Plasmodium vivax schizont stage in a thin smear of a patient | Figure 1

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Plasmodium vivax schizont stage in a thin smear of a patient. Note that the number of merozoites contained in the schizont is around 12-24 which is highly suggestive of Plasmodium vivax. Plasmodium falciparum may contain the same amount but they are rarely seen. Ring form and gametocyte morphology will help in their differentiation.

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Rapid tests for diagnosing malaria caused by Plasmodium vivax in people living in areas where malaria is very common

What is the aim of the review? Malaria infection is caused mainly by two species of malaria parasite: Plasmodium falciparum and Plasmodium vivax. The aim of this review was to evaluate rapid diagnostic tests (RDTs) to diagnose P vivax infection.

Why are rapid tests for P vivax malaria important? For clinical management, knowing which parasite species is causing the malaria is important as the drug treatments differ. For P vivax infection, an additional drug is required to eliminate the infection from the liver. For public health control of malaria, we know that P falciparum is declining over the previous 15 years, and infections from P vivax have therefore increased in importance.

What was studied in this review? RDTs provide results quickly and are often as a dipstick. We studied RDTs that specifically test for P vivax malaria. RDTs are simple to use, point‐of‐care tests. They are suitable for use in rural settings by primary healthcare workers, using a drop of blood on the dipstick that causes color change and a distinct line that indicates a positive test result. Healthcare workers in rural areas can perform RDTs for P vivax without needing a laboratory or special equipment. We wanted to find out which brands of RDTs were the most accurate for diagnosing P vivax malaria. We compared the new tests against the standard form of diagnosis with microscopy, and also more recent methods polymerase chain reaction (PCR): a molecular method to identify P vivax DNA in blood samples.

What are the main results of the review? We included 10 studies that looked at the accuracy of six diagnostic test brands for detecting P vivax malaria in people with suspected malaria symptoms. The studies were conducted in Ethiopia (four studies), India (two studies), and Bangladesh, Brazil, Colombia, and Sudan (one study each).

Compared with microscopy, the Care Start Malaria Pf/Pv Combo test performed well with 99% sensitivity and specificity (four studies). This means that:

Compared with microscopy, the Falcivax Device Rapid test had a sensitivity of 77% and a specificity of 99% (two studies). This means that:

We are moderately confident (certain) in the accuracy results for the Care Start Malaria Pf/Pv Combo test. The results are from a small number of studies (four), so our findings may change when results from further studies become available.

We are less confident in the accuracy results for the Falcivax Device Rapid test, because these came from only two studies. Our findings for this test will probably change when results from further studies become available.

Our results are based on a small number of studies, so we could not reliably assess all six brands of antibody test or compare their accuracy. Most studies included in this review had limitations: it was not clear how people were selected for testing, or how the study results were assessed and checked, which could have affected the results. Some rapid antibody tests were investigated by only one study. Some studies did not report clearly how common P malaria was in the area where the study was done.

How up‐to‐date is this review? The review authors searched for studies published up to 30 July 2019.

Researchers have found multiresistant forms of Plasmodium falciparum that have developed even higher levels of antimalarial drug resistance and are now rapidly spreading in Southeast Asia. The results come from two new studies published in Lancet Infectious Diseases. The multi-country randomized clinical trial found that the spread of multiresistant parasites caused malaria treatment failure with the combination of first-line dihydroartemisinin-piperaquine (DHA-PPQ) drugs in half of the cases (50.0%; CI 95% 41.1-58.3) in western and northeastern Cambodia, northeast Thailand and southwest Vietnam over the 2015-2018 time period. The genomic epidemiology study showed that by 2016-2018, Plasmodium falciparum represented over 80 percent of parasites circulating in northeastern Thailand and Vietnam, although they only emerged in western Cambodia in 2008. The findings underscore the urgent need to eliminate this parasite collapse with increasing drug resistance, and the importance of genetic surveillance in accelerating malaria elimination efforts, the researchers said. At this time, they call for the abandonment of DHA-PPQ use in affected countries. An accelerated malaria elimination program is needed to prevent resistant malaria from spreading further and trigger a global health emergency, similar to the one in which millions of chloroquine resistant malaria died in the 1980s. Source: Lancet Infectious Diseases.

\n\nPlasmodium spp found in patient recently returning from Afghanistan.

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