title: Bedside diagnosis of imported malaria using the Binax Now malaria antigen detection test.
abstract: Malaria may be misdiagnosed in non-endemic countries when the necessary experience for rapid expert microscopy is lacking. Rapid diagnostic tests may improve the diagnosis and may play a role as a bedside diagnostic tool. In a multicentre study we recruited patients suspected of malaria over a period of 14 months. The Binax Now Malaria rapid test was used at the bedside and in the clinical microbiology laboratory. The training of clinical staff was monitored and their experience with the use of the test was recorded. 542 patients were included, 80 of whom had malaria diagnosed by microscopy. The rapid test used at the bedside had a sensitivity of 88% for the detection of P. falciparum compared to 95% when the test was performed in the microbiology laboratory. The risk of technical problems and invalid tests was highest when the test was used at the bedside. The rapid diagnostic test may be useful for the diagnosis of P. falciparum malaria when used by routine laboratory staff, but could lead to misdiagnoses when used at the bedside. Microscopy is still essential in order to identify the few missed diagnoses, to determine the degree of parasitaemia, and to ensure species diagnosis, including mixed infections.
authors.affiliation: Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Denmark. Lothar.Wiese@rh.dk.
authors.forename: Lothar
authors.initials: L
authors.lastname: Wiese
authors.forename: Brita
authors.initials: B
authors.lastname: Bruun
authors.forename: Leif
authors.initials: L
authors.lastname: Baek
authors.forename: Alice
authors.initials: A
authors.lastname: Friis-Møller
authors.forename: Bente
authors.initials: B
authors.lastname: Gahrn-Hansen
authors.forename: Joanna
authors.initials: J
authors.lastname: Hansen
authors.forename: Ole
authors.initials: O
authors.lastname: Heltberg
authors.forename: Tove
authors.initials: T
authors.lastname: Højbjerg
authors.forename: Maren Kathrine
authors.initials: MK
authors.lastname: Hornstrup
authors.forename: Birgit
authors.initials: B
authors.lastname: Kvinesdal
authors.forename: Grethe
authors.initials: G
authors.lastname: Gomme
authors.forename: Jørgen A L
authors.initials: JA
authors.lastname: Kurtzhals
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D002845:Chromatography / Q000379:methods; D002983:Clinical Competence; D003951:Diagnostic Errors; D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D010961:Plasmodium / Q000302:isolation & purification*; D010976:Platelet Count / Q000379:methods; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011933:Reagent Kits, Diagnostic
chemical_list: D015415:Biomarkers; D011933:Reagent Kits, Diagnostic