Rapid Diagnostic Tests Show False Positive Leading to Dilemma in Malarial Treatment: A Case Study

  • Susanta Kumar Panda
  • Amit Kumar
Part of the SpringerBriefs in Applied Sciences and Technology book series (BRIEFSAPPLSCIENCES)


The absolute necessity for rational therapy in the face of rampant drug resistance places increasing importance on the accuracy of malaria diagnosis. Giemsa microscopy and Triple test method Rapid Diagnostic Test (RDT) represent the two diagnoses most likely to have the largest impact on malaria control in this present study. These two methods have their characteristic strengths and limitation. These tests were carried out on 156 patients of endemic areas of Gajapati district of Odisha State. These tests were evaluated by two methods, i.e. microscopic slide test and RDT kit method. RDT kits belong to Advantage MAL CARD Malaria pLDH (Plasmodium Lactate Dehydrogenase) antibody Pre-coated (J. Mitra & Co, India) card test, ParaHIT PfHRP2 (Histidine-Rich Protein 2) antibody pre-coated dip stick (Span Diagnostic Ltd, India) and S.D BIOLINE pf/pv capture antigen MSP (Merozoite Surface Protein) pre-coated card (S.D. BIO Standard Diagnostic Pvt. Ltd, India). A little amount of whole blood (5 μl) was taken using the plastic loop given with the kit, at the same time two slides are also taken. Out of 156 patients it was detected that 128 were negative and 28 were positive according to microscopic detection. Out of these 28 positives 23 were only P. falciparum, 2 were only P. vivax, 3 were having both PF and PV infection detected. On the other hand 32 were positive and 4 were false positive as shown by Advantage MAL CARD and ParaHIT, where as 49 were positive and 21 were false positive by the S.D. MSP pre-coated antigen card test kits.


Malaria Malarial treatment Rapid diagnostics test 



We acknowledge the Chief District Medical Officer, Department of Health, District Gajapati and kind cooperation of Community Health Centres medical officers, health workers and officials, for their help in Blood sample collection, Patient data collection, processing and analysis.


  1. 1.
    Am J Trop Med Hyg (2009) Performance of malaria rapid diagnostic tests as part of routine malaria case management in Kenya. Am J Trop Med Hyg 80:470–474Google Scholar
  2. 2.
    Piper R, Lebras J, Wentworth L, Hunt-Cooke A, Houze S, Chiodini P, Makler M (1999) Immunocapture diagnostic assays for malaria using Plasmodium lactate dehydrogenase (pLDH). Am J Trop Med Hyg 60:109–118Google Scholar
  3. 3.
    Palmer CJ, Lindo JF, Winslow I, Klaskala I, Queseda JA, Kaminsky R, Baum MK, Ager AL (1998) Evaluation of the optimal test for rapid diagnosis of Plasmodium vivax and Plasmodium falciparum malaria. J Clin Microbiol 36:203–206Google Scholar
  4. 4.
    Tjitra E, Suprianto S, Dyer M, Currie BJ, Anstey NM (1999) Field evaluation of the ICT malaria P.f/P.v immunochromatographic test for detection of Plasmodium falciparum and Plasmodiumvivax in patients with a presumptive clinical diagnosis of malaria in eastern Indonesia. J Clin Microbiol 37:2412–2417Google Scholar
  5. 5.
    World Health Organisation (2004) World health report 2004. World Health Organisation, Geneva, SwitzerlandGoogle Scholar
  6. 6.
    Moody A (2002) Rapid diagnostic tests for malaria parasites. Clin Microbiol Rev 15:66–78CrossRefGoogle Scholar
  7. 7.
    Standard Diagnostics. One step malaria P.f/P.v antigen rapid test: SD bioline malaria antigen. Available at: Accessed 20 Nov
  8. 8.
    Iqbal J, Hira PR, Sher A, Al-Enezi AA (2001) Diagnosis of imported malaria by Plasmodium lactate dehydrogenase (pLDH) and histidine-rich protein 2 (PfHRP-2)-based immunocapture assays. Am J Trop Med Hyg 64:20–23, Microbiol Rev 15:66–78Google Scholar
  9. 9.
    Humar A, Harrington MA, Pillai D, Kain KC (1997) ParaSight-F test compared with the polymerase chain reaction and microscopy for the diagnosis of Plasmodium falciparum malaria in travelers. Am J Trop Med Hyg 56:44–48Google Scholar
  10. 10.
    Am J Trop Med Hyg (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 86:194–198Google Scholar
  11. 11.
    WHO (2003) Malaria rapid diagnostics: making it work. Meeting report 20–23 Jan 2003, World Health Organization (RS/2003/GE/05[PHL]), ManilaGoogle Scholar
  12. 12.
    Shiff CJ, Premji Z, Minjas JN (1993) The rapid manual para-sight-f test. A new diagnostic tool for Plasmodium falciparum infection. Trans R Soc Trop Med Hyg 87:646–648CrossRefGoogle Scholar
  13. 13.
    Coleman RE, Maneechai N, Rachaphaew N, Kumpitak C, Miller RS, Soyseng V, Thimasaran K, Sattabongkot J (2002) Comparison of field and expert laboratory microscopy for active surveillance for asymptomatic Plasmodium falciparum and Plasmodium vivax in Western Thailand. Am J Trop Med Hyg 67:141–144Google Scholar
  14. 14.
    Laferl H, Kandel K, Pichler H (1997) False positive dipstick test for malaria. N Engl J Med 337:1635–1636CrossRefGoogle Scholar
  15. 15.
    Grobusch MP, Alpermann U, Schwenke S, Jelinek T, Warhurst DC (1999) False-positive rapid tests for malaria in patients with rheumatoid factor. Lancet 353:297CrossRefGoogle Scholar
  16. 16.
    Mishra B, Samantaray JC, Kumar A, Mirdha BR (1999) Study of false positivity of two rapid antigen detection tests for diagnosis of Plasmodium falciparum malaria. J Clin Microbiol 37:1233Google Scholar
  17. 17.
    Biswas S, Tomar D, Rao DN (2005) Investigation of the kinetics of histidine-rich protein 2 and of the antibody responses to this antigen, in a group of malaria patients from India. Ann Trop Med Parasitol 99:553–562CrossRefGoogle Scholar
  18. 18.
    Durand F, Faure O, Brion JP, Pelloux H (2005) Invalid result of Plasmodium falciparum malaria detection with the Binax-NOW Malaria rapid diagnostic test. J Med Microbiol 54:1115CrossRefGoogle Scholar
  19. 19.
    Peeling RW, Smith PG, Bossuyt PM (2006) A guide for diagnostic evaluations. Nat Rev Microbiol 4(Suppl):S2–S6CrossRefGoogle Scholar
  20. 20.
    World Health Organization (2005) Malaria light microscopy. Creating a culture of quality. Report of WHO SEARO/WPRO workshop on quality assurance for malaria microscopy, Kuala Lumpur, Malaysia: RS/2005/GE/03(MAA), 18–21 April 2005Google Scholar
  21. 21.
    Bell D, Wongsrichanalai C, Barnwell JW (2006) Ensuring quality and access for malaria diagnosis: how can it be achieved? Nat Rev Microbiol 4:682–695CrossRefGoogle Scholar

Copyright information

© The Author(s) 2015

Authors and Affiliations

  1. 1.BioAxis DNA Research Centre (P) LimitedHyderabadIndia

Personalised recommendations