title: Comparison of the diagnostic performance of microscopic examination with nested polymerase chain reaction for optimum malaria diagnosis in Upper Myanmar.
abstract: Accurate diagnosis of Plasmodium infection is crucial for prompt malaria treatment and surveillance. Microscopic examination has been widely applied as the gold standard for malaria diagnosis in most part of malaria endemic areas, but its diagnostic value has been questioned, particularly in submicroscopic malaria. In this study, the diagnostic performance of microscopic examination and nested polymerase chain reaction (PCR) was evaluated to establish optimal malaria diagnosis method in Myanmar.
  
  
  
  A total of 1125 blood samples collected from residents in the villages and towns located in Naung Cho, Pyin Oo Lwin, Tha Beik Kyin townships and Mandalay of Upper Myanmar were screened by microscopic examination and species-specific nested PCR method.
  
  
  
  Among the 1125 blood samples, 261 samples were confirmed to be infected with malaria by microscopic examination. Evaluation of the 1125 samples by species-specific nested PCR analysis revealed that the agreement between microscopic examination and nested PCR was 87.3% (261/299). Nested PCR successfully detected 38 Plasmodium falciparum or Plasmodium vivax infections, which were missed in microscopic examination. Microscopic examinations also either misdiagnosed the infected Plasmodium species, or did not detect mixed infections with different Plasmodium species in 31 cases.
  
  
  
  The nested PCR method is more reliable than conventional microscopic examination for the diagnosis of malaria infections, and this is particularly true in cases of mixed infections and submicroscopic infections. Given the observed higher sensitivity and specificity of nested PCR, the molecular method holds enormous promise in malaria diagnosis and species differentiation, and can be applied as an effective monitoring tool for malaria surveillance, control and elimination in Myanmar.
authors.affiliation: Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea.|BK21Plus Team for Anti-Aging Biotechnology and Industry, Department of Convergence Medical Science, Gyeongsang National University, Jinju, 52727, Republic of Korea.
authors.forename: Jung-Mi
authors.initials: JM
authors.lastname: Kang
authors.affiliation: Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea.
authors.forename: Pyo-Yun
authors.initials: PY
authors.lastname: Cho
authors.affiliation: Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar.
authors.forename: Mya
authors.initials: M
authors.lastname: Moe
authors.affiliation: Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea.
authors.forename: Jinyoung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea.
authors.forename: Hojong
authors.initials: H
authors.lastname: Jun
authors.affiliation: Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea.
authors.forename: Hyeong-Woo
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea.
authors.forename: Seong Kyu
authors.initials: SK
authors.lastname: Ahn
authors.affiliation: Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea.
authors.forename: Tae Im
authors.initials: TI
authors.lastname: Kim
authors.affiliation: Department of Convergence Medicine, University of Ulsan College of Medicine and Asan Institute for Life Sciences, Asan Medical Center, Seoul, 05505, Republic of Korea.
authors.forename: Jhang Ho
authors.initials: JH
authors.lastname: Pak
authors.affiliation: Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar.
authors.forename: Moe Kyaw
authors.initials: MK
authors.lastname: Myint
authors.affiliation: Department of Medical Research Pyin Oo Lwin Branch, Pyin Oo Lwin, Myanmar. dr.khinlin.dir@gmail.com.
authors.forename: Khin
authors.initials: K
authors.lastname: Lin
authors.affiliation: Department of Tropical Medicine and Inha Research Institute for Medical Sciences, Inha University School of Medicine, Incheon, 22212, Republic of Korea. tongsookim@inha.ac.kr.
authors.forename: Tong-Soo
authors.initials: TS
authors.lastname: Kim
authors.affiliation: Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, 52727, Republic of Korea. bkna@gnu.ac.kr.|BK21Plus Team for Anti-Aging Biotechnology and Industry, Department of Convergence Medical Science, Gyeongsang National University, Jinju, 52727, Republic of Korea. bkna@gnu.ac.kr.
authors.forename: Byoung-Kuk
authors.initials: BK
authors.lastname: Na
mesh_terms: D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis*; D016780:Malaria, Vivax / Q000175:diagnosis*; D008853:Microscopy / Q000592:standards*; D002052:Myanmar; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D010966:Plasmodium vivax / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000592:standards*; D015203:Reproducibility of Results
keywords: Diagnosis; Malaria; Microscopic examination; Myanmar; Species-specific nested PCR