1/30/2018 CDC - Malaria - Diagnosis & Treatment (United States) - Diagnosis (U.S.

) - Rapid Diagnositc Test

Malaria Diagnosis (U.S.) – Rapid Diagnostic Test

A Rapid Diagnostic Test (RDT) is an alternate way of quickly establishing the

diagnosis of malaria infection by detecting specific malaria antigens in a person's
blood. RDTs have recently become available in the United States.

Technique
A blood specimen collected from the patient is applied to the sample pad on the test
card along with certain reagents. After 15 minutes, the presence of specific bands in
the test card window indicate whether the patient is infected with Plasmodium
falciparum or one of the other 3 species of human malaria. It is recommended that the
laboratory maintain a supply of blood containing P. falciparum for use as a positive
control.

Advantages
High-quality malaria microscopy is not always immediately available in every clinical
setting where patients might seek medical attention. Although this practice is
discouraged, many healthcare settings either save blood samples for malaria
microscopy until a qualified person is available to perform the test, or send the blood
samples to commercial or reference laboratories. These practices have resulted in
long delays in diagnosis. The laboratories associated with these health-care settings
may now use an RDT to more rapidly determine if their patients are infected with
malaria.

Binax NOW is the only brand of malaria RDT approved for use in the United
States. The picture above demonstrates a positive test for Plasmodium
falciparum. (Howden BP et al. Chronic falciparum malaria causing massive
splenomegaly 9 years after leaving an endemic area. MJA 2005; 185: 186-188.
©Copyright 2005. The Medical Journal of Australia - reproduced with
https://www.cdc.gov/malaria/diagnosis_treatment/rdt.html
permission.) 1/2
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Disadvantages
The use of the RDT does not eliminate the need for malaria microscopy. The RDT
may not be able to detect some infections with lower numbers of malaria parasites
circulating in the patient’s bloodstream. Also, there is insufficient data available to
determine the ability of this test to detect the 2 less common species of malaria, P.
ovale and P. malariae . Therefore all negative RDTs must be followed by microscopy to
confirm the result.

In addition, all positive RDTs also should be followed by microscopy. The currently
approved RDT detects 2 different malaria antigens; one is specific for P.
falciparum and the other is found in all 4 human species of malaria. Thus, microscopy
is needed to determine the species of malaria that was detected by the RDT. In
addition, microscopy is needed to quantify the proportion of red blood cells that are
infected, which is an important prognostic indicator.

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