The reliability of diagnostic techniques in the diagnosis and management of malaria in the absence of a gold standard.

Abstract

The accuracy of techniques for the diagnosis of malaria are usually compared with optical microscopy, which is considered to be a gold standard. However, microscopy is prone to error and therefore makes it difficult to assess the reliability of other diagnostic techniques. We did a systematic review to assess the specificity and sensitivity of diagnostic techniques in different settings, using a statistical method that avoided defining a gold standard. Performance varied depending on species of the malaria parasite, level of parasitaemia, and immunity. Overall, histidine-rich protein 2 (HRP2)-based dipsticks showed a high sensitivity (92.7%) and specificity (99.2%) for Plasmodium falciparum in endemic areas. The acridine orange test was more sensitive (97.1%) in detecting P falciparum in epidemiological studies, with a specificity of 97.9%. In the absence of a gold standard, HRP2 dipsticks and acridine orange could provide an alternative for detecting falciparum infections in endemic areas and epidemiological studies, respectively. Microscopy still remains more reliable in detecting non-falciparum infections.

• Authors: L B Ochola, P Vounatsou, T Smith, M L H Mabaso, C R J C Newton
• Journal: The Lancet. Infectious diseases (Lancet Infect Dis) Vol. 6 Issue 9 Pg. 582-8 (Sep 2006) ISSN: 1473-3099 [Print] United States
• PMID: 16931409 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Topics

• Animals
• Humans
• Malaria (diagnosis, therapy)
• Microscopy (standards)
• Patient Selection
• Plasmodium (isolation & purification)
• Reproducibility of Results
• Sensitivity and Specificity