title: The importance of accuracy in diagnosis of positive malaria cases in a country progressing towards malaria elimination.
abstract: BACKGROUND
  With Sri Lanka aiming towards malaria elimination by 2015, the National Anti Malaria Campaign has stressed on the importance of identification of the species of Plasmodium either by examination of stained blood smears for malaria parasites or by Rapid Diagnostic Tests for malaria antigens before the initiation of treatment. This study aims at confirmation of the accuracy of clinical and/or microscopical malaria diagnosis using serology.
  
  
  METHODS
  Study population comprised 51 individuals diagnosed with malaria either microscopically or clinically during the first half of 2011. ELISA for detection of the two significant blood antigens (AMA-1 and MSP1-19) was carried out in these individuals, 14-28 days after being diagnosed as being positive for malaria microscopically.
  
  
  RESULTS
  ELISA confirmed the microscopic diagnosis in all 47 of the patients including two mixed infections which flagged positive for both parasite antigens. However, four individuals diagnosed clinically as being positive for P. vivax by Health Care Providers were negative for malaria antibodies by ELISA.
  
  
  CONCLUSIONS
  With 175 cases of malaria reported in 2011, a formidable challenge exists to diagnose malaria positive blood smears due to the large number of negative blood smears being seen daily. After routine cross checking of positive slides, it is heartening to note that there were no false positives detected through serological assays amongst patients who were diagnosed as malaria positive by microscopy. Presumptive treatment of febrile patients with anti-malarials can lead to waste of resources and adversely impact the condition of the patient if the fever is not due to malaria.
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Sumadhya Deepika
authors.initials: SD
authors.lastname: Fernando
authors.affiliation: Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
authors.forename: Chathuri J
authors.initials: CJ
authors.lastname: Navaratne
authors.affiliation: Anti Malaria Campaign, Elvitigala Mawatha, Colombo, Sri Lanka.
authors.forename: Gawrie Nl
authors.initials: GN
authors.lastname: Galappaththy
authors.affiliation: Anti Malaria Campaign, Elvitigala Mawatha, Colombo, Sri Lanka.
authors.forename: Rabindra R
authors.initials: RR
authors.lastname: Abeyasinghe
authors.affiliation: National Institute for Biological Standards and Control, Hertfordshire, United Kingdom.
authors.forename: Nilupa
authors.initials: N
authors.lastname: Silva
authors.affiliation: Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
authors.forename: Renu
authors.initials: R
authors.lastname: Wickermasinghe
keywords: Clinical diagnosis; Diagnosis; Elimination; Malaria; Microscopy; Serology