Validation of RealAmp Method for the Diagnosis of Malaria in Endemic Areas of Brazil

Malaria Diagnosis Clinical Trial

Official title:

Validation of RealAmp Method for the Diagnosis of Malaria in Endemic Areas of Brazil

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02371395
• Other study ID #: 6619
• Status: Completed
• Start date: January 2015
• Est. completion date: June 2015

Study information

• Verified date: May 2015
• Source: Centers for Disease Control and Prevention
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Worldwide, approximately 2 billion people live in areas at risk for malaria with morbidity surpassing 250 million cases, with approximately 800,000 deaths, per year. Of the four species of malaria parasites that cause human infection, P. falciparum is responsible for the majority of severe malaria cases followed by P. vivax. Early and accurate diagnosis is essential for prompt and correct treatment, which can reduce the death rate and interrupt transmission. Currently, conventional methods for the diagnosis of malaria include microscopic examination of thin and thick blood smears and rapid diagnostic tests (RDTs). Light microscopy in practice typically detects parasitemia as low as 100 parasites/µl and it can differentiate species. The advantage of microscopy includes the ability to estimate parasitemia, the possibility to identify parasite stages, including gametocytes, and its low cost. However, this method is labor intensive, difficult to standardize, and requires well-trained microscopists. The majority of RDTs are based on detection of P. falciparum histidine-rich protein 2 (HRP-2) antigen and do not detect all malaria species. RDTs that detect lactose dehydrogenase (LDH) and aldolase generally broadly react with all four species of malaria parasites and therefore cannot differentiate among the species although efforts are underway to improve their performance for species detection. In settings where multiple malaria species co-circulate, molecular methods may be more reliable than microscopy and RDTs in accurately diagnosing the species of malaria parasites with low parasitemias. However, conventional molecular methods, such as nested polymerase chain reaction (nested PCR) or real-time PCR, are technically challenging and resource intensive and are generally restricted to reference laboratories due to the need for well-equipped laboratories. Recently, new molecular methods that can be used in field settings have been developed and this opens up new opportunities for exploring molecular tools for malaria diagnosis in endemic countries. With the objective of facilitating use of molecular tools for malaria control programs, the malaria laboratory at the Centers for Disease Control and Prevention (CDC) in Atlanta, USA developed a simple isothermal molecular method called Real-Time Fluorescence Loop-Mediated Isothermal Amplification (RealAmp) for the diagnosis of malaria. Currently, RealAmp primers exist for detecting the Plasmodium genus and the detection of P. falciparum and P. vivax species. The RealAmp method has great potential as a molecular tool for the diagnosis of malaria in the field (and other infections of major public health impact, such as HIV and tuberculosis). It can provide an alternative to conventional PCR-based diagnostic methods for field use in clinical and operational programs. The objective of this proposal is to validate the sensitivity of RealAmp for detection of malaria parasites in blood spots from patients with clinical diagnosis of malaria in two endemic states of Brazil with co-circulation of P. falciparum and P. vivax. In this evaluation, RealAmp and microscopic examination will be compared to a real-time PCR method as a reference test.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1000
• Est. completion date: June 2015
• Est. primary completion date: June 2015
• Accepts healthy volunteers: No
• Gender: All
• Age group: 7 Years and older

Eligibility

Inclusion Criteria:

• Age 7 years

• Signed informed consent for patients 18 years and older

• Signed parental/guardian consent form and assent from the patient (for those less than 18 years)

• Documented fever (auxiliary temperature greater than 37.5C) or self-reported fever in previous 24 hours in the absence of another obvious cause of fever

• First visit for current illness at the diagnostic post

Exclusion Criteria:

• Absence of fever or no history of fever

• Follow-up visit for the current illness

• No consent/assent to participate

• Antimalarial treatment use in previous 30 days

Related Conditions & MeSH terms

• Malaria
• Malaria Diagnosis

Intervention

Other:
• Realtime amplification (RealAmp)
Molecular assay for the diagnosis of malaria.

Locations

Country	Name	City	State
Brazil	Hospital do Jurua	Cruzeiro do Sul

Sponsors (2)

Lead Sponsor	Collaborator
Centers for Disease Control and Prevention	Evandro Chagas Institute of Clinical Research

Country where clinical trial is conducted

Brazil, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Malaria Diagnosis Using RealAmp and Microscopy.	These are the results of the different tests used in the evaluation.	12 months