![]() ![]() Human malaria is caused by five species of Plasmodium spp. Malaria is a public health problem reported worldwide especially in the African region (213 million or 93%), with an estimated 405,000 deaths from malaria globally in the year 2018 1. The results of this study will support the selection and careful interpretations of RDTs for a better diagnosis of Plasmodium mixed-species infections and appropriate treatment of malaria patients in endemic and non-endemic settings. Malaria RDTs targeting Pf-HRP2/pan-pLDH could detect a higher proportion of Plasmodium mixed infections than microscopy, while RDTs targeting Pf-HRP2/Pv-specific LDH could detect a lower proportion of Plasmodium mixed infections than PCR methods. This is the first study to summarize the discordant results between RDTs and microscopy/PCR in detecting Plasmodium mixed infections. The subgroup analysis between RDTs and PCR methods demonstrated that RDTs targeting Pf-specific HRP2/Pv-specific LDH could detect a significantly lower proportion of Plasmodium mixed infections than PCR methods (p = 0.0005, OR = 0.42, 95% CI 0.26–0.68). Subgroup analysis demonstrated that only RDTs targeting Pf-specific histidine-rich protein 2 (HRP2)/pan-specific lactate dehydrogenase (LDH) could detect a significantly higher proportion of Plasmodium mixed infections than microscopy (p = 0.004, OR = 8.46, 95% CI 2.75–26.1). Overall, the meta-analysis showed that RDTs could detect a significantly higher proportion of Plasmodium mixed infections than microscopy (p = 0.0007, OR = 3.33, 95% CI 1.66–6.68). Twenty-eight studies were included in the present study. Plots were drawn using RevMan (version 5.3 Cochrane Community). The estimates of the different proportions in each analysis group that were visually summarized in a forest plot showed the odds ratio (OR) and 95% confidence interval (CI). Studies were grouped according to the different RDT types including RDT type 2 (pf-HRP2/pan-aldolase), RDT type 3 (pf-HRP2/pan-pLDH), RDT type 4 (Pf-LDH/pan-pLDH), RDT type 5 (Pf/Pv-pLDH), and RDT type 6 (pf-HRP2/Pv-pLDH) for subgroup analysis. The PubMed (MEDLINE), Web of Science, and Scopus databases were systematically reviewed to identify related studies that reported the performance of RDTs in detecting Plasmodium mixed infections. The present study aimed to evaluate the discordant results between RDTs and microscopy/polymerase chain reaction (PCR) in detecting Plasmodium mixed infections. ![]() Nevertheless, little is known about the performance of RDTs in detecting Plasmodium mixed infections. Population sample size: n= 607 from 100 selected random households to recruit children 6 months to 11 years old (Uganda), n=493 from visited households to recruit children and adults as part of an ongoing study to assess mass drug administration for malaria elimination (Myanmar), n=93 whole blood specimens from 16 human volunteers.Malaria rapid diagnostic tests (RDTs) are widely used to detect malaria parasites among patients who suspected malaria infections in malaria-endemic areas where microscopy is unavailable. Inclusion criteria: no fever history in the previous 7 days, axillary temperature less than 37.5☌, absence of other clinical signs of malaria, and no malaria treatment within the previous 60 days. RDT (RDT), the hsRDT uses the same immunochromatographic cassette platform, has the same whole blood volume requirements (5 µL), and takes only 5 minutes longer to result, making this device a promising and highly sensitive field tool.Ī quantitative reverse transcription PCR (qRT-PCR) and a highly sensitive enzyme-linked immunosorbent assay (ELISA) test for histidine-rich protein II (HRP2) were used as reference assays. Compared with the current commercial HRP2-based SD BIOLINE Malaria Ag P.f. An Alere ™ Malaria Ag P.f Ultra Sensitive RDT (hsRDT) was developed for field use and evaluated for detection of low-density infections. Although laboratory assays are more sensitive than microscopy and RDTs, they are also more expensive, require highly trained personnel, take longer to produce results, and are more difficult to deploy for large-scale field use. ![]()
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