title: Prevalence of PCR detectable malaria infection among febrile patients with a negative Plasmodium falciparum specific rapid diagnostic test in Zanzibar.
abstract: We screened for malaria in 594 blood samples from febrile patients who tested negative by a Plasmodium falciparum-specific histidine-rich protein-2-based rapid diagnostic test at 12 health facilities in Zanzibar districts North A and Micheweni, from May to August 2010. Screening was with microscopy, polymerase chain reaction (PCR) targeting the cytochrome b gene (cytbPCR) of the four major human malaria species, and quantitative PCR (qPCR). The prevalence of cytbPCR-detectable malaria infection was 2% (12 of 594), including 8 P. falciparum, 3 Plasmodium malariae, and 1 Plasmodium vivax infections. Microscopy identified 4 of 8 P. falciparum infections. Parasite density as estimated by microscopy or qPCR was > 4,000 parasites/μL in 5 of 8 cytbPCR-detectable P. falciparum infections. The infections that were missed by the rapid diagnostic test represent a particular challenge in malaria elimination settings and highlight the need for more sensitive point-of-care diagnostic tools to improve case detection of all human malaria species in febrile patients.
authors.affiliation: Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA 94143, USA. kimberly.baltzell@nursing.ucsf.edu
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Baltzell
authors.forename: Deler
authors.initials: D
authors.lastname: Shakely
authors.forename: Michelle
authors.initials: M
authors.lastname: Hsiang
authors.forename: Jordan
authors.initials: J
authors.lastname: Kemere
authors.forename: Abdullah Suleiman
authors.initials: AS
authors.lastname: Ali
authors.forename: Anders
authors.initials: A
authors.lastname: Björkman
authors.forename: Andreas
authors.initials: A
authors.lastname: Mårtensson
authors.forename: Rahila
authors.initials: R
authors.lastname: Omar
authors.forename: Kristina
authors.initials: K
authors.lastname: Elfving
authors.forename: Mwinyi
authors.initials: M
authors.lastname: Msellem
authors.forename: Berit
authors.initials: B
authors.lastname: Aydin-Schmidt
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rosenthal
authors.forename: Bryan
authors.initials: B
authors.lastname: Greenhouse
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017931:DNA Primers; D016054:DNA, Protozoan / Q000235:genetics; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D008853:Microscopy; D010963:Plasmodium falciparum / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D010966:Plasmodium vivax / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D016133:Polymerase Chain Reaction / Q000379:methods*; D015995:Prevalence; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D014195:Travel; D055815:Young Adult
chemical_list: D017931:DNA Primers; D016054:DNA, Protozoan