Malaria is a reemerging infectious disease in Korea. We experienced a case of asymptomatic P. vivax malaria accompanied by thrombocytopenia, mimicking immune thrombocytopenic purpura. The patient was exposed to mosquito 12 weeks ago. She experienced a characteristic febrile episode lasting for 2 weeks and remained asymptomatic thereafter. It was 7 weeks after the characteristic febrile episode when the diagnosis was established by the parasitemia. Malaria should be considered in the differential diagnosis of thrombocytopenia in Korea, especially in patients with febrile episodes.
Communicable Diseases, Emerging ; Culicidae ; Diagnosis ; Diagnosis, Differential ; Humans ; Korea ; Malaria ; Malaria, Vivax* ; Parasitemia ; Plasmodium vivax* ; Plasmodium* ; Purpura, Thrombocytopenic, Idiopathic* ; Thrombocytopenia

BACKGROUND: Examination of peripheral blood smear (PBS) is the gold standard for the diagnosis of malaria; however, its diagnostic utility will be dependent on the examiner's microscopic experience, the quality of the smear, and the degree of parasitemia. Therefore, it is essential to have available a rapid and simple test that is as sensitive and specific as PBS, at a small-middle range medical center, a health care center, and a military hospital in a malaria endemic area. METHODS: Malaria antigen and antibody tests were performed on 120 febrile patients who were requested for complete blood count (CBC) and PBS at two military hospitals from May 2004 to August 2005. RESULTS: Of the 45 patients who were diagnosed with malaria by examination of peripheral blood smears, 42 were positive on both malaria antigen and antibody tests, and 2 were positive on either antigen or antibody test. Only 1 patient was negative on the both test. Furthermore, all 75 patients with negative microscopic examinations also had negative malaria antigen and antibody tests. CONCLUSIONS: The results of this study show that a rapid differential diagnosis of malaria can be made by performing malaria antigen and antibody tests on febrile patients at hospitals in malaria endemic areas. Moreover, the test is simple and convenient enough to be performed without any special equipment or experience.
Blood Cell Count ; Delivery of Health Care ; Diagnosis ; Diagnosis, Differential* ; Fever of Unknown Origin* ; Fever* ; Hospitals, Military ; Humans ; Malaria* ; Malaria, Vivax* ; Parasitemia

BACKGROUND: Alteration in plasma lipid levels during malaria attacks was studied to evaluate the diagnstic values in vivax malaria. METHODS: The plasma levels of total cholesterol, triglycerides, HDL-cholesterol (HDL-c), and LDL-cholesterol (LDL-c) were analyzed and compared in 32 patients with vivax malaria at presentation, in 10 patients after 17-days of treatment with anti-malaria drug, and in 40 control individuals. Interrelation of lipid profile with other parameters including parasitemia level, platelet count, hemoglobin and WBC counts were analysed. RESULTS: In patients with malaria, serum total cholesterol, triglycerides, HDL-c and LDL-c concentrations were significantly lower than those of control subjects. None of lipid profile showed any correlation with the parasitemia level. After treatment, HDL-c was significantly elevated. CONCLUSION: These results suggest that lipid profile, especially decreased of HDL-c, may be a valuable information in the diagnosis of the malaria.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Diagnosis ; Humans ; Malaria ; Malaria, Vivax ; Parasitemia ; Plasma ; Plasmodium vivax* ; Plasmodium* ; Platelet Count ; Triglycerides

BACKGROUND: Alteration in plasma lipid levels during malaria attacks was studied to evaluate the diagnstic values in vivax malaria. METHODS: The plasma levels of total cholesterol, triglycerides, HDL-cholesterol (HDL-c), and LDL-cholesterol (LDL-c) were analyzed and compared in 32 patients with vivax malaria at presentation, in 10 patients after 17-days of treatment with anti-malaria drug, and in 40 control individuals. Interrelation of lipid profile with other parameters including parasitemia level, platelet count, hemoglobin and WBC counts were analysed. RESULTS: In patients with malaria, serum total cholesterol, triglycerides, HDL-c and LDL-c concentrations were significantly lower than those of control subjects. None of lipid profile showed any correlation with the parasitemia level. After treatment, HDL-c was significantly elevated. CONCLUSION: These results suggest that lipid profile, especially decreased of HDL-c, may be a valuable information in the diagnosis of the malaria.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Diagnosis ; Humans ; Malaria ; Malaria, Vivax ; Parasitemia ; Plasma ; Plasmodium vivax* ; Plasmodium* ; Platelet Count ; Triglycerides

BACKGROUND: We evaluated the posttreatment response to chloroquine among 81 patients with vivax malaria who were residents in Northern area of Kyunggi province in 1996. The result of chloroquine therapy was followed 28 days after treatment. Material and METHODS: Diagnosis of malaria was made by microscopic examination of Giemsa stain of peripheral blood. Parasitemia levels from each patient were counted before treatment, 3, 14 and 28 days after treatment. RESULTS: Eight-one patients successfully completed the therapy. All patients were army soldiers, who were residing in northern area of Kyunggi province. The 14-day cumulative incidence of therapeutic failure for P. vivax was 2.5% (n=2) and 0% (n=81) at 28th day. One patient had a recurrence eight months after completion of antimalarial treatment. CONCLUSION: The results suggest that recent resurgent malaria in Korea need more careful therapy. Antimalarial treatment should not be completed without microscopic confirmation.
Azure Stains ; Chloroquine ; Diagnosis ; Gyeonggi-do ; Humans ; Incidence ; Korea* ; Malaria ; Malaria, Vivax* ; Military Personnel ; Parasitemia ; Plasmodium vivax ; Primaquine ; Recurrence

BACKGROUND: The diagnosis of malaria has been usually made using microscopic examination of Wright stained thin blood films in Korean army. This method is labor-intensive, time consuming and requires the microscopic expertise. Therefore, the alternative techniques, rapid diagnostic test, have been sought for use in Korean army. We performed a comparison of the OptiMAL test with GENEDIA Malaria (P. vivax) Ab Rapid I, II to assess its sensitivity and specificity of Plasmodium vivax malaria. METHODS: Blood specimen were collected from 51 patients who were presented and initially diagnosed for P. vivax by the microscopy of blood smears and from 30 control patients without malaria infection at the Capital Armed Forces General Hospital (CAFGH) between October 2000 and February 2001. Among the 51 patients, we also collected 24 samples from 24 patients at 2 or 3 days after therapy. The OptiMAL test and GENEDIA Malaria (P. vivax) Ab Rapid I, II were performed according to the manufacturer's instructions on all samples respectively. RESULTS: Compared with the blood film, sensitivities and specificities of the OptiMAL test, GENEDIA Malaria (P. vivax) Ab Rapid I and GENEDIA Malaria (P. vivax) Ab Rapid II were 94.1~100% (29/29), 80.4~83.3%, 96.1~96.7% respectively. One case was interpreted as 'undetermined' by OptiMAL test. In 24 patients during therapy, the sensitivities of the OptiMAL test, GENEDIA Malaria (P. vivax) Ab Rapid I and GENEDIA Malaria (P. vivax) Ab Rapid II on 8 specimens with mean 120/microliter parasitemia and 16 specimens with negative parasitemia were 75~43.8%, 87.5~81.3%, 100~100% respectively. CONCLUSION: Our data demonstrated that the sensitivity and specificity of the GENEDIA Malaria (P. vivax) Ab Rapid I were not satisfactory, but the sensitivity and specificity of the OptiMAL test and GENEDIA Malaria (P. vivax) Ab Rapid II were relatively high and useful diagnostic tests for diagnosis of P. vivax in areas like the militaries where laboratory facilities are poor or non-existent.
Arm ; Diagnosis* ; Diagnostic Tests, Routine ; Hospitals, General ; Humans ; Malaria* ; Malaria, Vivax ; Microscopy ; Military Personnel* ; Parasitemia ; Plasmodium vivax* ; Plasmodium* ; Sensitivity and Specificity

Rapid diagnostic tests (RDTs) for malaria using antibodies against pan-Plasmodium antigen lactate dehydrogenase (pLDH) are commonly used for malaria diagnosis. The level of malaria parasitemia determined by peripheral blood smears (PBS) correlates with the pLDH concentration in most cases. We report a case of malaria recurrence associated with false-negative RDT results. A 22-year-old male patient was admitted to the Armed Forces Capital Hospital with fever and chills, and was diagnosed with malaria infection. Four days after antimalarial treatment, these symptoms recurred. After admitting to our hospital, doxycycline was administered for 4 days. Even after administration of doxycycline, the malaria parasites in blood smears remained positive, but RDT showed negative results. Therefore, for patients receiving doxycycline, serial blood smear testing should be performed to exclude false-negative malaria RDT results.
Antibodies ; Arm ; Chills ; Diagnosis ; Diagnostic Tests, Routine ; Doxycycline ; Fever ; Humans ; L-Lactate Dehydrogenase ; Malaria ; Male ; Parasitemia ; Parasites ; Recurrence ; Young Adult

BACKGROUND: In the Republic of Korea, Plasmodium vivax malaria, which had disappeared since 1984, re-emerged in 1993. Currently, malaria is becoming a serious public health problem in the Republic of Korea. The diagnosis of malaria has relied on microscopic examination such as thin and thick blood smears. However, even for expert microscopists, this test is a laborious and time-consuming procedure. Therefore, the development of a reliable, easy, and convenient diagnostic test is crucial. Recently, the LG malaria anti-PvTM enzyme-linked immunosorbent assay (ELISA) kit for the detection of a specific antibody against the merozoite surface protein (MSP) of P. vivax was developed. The aim of this study was to evaluate the diagnostic kit for P. vivax malaria in the Republic of Korea. METHODS: To determine the usefulness of the LG malaria anti-PvTM as a diagnostic kit for vivax malaria, a total of 59 serum samples from patients with P. vivax malaria were tested. The patients were diagnosed microscopically and the parasitemia index of their blood was calculated. Sera from 203 uninfected healthy blood donors, which were microscopically negative for Plasmodium vivax, were used as negative controls. RESULTS: The sensitivity and specificity of the LG malaria anti-PvTM were 98.31% (58/59) and 98.03% (199/203), respectively. The false-positive and false-negative rates were 1.97% (4/203) and 1.69% (1/59), respectively. CONCLUSIONS: The diagnostic kit, LG malaria anti-PvTM, might be a useful tool for diagnosis and screening of P. vivax malaria in Korea.
Blood Donors ; Diagnosis* ; Diagnostic Tests, Routine ; Enzyme-Linked Immunosorbent Assay ; Humans ; Korea ; Malaria* ; Malaria, Vivax* ; Mass Screening ; Merozoites ; Parasitemia ; Plasmodium vivax* ; Plasmodium* ; Public Health ; Republic of Korea* ; Sensitivity and Specificity

BACKGROUND: Microscopic examination of peripheral blood smears has been a standard diagnostic test for malarial infection for a long time, but it is labor-intensive and time-consuming. Recently, a rapid diagnostic test for malarial infection containing a dipstick bearing monoclonal antibodies against the intracellular metabolic enzyme, parasite lactate dehydrogenase (pLDH), was introduced (DiaMed OptiMAL(epsilon)). We evaluated the usefulness of the OptiMAL test in malaria diagnosis by comparing with a microscopic examination of peripheral blood smears. METHODS: Fifty-eight (initial 44 and follow-up 14) whole blood samples were obtained from 44 patients who were suspected of having malarial infection. After 1 drop of whole blood reacted with the dipstick, band numbers and positions on the dipsticks determined the results. All results were compared to those of microscopic examination findings. RESULTS: The OptiMAL test revealed 100% sensitivity and specificity by comparing with the microscopic examination. The intensity of stained bands showed positively correlated with the severity of parasitemia. The OptiMAL test revealed a more rapid negative conversion than the microscopic examination after treatment. CONCLUSIONS: The OptiMAL test is a simple, rapid and accurate test for diagnosis of malarial infection; moreover, it is good tool for monitoring after treatment.
Antibodies, Monoclonal ; Diagnosis* ; Diagnostic Tests, Routine ; Follow-Up Studies ; Humans ; L-Lactate Dehydrogenase ; Lactic Acid* ; Malaria* ; Parasitemia ; Parasites* ; Plasmodium ; Sensitivity and Specificity

BACKGROUND: There were no reports of any other species of Plasmodium except for P. vivax in Korea and the diagnosis of malaria has been made using microscopic examination of Giemsa-stained thick and thin blood films. This method is labor-intensive, time consuming and requires microscopic expertise. Therefore, the alternative techniques, rapid immunocapture assays, have been sought for use in the Korean Military. We performed an evaluation of the OptiMAL test to assess its sensitivity and treatment monitoring of Plasmodium vivax malaria. METHODS: We collected 77 whole blood in EDTA from 55 patients who were presented and diagnosed for P. vivax by microscopy of blood smears (thick and thin) at the Capital Armed Forces General Hospital (CAFGH) between May and October 2000. The OptiMAL test was performed according to the manufacturer's instructions on all samples. RESULTS: Compared with the blood film, the OptiMAL test identified 51 cases (83.6%) among 61 microscopy positive cases. Six cases were misinterpreted as Plasmodium falciparum. The diagnostic sensitivity of the OptiMAL test was 93.4% on 61 samples and 96.7% on 30 samples at a parasitemia level of more than 2,000/L parasites regardless of Plasmodium species. The discrepancy rate between the microscopy and the OptiMAL test is 38.1% in the samples from 21 patients at 2 or 3 days after treatment. CONCLUSIONS: Our data demonstrated that the OptiMAL test has limits and is not yet satisfactory to replace the conventional microscopy. However, regardless of the Plasmodium species the sensitivity of the OptiMAL test is relatively high and is comparable to that of microscopy in detecting malaria at the parasitemia level of more than 2,000/L parasites. It is an easy, rapid and useful tool in a field like the military.
Arm ; Diagnosis* ; Edetic Acid ; Hospitals, General ; Humans ; Korea ; Malaria ; Malaria, Vivax* ; Microscopy ; Military Personnel ; Parasitemia ; Parasites ; Plasmodium falciparum ; Plasmodium vivax* ; Plasmodium*