Comparative evaluation of fluorescent in situ hybridization and Giemsa microscopy with quantitative real-time PCR technique in detecting malaria parasites in a holoendemic region of Kenya.

BACKGROUND: Early and accurate diagnosis of malaria is important in treatment as well as in the clinical evaluation of drugs and vaccines. Evaluation of Giemsa-stained smears remains the gold standard for malaria diagnosis, although diagnostic errors and potential bias estimates of protective efficacy have been reported in practice. Plasmodium genus fluorescent in situ hybridization (P-Genus FISH) is a microscopy-based method that uses fluorescent labelled oligonucleotide probes targeted to pathogen specific ribosomal RNA fragments to detect malaria parasites in whole blood. This study sought to evaluate the diagnostic performance of P-Genus FISH alongside Giemsa microscopy compared to quantitative reverse transcription polymerase chain reaction (qRT-PCR) in a clinical setting. METHOD: Five hundred study participants were recruited prospectively and screened for Plasmodium parasites by P-Genus FISH assay, and Giemsa microscopy. The microscopic methods were performed by two trained personnel and were blinded, and if the results were discordant a third reading was performed as a tie breaker. The diagnostic performance of both methods was evaluated against qRT-PCR as a more sensitive method. RESULTS: The number of Plasmodium positive cases was 26.8% by P-Genus FISH, 33.2% by Giemsa microscopy, and 51.2% by qRT-PCR. The three methods had 46.8% concordant results with 61 positive cases and 173 negative cases. Compared to qRT-PCR the sensitivity and specificity of P-Genus FISH assay was 29.3 and 75.8%, respectively, while microscopy had 58.2 and 93.0% respectively. Microscopy had a higher positive and negative predictive values (89.8 and 68.0% respectively) compared to P-Genus FISH (56.0 and 50.5%). In overall, microscopy had a good measure of agreement (76%, k = 0.51) compared to P-Genus FISH (52%, k = 0.05). CONCLUSION: The diagnostic performance of P-Genus FISH was shown to be inferior to Giemsa microscopy in the clinical samples. This hinders the possible application of the method in the field despite the many advantages of the method especially diagnosis of low parasite density infections. The P-Genus assay has great potential but application of the method in clinical setting would rely on extensive training of microscopist and continuous proficiency testing.

Toxicity of six plant extracts and two pyridone alkaloids from Ricinus communis against the malaria vector Anopheles gambiae.

BACKGROUND: The African malaria vector, Anopheles gambiae s.s., is known to feed selectively on certain plants for sugar sources. However, the adaptive significance of this behaviour especially on how the extracts of such plants impact on the fitness of this vector has not been explored. This study determined the toxicity and larvicidal activity on this vector of extracts from six selected plants found in Kenya and two compounds identified from Ricinus communis: 3-carbonitrile-4-methoxy-N-methyl-2-pyridone (ricinine), and its carboxylic acid derivative 3-carboxy-4-methoxy-N-methyl-2-pyridone, the latter compound being reported for the first time from this plant. METHODS: Feeding assays tested for toxic effects of extracts from the plants Artemisia afra Jacq. ex Willd, Bidens pilosa L., Parthenium hysterophorus L., Ricinus coummunis L., Senna didymobotrya Fresen. and Tithonia diversifolia Hemsl. on adult females and larvicidal activity was tested against third-instar larvae of Anopheles gambiae s.s. Mortality of larvae and adult females was monitored for three and eight days, respectively; Probit analysis was used to calculate LC50. Survival was analysed with Kaplan-Meier Model. LC-MS was used to identify the pure compounds. RESULTS: Of the six plants screened, extracts from T. diversifolia and R. communis were the most toxic against adult female mosquitoes after 7 days of feeding, with LC50 of 1.52 and 2.56 mg/mL respectively. Larvicidal activity of all the extracts increased with the exposure time with the highest mortality recorded for the extract from R. communis after 72 h of exposure (LC50 0.18 mg/mL). Mosquitoes fed on solutions of the pure compounds, 3-carboxy-4-methoxy-N-methyl-2-pyridone and ricinine survived almost as long as those fed on the R. communis extract with mean survival of 4.93 ± 0.07, 4.85 ± 0.07 and 4.50 ± 0.05 days respectively. CONCLUSIONS: Overall, these findings demonstrate that extracts from the six plant species exhibit varying bioactivity against the larvae and adult females of An. gambiae s.s. T. diversifolia and R. communis showed highest bioactivity against adult females An. gambiae and larvae while longevity of female An. gambiae s.s. decreased with exposure time to the two pure compounds.