Open Access Research

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

Tom van Gool13*, Marlies E van Wolfswinkel2, Rob Koelewijn3, Pieter PAM van Thiel4, Jan Jacobs5, Jaap J van Hellemond36 and Perry JJ van Genderen27

Author Affiliations

1 Department of Parasitology, Academic Medical Center, Amsterdam, The Netherlands

2 Department of Internal Medicine, Harbour Hospital, Rotterdam, The Netherlands

3 Department of Parasitology, Harbour Hospital, Rotterdam, The Netherlands

4 Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands

5 Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium

6 Department of Medical Microbiology and Infectious Diseases, Erasmus University Hospital, Rotterdam, The Netherlands

7 Institute for Tropical Diseases, Harbour Hospital, Rotterdam, The Netherlands

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Malaria Journal 2011, 10:300  doi:10.1186/1475-2875-10-300

Published: 14 October 2011

Abstract

Background

Counts of malaria parasites in peripheral blood are important to assess severity of Plasmodium falciparum malaria. Thin and thick smears are routinely used for this purpose.

Methods

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.

Results

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.

Conclusions

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.

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