Diagnosis

Several methods are available for malaria diagnosis. Direct microscopy remains the gold standard for malaria diagnosis. Giemsa- or Field-stained thin and thick blood films enable the Plasmodium species and parasitemia to be determined with a high degree of accuracy by skilled microscopists. The sensitivity of detection by the thick blood film is approximately 0.0001 parasites per 100 red cells. The newer methods discussed below are useful as an adjunct to direct microscopy, particularly for those who are not regularly examining malaria films, but are not a substitute.

Fluorescence microscopy uses acridine orange dye which selectively targets parasite DNA and has been incorporated into a commercial test (QBC II). This is as sensitive as thick films, although parasitemia estimation is unreliable. It has the disadvantage of needing a trained microscopist to perform the test and requires an ultraviolet microscope.

HRP2 antigen capture assays provide a qualitative method which uses a monoclonal antibody to a water-soluble protein of Plasmodium falciparum. It may show a positive result before and after that seen by microscopy. It is an easy test to perform and does not need trained staff. It is useful in detecting P. falciparum in mixed infections. It is commercially available as ParaSight F and as the ICT malaria P. falciparum test.

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