COMPARISON OF PERIPHERAL BLOOD FILM STAINED BY

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Int. J. Pharm. Med. & Bio. Sc. 2014
Prakriti Vohra et al., 2014
ISSN 2278 – 5221 www.ijpmbs.com
Vol. 3, No. 3, July 2014
© 2014 IJPMBS. All Rights Reserved
Research Paper
COMPARISON OF PERIPHERAL BLOOD FILM
STAINED BY GIEMSA STAIN, ACRIDINE ORANGE
STAINING AND RAPID DIAGNOSTIC TESTS FOR
DETECTION OF P. VIVAX AND P. FALCIPARUM IN
CLINICALLY SUSPECTED CASES OF MALARIA
Prakriti Vohra2*, Shalu Mengi1, Ruhi Bunger3, Deepak Pathania4 and Varsha A Singh5
*Corresponding Author: Prakriti Vohra  [email protected]
Malaria is one of the major public health challenges and syndromic approach is unreliable
because of non-specific and overlapping symptoms with other febrile diseases. Due to emerging
drug resistance, accurate diagnosis of malaria is essential to start rational therapy for malaria.
Various diagnostic techniques available include: Peripheral blood film, acridine orange staining,
rapid diagnostic tests. Materials and Methods: This three years study was conducted in department
of microbiology, Maharishi Markandeshwar Institute of Medical Research & Sciences (MMIMSR),
Mullana, Ambala. The blood samples collected from 218 clinically suspected cases of malaria
were subjected to Giemsa staining, acridine orange staining and Rapid Diagnostic Test (RDT)
as per standard procedures. Results: In the present study, out of total 218 cases tested, 19.7%,
18.8% and 17.% were positive by Giemsa stain, acridine orange staining procedure and RDT,
respectively. On further examination of positive cases; P. falciparum was detected in 70%, 80%
and 90% cases and P. vivax in 90%, 82.5%, and 75% cases by Giemsa staining, acridine
orange and RDT, respectively. Conclusion: For P. vivax and for P. falciparum, Giemsa stain and
RDT have better diagnostic accuracy, respectively.
Keywords: Acridine orange staining, Comparison, Giemsa staining, Malaria, Rapid Diagnostic
Tests (RDTs)
INTRODUCTION
scientist, discovered the malaria parasite almost
125 years ago. Yet even today, malaria as a
Charles Louis alphonse laveran, a French
1
Department of Microbiology, Maharishi Markandeshwar University, Solan.
2
Department of Microbiology, Shaheed Hasan Khan Mewati, Government Medical College, (SHKM,GMC) Nalhar, Mewat.
3
Department of Microbiology, Maharishi Markandeshwar Institute of Medical Sciences & Research (MMIMSR) Mullana, Ambala.
4
Department of Social & Preventive Medicine, Maharishi Markandeshwar Institute of Medical Sciences & Research,(MMIMSR) Mullana,
Ambala.
5
Department of Microbiology, Maharishi Markandeshwar Institute of Medical sciences & Research,(MMIMSR) Mullana, Ambala.
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Int. J. Pharm. Med. & Bio. Sc. 2014
Prakriti Vohra et al., 2014
orange staining and antigen detection using
malaria pLDH /HRP2 combo test kit was planned.
disease continues to be the world’s foremost
tropical disease and a major public health
challenge (Sharma, 2007). Due to the rapid
expansion of resistance to anti malarial drugs,
the battle against malaria has become even more
urgent (Mugisha, 2003).
This study attempts to compare the current
methodologies- traditional microscopy using
giemsa stain, acridine orange fluorescent staining
procedure and a rapid detection test thereafter
approach to the diagnosis of malaria in a practical
and helpful way for the laboratory and for the
physician caring for the patient .
Syndromic approach is unreliable because of
the non specific and overlapping symptoms with
other febrile diseases resulting in over diagnosis
of malaria, over prescription of anti malarial drugs,
under diagnosis and inappropriate treatment of
non malarial febrile illnesses. Thus, a diagnosis
of malaria infection based on clinical decision
alone is unreliable and, if possible, should be
supported and verified with a laboratory based
confirmatory test (Uzochukwu, 2010).
MATERIALS AND METHODS
The present study was conducted in department
of microbiology, MMIMSR, Mullana during a period
of three years, i.e., from March 2009 to March
2012.
1. A total of 218 clinically suspected cases of
In malaria patients prompt and accurate
diagnosis and treatment with appropriate antimalarial drugs is the most important strategy for
effective case management (Tekola, 2010) .
Failure to diagnose malaria correctly can lead to
omission of a drug when a drug is required,
administration of drug when no drug is required,
or administration of an ineffective drug. Nonrational drug use, in turn, can promote drug
resistance (McKenzie, 2003).
malaria were enrolled in the study. 5 ml of
whole blood was collected into the collection
tube containing EDTA by venepuncture from
patients presenting clinically with fever with
chills and rigor and other suggestive
symptoms
of
malaria
(Mackie
and
MacCartney). Confirmation of diagnosis of
malaria was done using three available
techniques, the criteria for confirmation of
positivity was positive by any of the three
The diagnostic modalities which are available
for malaria range from conventional thick and thin
smear to rapid modalities like fluorescent staining
and antigen detecting test detecting parasitic
antigens like histidine rich protein-2 (HRP-2),
plasmodium lactate dehydrogenase (pLDH ) and
pan specific aldolase (Wongsrichanalai, 2007).
Keeping an eye on these state of the art
techniques in the diagnosis of malaria,
comparative study of the commonly employed
diagnostic techniques in diagnosis of malaria, i.e.,
giemsa stained thick and thin smear, acridine
following methods.
2. Thick and thin blood smears (Mackie and
MacCartney): For prepration of blood films,
thoroughly cleaned 25 mm × 75 mm glass
slides which were free of grease and
scratches were used. Thick and thin blood
smears were prepared as per the standard
method. The smears were stained with giemsa
stain. Thick smears were reported negative
after examination of 200-300 oil immersion
fields with no parasites observed; a thin smear
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Int. J. Pharm. Med. & Bio. Sc. 2014
Prakriti Vohra et al., 2014
Table 1: Comparison of Various Methods for Detection
of Different Species of Malaria Parasite (n=50)
S. No.
Method
Malarial Parasite Species
None
P. vivax
P. falciparum
P. malariae
P. ovale
n
%
n
%
n
%
n
%
N
%
1.
Giemsa (n=50)
7
14
36
72
7
14
0
0
0
0
2.
Acridine orange (n=50)
9
18
33
66
8
16
0
0
0
0
3.
RDT (n=50)
11
22
30
60
9
18
0
0
0
0
Note: c2=1.68 (df=4); p=0.794
was given negative when no parasites were
RESULTS
observed in 200 oil immersion fields.
blood was mixed with 10 µL of acridine orange
A total of 50 cases were found to be positive using
any of the three methods (Giemsa stain, Acridine
orange fluorescent stain or RDT). Thus the
stain on a glass slide and covered with a
prevalence of malaria among clinically suspected
coverslip and prepration was examined under
cases was 22.9%.
3. Acridine orange staining technique: 75 µL of
fluorescent microscope (Lowe, 1996).
In the present study out of total 218 cases
tested, 43 (19.7%), 41(18.8%) and 39 (17.%) were
4. Detection of antigen: The malaria pLDH /HRP2
positive by Giemsa staining, acridine orange
combo test kit contains a membrane strip,
staining procedure and RDT respectively.
which is precoated with two antibodies as two
separate lines across a test strip. One
On examination of positive cases; Giemsa,
monoclonal antibody is panspecific to pLDH
acridine orange and RDTs could confirm the
of the Plasmodium vivax and the other line
consists of a monoclonal antibody specific to
diagnosis of P. vivax in 36 (90%), 33 (82.5%), 30
(75%) cases and that of P. falciparum in 7 (70%),
the HRP2 of the Plasmodium falciparum
8 (80%), 9 (90%) cases, respectively.
species.
5. Microlitres of whole blood was added into the
While sensitivity of Giemsa staining, acridine
orange staining and RDT for detection of P. vivax
sample well. Two drops of assay buffer were
is 90%, 82.5%, 75% and specificity is 100%,
added into the buffer well. The result was read
100%, 100% and for P. falciparum sensitivity of
Giemsa staining, acridine orange staining and
RDT 70%, 80%, 90% and specificity of
in 20 min (Moody, 2002).
STATISTICAL ANALYSIS
100%,100%, 100%, respectively (Table 2).
Data was statistically analyzed by using spss/pc
+ (statistical package for social sciences). Chisquare test (2) was applied whenever possible
and p-value was calculated.
DISCUSSION
The results of present study indicated that 50
(22.9%) were infected with malaria and the rest
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Int. J. Pharm. Med. & Bio. Sc. 2014
Prakriti Vohra et al., 2014
Table 2: Diagnostic Efficacy of Different Methods for Malarial Parasite Species
Method
Diagnostic Efficacy
Sensitivity
Specificity
PPV
NPV
Diagnostic Accuracy
Giemsa stain
90.0
100.0
100.0
71.4
92.0
Acridine orange
82.5
100.0
100.0
58.8
86.0
RDT
75.0
100.0
100.0
50.0
80.0
Giemsa stain
70.0
100.0
100.0
93.0
94.0
Acridine orange
80.0
100.0
100.0
95.2
96.0
RDT
90.0
100.0
100.0
97.6
98.0
For P. vivax
For P. falciparum
168 (77.1%) were malaria negative. (Table 1) as
seen in studies conducted by Iqbal et al. (2003),
Htut et al. (2002), Iqbal et al. (2002), Endeshaw
et al. (2010), Lema et al. (1999).
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Giemsa staining is the Gold standard as
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