Diagnosis of placental malaria in poorly fixed and processed placental tissue

Placental histopathology has been considered the gold standard for diagnosis of malaria during pregnancy. However, in under-resourced areas placental tissue is often improperly fixed and processed; the resulting formalin pigment is difficult to distinguish from malaria pigment. This study examines t...

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Bibliographic Details
Published in:Malaria journal 2016-05, Vol.15 (1), p.272-272, Article 272
Main Authors: Liu, Yunhao, Griffin, Jennifer B, Muehlenbachs, Atis, Rogerson, Stephen J, Bailis, Anya J, Sharma, Rajni, Sullivan, David J, Tshefu, Antoinette K, Landis, Sarah H, Kabongo, Jean-Marie M, Taylor, Steve M, Meshnick, Steven R
Format: Article
Language:English
Subjects:
Adolescent
Adult
Analysis
Care and treatment
Democratic Republic of the Congo
Diagnostic Tests, Routine - methods
Epidemiology
Female
Health aspects
Humans
Immunohistochemistry - methods
Malaria
Malaria - diagnosis
Malaria - parasitology
Malaria - pathology
Placenta - parasitology
Placenta - pathology
Placenta Diseases - diagnosis
Placenta Diseases - parasitology
Placenta Diseases - pathology
Plasmodium falciparum
Polymerase Chain Reaction - methods
Pregnancy
Pregnant women
Prospective Studies
Sensitivity and Specificity
Young Adult
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Summary:Placental histopathology has been considered the gold standard for diagnosis of malaria during pregnancy. However, in under-resourced areas placental tissue is often improperly fixed and processed; the resulting formalin pigment is difficult to distinguish from malaria pigment. This study examines two alternative diagnostic methods: polymerase chain reaction (PCR) and a novel immunohistochemistry (IHC)-based method using an antibody against histidine-rich protein 2 (HRP2). Placental histopathology from 151 pregnant women in Kinshasa was assessed by two blinded microscopists and compared with peripheral blood PCR and IHC for HRP2. The Cohen's kappa coefficients were calculated to assess the test agreement. The sensitivity and specificity of individual tests were calculated using PCR or IHC as the reference standard as well as latent class analysis (LCA). PCR and IHC correlated fairly well. The correlation between the two blinded microscopists was poor, as there was widespread formalin pigment. Using LCA, all of the tests had high specificities. The most sensitive test was IHC (67.7 %), with PCR as second-best (56.1 %). PCR and/or IHC are suitable diagnostics when the presence of formalin pigment substantially compromises placental histopathology.
ISSN:1475-2875
1475-2875
DOI:10.1186/s12936-016-1314-6