title: Malaria detection using inertial microfluidics.
abstract: Diagnosis of malaria at the early stage of infection is challenging due to the difficulty in detecting low abundance parasites from blood. Molecular methods such as real-time polymerase chain reaction (qPCR) can be especially useful for detecting low parasitemia levels due to their high sensitivity and their ability to recognize different malarial species and strains. Unfortunately, the accuracy of qPCR-based malaria detection can be compromised by many factors, including the limited specificity of primers, presence of PCR inhibitors in blood serum and DNA contamination from nucleated blood cells. Here, we use a label-free, shear-modulated inertial microfluidic system to enrich malaria parasites from blood so as to facilitate a more reliable and specific PCR-based malaria detection. This technique capitalizes on cell focusing behaviors in high aspect ratio microchannels coupled with pinched flow dynamics to isolate ring-stage malaria parasites from lysed blood containing white blood cells (WBCs). In this high aspect ratio (ratio of the channel height to the width) platform, the high shear rate along the channel width causes the dispersed WBCs at the inlet to migrate and align into two streams near the channel sidewalls while the malaria parasites remain unfocused. Sensitive detection of parasites at spiked densities ranging from 10(3) to 10(4)Plasmodium falciparum parasites per mL (~2-10 per μL) has been demonstrated; they have also been quantified in whole blood using qPCR. This is approximately 100-fold more sensitive than the gold standard conventional microscopy analysis of thick blood smears. The simplicity of this device makes it ideal for integration with an automatic system for ultra-fast and accurate detection despite low levels of parasitemia. It can also help in malaria screening and elimination efforts.
authors.affiliation: BioSystems and Micromechanics (BioSyM) IRG, Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore. ctlim@nus.edu.sg.
authors.forename: Majid Ebrahimi
authors.initials: ME
authors.lastname: Warkiani
authors.forename: Andy Kah Ping
authors.initials: AK
authors.lastname: Tay
authors.forename: Bee Luan
authors.initials: BL
authors.lastname: Khoo
authors.forename: Xu
authors.initials: X
authors.lastname: Xiaofeng
authors.forename: Jongyoon
authors.initials: J
authors.lastname: Han
authors.forename: Chwee Teck
authors.initials: CT
authors.lastname: Lim
mesh_terms: D004867:Equipment Design; D004912:Erythrocytes / Q000469:parasitology; D006801:Humans; D056656:Lab-On-A-Chip Devices; D008288:Malaria / Q000175:diagnosis* / Q000469:parasitology*; D010963:Plasmodium falciparum / Q000254:growth & development / Q000302:isolation & purification*; D060888:Real-Time Polymerase Chain Reaction / Q000295:instrumentation