Friday, 3 February 2012

MALARIA: How Do We Best Diagnose Malaria in Africa?

Philip J. Rosenthal Department of Medicine, University of California, San Francisco, California
For many decades, the cornerstone of malaria management in Africa was to treat all febrile children with chloroquine. With high-level resistance to chloroquine and improved means of malaria diagnosis, recommendations for the management of malaria in Africa have changed in two important ways in the last few years. First, recommended therapy for uncomplicated falciparum malaria has moved to highly effective artemisinin-based combination therapies.1 Second, it is now recommended that the treatment of malaria be confined to parasitologically confirmed cases. This recommendation requires the availability of reliable diagnostic tests. The gold standard test for the diagnosis of malaria is microscopy. Evaluation of Giemsa-stained thick smears, when performed by expert microscopists, provides accurate diagnosis of malaria, although assuring expert slide preparation and reading can be difficult.2 Indeed, microscopy is often unavailable, especially in rural settings. In this regard, the advent of rapid diagnostic tests (RDTs) for malaria is an important advance. Multiple immunochromatographic tests, incorporating a number of different parasite antigens and produced by many different manufacturers, are now available.3 At best, these tests offer a simple, fairly inexpensive, and reliable means of diagnosis that can be performed by healthcare workers with limited training. However, concerns with RDTs include potential unreliability because of inconsistent manufacture or poor storage, uncertain supply, and potential misreading of results by unskilled health workers. An additional, generally unappreciated concern when considering RDTs is differences between available tests......

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