consecutive samplings is recommended. A high index of suspicion and a close interaction with the laboratory may assure timely diagnosis of imported malaria.

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Related in: MedlinePlus

Two- and three-band (below) malaria rapid diagnostic tests (MRDTs) with blood transfer devices (pipette and loop). Control and test lines are cherry-red colored. The two-band MRDT (upper) displays a control line and a test line which targets P. falciparum-specific histidine-rich protein-2 (HRP-2) The three-band MRDT (below) displays a control line and two test lines, one targeting HRP-2 and another line targeting pan-parasite lactate dehydrogenase
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Fig3: Two- and three-band (below) malaria rapid diagnostic tests (MRDTs) with blood transfer devices (pipette and loop). Control and test lines are cherry-red colored. The two-band MRDT (upper) displays a control line and a test line which targets P. falciparum-specific histidine-rich protein-2 (HRP-2) The three-band MRDT (below) displays a control line and two test lines, one targeting HRP-2 and another line targeting pan-parasite lactate dehydrogenase

Mentions: Malaria rapid diagnostic tests (MRDTs) detect Plasmodium antigen by an antibody–antigen reaction on a nitrocellulose strip, which is embedded in a plastic cassette or occasionally in a cardboard format (Fig. 3). Malaria-positive samples will present cherry-red test lines which are read by the naked eye. Two-band MRDTs are mostly designed to detect P. falciparum; they display a control line and a test line which targets either histidine-rich protein-2 (HRP-2) or P. falciparum-specific parasite lactate dehydrogenase (Pf-pLDH). Three- and four-band malaria MRDTs display a control line and two or three test lines, one targeting a P. falciparum-specific antigen, another line targeting an antigen common to the four species [either pan-Plasmodium-specific lactate parasite dehydrogenase (pan-pLDH) or aldolase], and, in case of the four-band malaria RDTs, a third line which targets P. vivax-specific pLDH (Pv-pLDH).Fig. 3


Clinical practice: the diagnosis of imported malaria in children.

Maltha J, Jacobs J - Eur. J. Pediatr. (2011)

Two- and three-band (below) malaria rapid diagnostic tests (MRDTs) with blood transfer devices (pipette and loop). Control and test lines are cherry-red colored. The two-band MRDT (upper) displays a control line and a test line which targets P. falciparum-specific histidine-rich protein-2 (HRP-2) The three-band MRDT (below) displays a control line and two test lines, one targeting HRP-2 and another line targeting pan-parasite lactate dehydrogenase
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3117262&req=5

Fig3: Two- and three-band (below) malaria rapid diagnostic tests (MRDTs) with blood transfer devices (pipette and loop). Control and test lines are cherry-red colored. The two-band MRDT (upper) displays a control line and a test line which targets P. falciparum-specific histidine-rich protein-2 (HRP-2) The three-band MRDT (below) displays a control line and two test lines, one targeting HRP-2 and another line targeting pan-parasite lactate dehydrogenase
Mentions: Malaria rapid diagnostic tests (MRDTs) detect Plasmodium antigen by an antibody–antigen reaction on a nitrocellulose strip, which is embedded in a plastic cassette or occasionally in a cardboard format (Fig. 3). Malaria-positive samples will present cherry-red test lines which are read by the naked eye. Two-band MRDTs are mostly designed to detect P. falciparum; they display a control line and a test line which targets either histidine-rich protein-2 (HRP-2) or P. falciparum-specific parasite lactate dehydrogenase (Pf-pLDH). Three- and four-band malaria MRDTs display a control line and two or three test lines, one targeting a P. falciparum-specific antigen, another line targeting an antigen common to the four species [either pan-Plasmodium-specific lactate parasite dehydrogenase (pan-pLDH) or aldolase], and, in case of the four-band malaria RDTs, a third line which targets P. vivax-specific pLDH (Pv-pLDH).Fig. 3

Bottom Line: Molecular methods in reference settings are an adjunct for species differentiation.They do not provide information about parasite density and should be used as an adjunct (and not a substitute) to microscopy.In case of persistent suspicion and negative microscopy results, repeat testing every 8-12 h for at least three consecutive samplings is recommended.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Health, Medicine and Life Sciences (FHML), Maastricht, The Netherlands. j.maltha@student.maastrichtuniversity.nl

ABSTRACT
The present paper reviews the diagnosis of imported malaria in children. Malaria is caused by a parasite called Plasmodium and occurs in over 100 countries worldwide. Children account for 10-15% of all patients with imported malaria and are at risk to develop severe and life-threatening complications especially when infected with Plasmodium falciparum. Case-fatality ratios vary between 0.2% and 0.4%. Children visiting friends and relatives in malaria endemic areas and immigrants and refugees account for the vast majority of cases. Symptoms are non-specific and delayed infections (more than 3 months after return from an endemic country) may occur. Microscopic analysis of the thick blood film is the cornerstone of laboratory diagnosis. For pragmatic reasons, EDTA-anticoagulated blood is accepted, provided that slides are prepared within 1 h after collection. Information about the Plasmodium species (in particular P. falciparum versus the non-falciparum species) and the parasite density is essential for patient management. Molecular methods in reference settings are an adjunct for species differentiation. Signals generated by automated hematology analyzers may trigger the diagnosis of malaria in non-suspected cases. Malaria rapid diagnostic tests are reliable in the diagnosis of P. falciparum but not for the detection of the non-falciparum species. They do not provide information about parasite density and should be used as an adjunct (and not a substitute) to microscopy. In case of persistent suspicion and negative microscopy results, repeat testing every 8-12 h for at least three consecutive samplings is recommended. A high index of suspicion and a close interaction with the laboratory may assure timely diagnosis of imported malaria.

Show MeSH
Related in: MedlinePlus