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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Sub-microscopic malaria cases and mixed malaria infection in a remote area of high malaria endemicity in Rattanakiri province, Cambodia: Implication for malaria elimination
Malaria Journal, Volume 9, No. 1, Article 108, Year 2010
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Description
Background: Malaria microscopy and rapid diagnostic tests are insensitive for very low-density parasitaemia. This insensitivity may lead to missed asymptomatic sub-microscopic parasitaemia, a potential reservoir for infection. Similarly, mixed infections and interactions between Plasmodium species may be missed. The objectives were first to develop a rapid and sensitive PCR-based diagnostic method to detect low parasitaemia and mixed infections, and then to investigate the epidemiological importance of sub-microscopic and mixed infections in Rattanakiri Province, Cambodia. Methods. A new malaria diagnostic method, using restriction fragment length polymorphism analysis of the cytochrome b genes of the four human Plasmodium species and denaturing high performance liquid chromatography, has been developed. The results of this RFLP-dHPLC method have been compared to 1) traditional nested PCR amplification of the 18S rRNA gene, 2) sequencing of the amplified fragments of the cytochrome b gene and 3) microscopy. Blood spots on filter paper and Giemsa-stained blood thick smears collected in 2001 from 1,356 inhabitants of eight villages of Rattanakiri Province have been analysed by the RFLP-dHPLC method and microscopy to assess the prevalence of sub-microscopic and mixed infections. Results: The sensitivity and specificity of the new RFLP-dHPLC was similar to that of the other molecular methods. The RFLP-dHPLC method was more sensitive and specific than microscopy, particularly for detecting low-level parasitaemia and mixed infections. In Rattanakiri Province, the prevalences of Plasmodium falciparum and Plasmodium vivax were approximately two-fold and three-fold higher, respectively, by RFLP-dHPLC (59% and 15%, respectively) than by microscopy (28% and 5%, respectively). In addition, Plasmodium ovale and Plasmodium malariae were never detected by microscopy, while they were detected by RFLP-dHPLC, in 11.2% and 1.3% of the blood samples, respectively. Moreover, the proportion of mixed infections detected by RFLP-dHPLC was higher (23%) than with microscopy (8%). Conclusions: The rapid and sensitive molecular diagnosis method developed here could be considered for mass screening and ACT treatment of inhabitants of low-endemicity areas of Southeast Asia. © 2010 Steenkeste et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Steenkeste, Nicolas
Unknown Affiliation
Rogers, William Oscar
Unknown Affiliation
Okell, Lucy C.
Unknown Affiliation
Jeanne, Isabelle
Unknown Affiliation
Incardona, Sandra
Unknown Affiliation
Duval, Linda
Unknown Affiliation
Chy, Sophy
Unknown Affiliation
Hewitt, Sean E.
Unknown Affiliation
Chou, Monidarin
Unknown Affiliation
Socheat, Duong
Unknown Affiliation
Babin, François Xavier
Unknown Affiliation
Ariey, Frédéric
Unknown Affiliation
Rogier, Christophe
Unknown Affiliation
Statistics
Citations: 122
Authors: 13
Affiliations: 11
Identifiers
Doi:
10.1186/1475-2875-9-108
e-ISSN:
14752875
Research Areas
Genetics And Genomics
Infectious Diseases
Study Design
Cross Sectional Study