Diagnosis of clinical malaria in endemic settings

ABSTRACT

Introduction

Malaria continues to be a major global health problem, with over 228 million cases and 405,000 deaths estimated to occur annually. Rapid and accurate diagnosis of malaria is essential to decrease the burden and impact of this disease, particularly in children. We aimed to review the main available techniques for the diagnosis of clinical malaria in endemic settings and explore possible future options to improve its rapid recognition.

Areas covered

literature relevant to malaria diagnosis was identified through electronic searches in Pubmed, with no language or date restrictions and limited to humans.

Expert opinion

Light microscopy is still considered the gold standard method for malaria diagnosis and continues to be at the frontline of malaria diagnosis. However, technologies as rapid diagnostic tests, mainly those who detect histidine-rich protein-2, offer an accurate, rapid and affordable alternative for malaria diagnosis in endemic areas. They are now the technique most extended in endemic areas for parasitological confirmation. In these settings, PCR-based assays are usually restricted to research and they are not currently helpful in the management of clinical malaria. Other technologies, such as isothermal methods could be an interesting and alternative approach to PCR in the future.

KEYWORDS:

• malaria diagnosis
• microscopy
• rapid diagnostic tests
• PCR
• lamp

Article highlights

• Light microscopy of Giemsa stained blood slides is still considered the gold standard method for malaria diagnosis.

• Rapid diagnostic tests, particularly those who detect histidine-rich protein-2, are an accurate, rapid and affordable technology for malaria diagnosis in endemic areas. In fact, they are currently the most widely used method for parasitological confirmation.

• In resource poor areas the use of PCR-based assays is restricted to research and needs further optimization to become a helpful approach in the management of clinical malaria.

• Isothermal methods, specially LAMP and NASBA technology, are attractive alternatives to PCR for resource-limited settings.

Acknowledgments

We acknowledge support from the Spanish Ministry of Science and Innovation through the ‘Centro de Excelencia Severo Ochoa 2019-2023ʹ Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. CISM is supported by the Government of Mozambique and the Spanish Agency for International Development (AECID). NB is supported by a FPU pre-doctoral fellowship (FPU18/04260) from the Spanish Ministry of Universities.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.