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A simple and fast method to exclude high Plasmodium falciparum parasitaemia in travellers with imported malaria

DOI: 10.1186/1475-2875-10-300

Keywords: malaria, traveller, imported disease, aldolase, severe malaria, rapid diagnostic test

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Abstract:

In this study the Binax NOW? Malaria Test, an easy-to-perform rapid diagnostic test, with Histidine Rich Protein-2 (HRP-2) and aldolase as diagnostic markers, was used for semi-quantitative assessment of parasitaemia of P. faciparum.In 257 patients with imported P. falciparum malaria, reactivity of aldolase increased with higher parasitaemia. In all patients with a parasitaemia above 50,000 asexual parasites/μl (> 1%) co-reactivity of HRP-2 and aldolase was observed. Absence of aldolase reactivity in the presence of HRP-2 was a reliable predictive marker to exclude high (> 1%) parasitaemia in P. falciparum malaria.Assessment of HRP-2 and aldolase co-reactivity can be of help in clinical decision making in the acute care setting of returning travellers suspected of having malaria.The global burden of malaria is largely carried by the world's malaria-endemic regions with as many as 225 million cases and a death toll of more than 750,000 individuals in 2009 [1]. In striking contrast, in non-endemic industrialized countries malaria is seen as an occasionally imported disease in non-immune travellers, but it still represents a potentially fatal disease [2,3]. Without prompt and proper treatment malaria may rapidly progress to complications and even death. Hence, all patients must be assessed for signs or symptoms suggestive of an increased risk for complications. Due to unfamiliarity with the disease in non-endemic countries, ill-returning travellers frequently present to physicians who have no tropical medicine expertise and to primary health care facilities that lack expert diagnostic capabilities. As a result, diagnosis of malaria may be delayed or even missed, resulting in more severe disease or even fatalities [4,5].Recent studies in non-endemic industrialized countries showed that rapid diagnostic tests (RDTs) for malaria provide an excellent tool for diagnosis of malaria as compared to peripheral blood smears [6]. Although highly sensitive in diagnosing Plasmodium

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