Comparison of three PCR-based assays for the non-invasive diagnosis of malaria: detection of Plasmodium parasites in blood and saliva

  • R. Singh
  • D. P. Singh
  • R. Gupta
  • D. Savargaonkar
  • O. P. Singh
  • N. Nanda
  • R. M. Bhatt
  • N. Valecha
Article

Abstract

The conventional molecular diagnosis of malaria uses 18S rRNA-based PCR assay employing blood samples. This assay presents limitation in terms of long turnaround time and increased chances of false-positive results. Here, we evaluated one-step singleplex or multiplex PCR assay based on high copy species-specific consensus repeat sequences (CRS) along with standard 18S rRNA nested PCR (18S n-PCR) assay to detect P. falciparum and P. vivax infection using blood and saliva samples from Indian febrile patients. Out of 327 patients, 187 were found to be positive for malaria parasites by microscopic examination of peripheral blood smears. Among these 130 were P. vivax and 57 were P. falciparum cases. The18S n-PCR assay and CRS PCR assay identified 186 out of 187 cases (99.4 %). Multiplex CRS PCR assay detected Plasmodium in 176 out of 187 cases (94.1 %). Both singleplex and multiplex CRS PCR assay identified 6 mixed infection cases, while 18S n-PCR assay detected 10 mixed infection cases of P. vivax and P. falciparum, which were not recognized by microscopy. Non-invasive Plasmodium detection rate with DNA derived from saliva samples was highest for 18S n-PCR (87.36 %), followed by singleplex CRS (81 %) and multiplex CRS PCR assay (70.5 %). Specificity for P. vivax and P. falciparum detection for all assays was 98.48 % and 100 % respectively. Detection rate for P. vivax in saliva correlated with parasite density for CRS target-based assays. The species-specific CRS PCR, either as a singleplex or multiplex assay, can have an impact on diagnosis and epidemiological studies in malaria.

Keywords

Malaria Plasmodium Saliva Sample Parasite Density Vivax Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

The study was supported by NIMR and a grant (5/8-7(231)2011-ECD-II) from the Indian Council of Medical Research, New Delhi, India. The technical support of Mrs Alka Kapoor is gratefully acknowledged.

Conflict of interest

None to be declared.

References

  1. 1.
    WHO (2013) World Malaria Report 2013. World Health Organization, GenevaGoogle Scholar
  2. 2.
    Gupta B, Gupta P, Sharma A, Singh V, Dash AP, Das A (2010) High proportion of mixed-species Plasmodium infections in India revealed by PCR diagnostic assay. Trop Med Int Health 15(7):819–824PubMedCrossRefGoogle Scholar
  3. 3.
    Baird JK (2013) Evidence and implications of mortality associated with acute Plasmodium vivax malaria. Clin Microbiol Rev 26(1):36–57PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Mueller I, Galinski MR, Baird JK, Carlton JM, Kochar DK, Alonso PL, del Portillo HA (2009) Key gaps in the knowledge of Plasmodium vivax, a neglected human malaria parasite. Lancet Infect Dis 9(9):555–566PubMedCrossRefGoogle Scholar
  5. 5.
    Valecha N, Pinto RG, Turner GD, Kumar A, Rodrigues S, Dubhashi NG, Rodrigues E, Banaulikar SS, Singh R, Dash AP, Baird JK (2009) Histopathology of fatal respiratory distress caused by Plasmodium vivax malaria. Am J Trop Med Hyg 81(5):758–762PubMedCrossRefGoogle Scholar
  6. 6.
    Dorsey G, Gandhi M, Oyugi JH, Rosenthal PJ (2000) Difficulties in the prevention, diagnosis, and treatment of imported malaria. Arch Intern Med 160(16):2505–2510PubMedCrossRefGoogle Scholar
  7. 7.
    Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH (2007) A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg 77 (6 Suppl):119–127PubMedGoogle Scholar
  8. 8.
    McMorrow ML, Aidoo M, Kachur SP (2011) Malaria rapid diagnostic tests in elimination settings–can they find the last parasite? Clin Microbiol Infect 17(11):1624–1631PubMedCrossRefGoogle Scholar
  9. 9.
    Kumar N, Pande V, Bhatt RM, Shah NK, Mishra N, Srivastava B, Valecha N, Anvikar AR (2013) Genetic deletion of HRP2 and HRP3 in Indian Plasmodium falciparum population and false negative malaria rapid diagnostic test. Acta Trop 125(1):119–121PubMedCrossRefGoogle Scholar
  10. 10.
    Koita OA, Doumbo OK, Ouattara A, Tall LK, Konare A, Diakite M, Diallo M, Sagara I, Masinde GL, Doumbo SN, Dolo A, Tounkara A, Traore I, Krogstad DJ (2012) False-negative rapid diagnostic tests for malaria and deletion of the histidine-rich repeat region of the hrp2 gene. Am J Trop Med Hyg 86(2):194–198PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Hanscheid T, Grobusch MP (2002) How useful is PCR in the diagnosis of malaria? Trends Parasitol 18(9):395–398PubMedCrossRefGoogle Scholar
  12. 12.
    Snounou G, Viriyakosol S, Jarra W, Thaithong S, Brown KN (1993) Identification of the four human malaria parasite species in field samples by the polymerase chain reaction and detection of a high prevalence of mixed infections. Mol Biochem Parasitol 58(2):283–292PubMedCrossRefGoogle Scholar
  13. 13.
    Singh B, Bobogare A, Cox-Singh J, Snounou G, Abdullah MS, Rahman HA (1999) A genus- and species-specific nested polymerase chain reaction malaria detection assay for epidemiologic studies. Am J Trop Med Hyg 60(4):687–692PubMedGoogle Scholar
  14. 14.
    Singh B, Kim Sung L, Matusop A, Radhakrishnan A, Shamsul SS, Cox-Singh J, Thomas A, Conway DJ (2004) A large focus of naturally acquired Plasmodium knowlesi infections in human beings. Lancet 363(9414):1017–1024PubMedCrossRefGoogle Scholar
  15. 15.
    Perandin F, Manca N, Calderaro A, Piccolo G, Galati L, Ricci L, Medici MC, Arcangeletti MC, Snounou G, Dettori G, Chezzi C (2004) Development of a real-time PCR assay for detection of Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale for routine clinical diagnosis. J Clin Microbiol 42(3):1214–1219PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Han ET, Watanabe R, Sattabongkot J, Khuntirat B, Sirichaisinthop J, Iriko H, Jin L, Takeo S, Tsuboi T (2007) Detection of four Plasmodium species by genus- and species-specific loop-mediated isothermal amplification for clinical diagnosis. J Clin Microbiol 45(8):2521–2528PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Demas A, Oberstaller J, DeBarry J, Lucchi NW, Srinivasamoorthy G, Sumari D, Kabanywanyi AM, Villegas L, Escalante AA, Kachur SP, Barnwell JW, Peterson DS, Udhayakumar V, Kissinger JC (2011) Applied genomics: data mining reveals species-specific malaria diagnostic targets more sensitive than 18S rRNA. J Clin Microbiol 49(7):2411–2418PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Singh R, Savargaonkar D, Bhatt R, Valecha N (2013) Rapid detection of Plasmodium vivax in saliva and blood using loop mediated isothermal amplification (LAMP) assay. J Infect 67(3):245–247PubMedCrossRefGoogle Scholar
  19. 19.
    Putaporntip C, Buppan P, Jongwutiwes S (2011) Improved performance with saliva and urine as alternative DNA sources for malaria diagnosis by mitochondrial DNA-based PCR assays. Clin Microbiol Infect 17(10):1484–1491PubMedCrossRefGoogle Scholar
  20. 20.
    Steenkeste N, Incardona S, Chy S, Duval L, Ekala MT, Lim P, Hewitt S, Sochantha T, Socheat D, Rogier C, Mercereau-Puijalon O, Fandeur T, Ariey F (2009) Towards high-throughput molecular detection of Plasmodium: new approaches and molecular markers. Malar J 8:86PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Polley SD, Mori Y, Watson J, Perkins MD, Gonzalez IJ, Notomi T, Chiodini PL, Sutherland CJ (2010) Mitochondrial DNA targets increase sensitivity of malaria detection using loop-mediated isothermal amplification. J Clin Microbiol 48(8):2866–2871PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Haanshuus CG, Mohn SC, Morch K, Langeland N, Blomberg B, Hanevik K (2013) A novel, single-amplification PCR targeting mitochondrial genome highly sensitive and specific in diagnosing malaria among returned travellers in Bergen, Norway. Malar J 12:26PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Oyedeji SI, Awobode HO, Monday GC, Kendjo E, Kremsner PG, Kun JF (2007) Comparison of PCR-based detection of Plasmodium falciparum infections based on single and multicopy genes. Malar J 6:112PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Filisetti D, Bombard S, N'Guiri C, Dahan R, Molet B, Abou-Bacar A, Hansmann Y, Christmann D, Candolfi E (2002) Prospective assessment of a new polymerase chain reaction target (STEVOR) for imported Plasmodium falciparum malaria. Eur J Clin Microbiol Infect Dis 21(9):679–681PubMedCrossRefGoogle Scholar
  25. 25.
    Fontecha GA, Mendoza M, Banegas E, Poorak M, De Oliveira AM, Mancero T, Udhayakumar V, Lucchi NW, Mejia RE (2012) Comparison of molecular tests for the diagnosis of malaria in Honduras. Malar J 11:119PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Yin J-H, Xia Z-G, Liu C-S, Zhou S-S (2013) Noninvasive sampling of saliva as an alternative way for malaria diagnosis: a systematic review. Sci J Microbiol. doi: 10.7237/sjmb/180 Google Scholar
  27. 27.
    Nwakanma DC, Gomez-Escobar N, Walther M, Crozier S, Dubovsky F, Malkin E, Locke E, Conway DJ (2009) Quantitative detection of Plasmodium falciparum DNA in saliva, blood, and urine. J Infect Dis 199(11):1567–1574PubMedCrossRefGoogle Scholar
  28. 28.
    Buppan P, Putaporntip C, Pattanawong U, Seethamchai S, Jongwutiwes S (2010) Comparative detection of Plasmodium vivax and Plasmodium falciparum DNA in saliva and urine samples from symptomatic malaria patients in a low endemic area. Malar J 9:72PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Kimura M, O K, Liu Q, Zhou M, Kawamoto F, Wataya Y, Otani S, Yamaguchi Y, Tanabe K (1997) Identification of the four species of human malaria parasites by nested PCR that targets variant sequences in the small subunit rRNA gene. Parasitol Int 46(2):91–95CrossRefGoogle Scholar
  30. 30.
    Boonma P, Christensen PR, Suwanarusk R, Price RN, Russell B, Lek-Uthai U (2007) Comparison of three molecular methods for the detection and speciation of Plasmodium vivax and Plasmodium falciparum. Malar J 6:124PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • R. Singh
    • 1
    • 2
  • D. P. Singh
    • 1
  • R. Gupta
    • 3
  • D. Savargaonkar
    • 1
  • O. P. Singh
    • 1
  • N. Nanda
    • 1
  • R. M. Bhatt
    • 4
  • N. Valecha
    • 1
  1. 1.National Institute of Malaria Research (ICMR)New DelhiIndia
  2. 2.National Institute of Pathology (ICMR)Safdarjung Hospital CampusNew DelhiIndia
  3. 3.Department of PaediatricsVardhman Mahavir Medical College and Safdarjung HospitalNew DelhiIndia
  4. 4.National Institute of Malaria Research, Field StationRaipurIndia

Personalised recommendations