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Journal of Clinical Microbiology, April 2003, p. 1370-1374, Vol. 41, No. 4
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.4.1370-1374.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Diagnosis of Plasmodium falciparum Malaria at Delivery: Comparison of Blood Film Preparation Methods and of Blood Films with Histology

Stephen J. Rogerson,1,2,3* Patrick Mkundika,1 and Maxwell K. Kanjala1

Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi,1 School of Tropical Medicine, University of Liverpool, Liverpool, United Kingdom,2 Department of Medicine (RMH/WH), University of Melbourne, Parkville, Victoria 3052, Australia3

Received 7 October 2002/ Returned for modification 26 November 2002/ Accepted 14 January 2003

We compared peripheral and placental blood films (made by different techniques) with placental histology for diagnosis of Plasmodium falciparum malaria in pregnancy. Samples from 464 women were examined, of whom 124 (26.7%) had active P. falciparum infection and 148 (31.9%) had past infection. Placental histology was more sensitive (91%) than peripheral blood film (47%) or placental blood film (63%) examination and also detected past infection. Few women had microscopically detectable infection without a positive histology. Infection detected by histology only and past infection were both associated with significantly lower infant birth weight and with lower hemoglobin concentrations compared to the results for uninfected women. Thick blood films were prepared with blood obtained by placental incision or scraping of the incision margin (263 samples) or by washing of placental tissue (235 samples). Each gave similar sensitivities (76 to 78%), specificities (98 to 99%), positive predictive values (92 to 98%), and negative predictive values (93 to 94%); but the median levels of parasitemia were lower for incision samples (840 parasites/µl) than scrapings (2,295 parasites/µl) (P = 0.02). Placental histology is the most sensitive method for the diagnosis of malaria in pregnancy. Methods for preparation of placental films may affect the density, but not the prevalence, of P. falciparum infection detected.

* Corresponding author. Mailing address: Department of Medicine (RMH/WH), University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, Vic 3050, Australia. Phone: 61 3 9342 7701. Fax: 61 3 9347 1863. E-mail: sroger{at}unimelb.edu.au.

Journal of Clinical Microbiology, April 2003, p. 1370-1374, Vol. 41, No. 4
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.4.1370-1374.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Rogerson, S. J., Mwapasa, V., Meshnick, S. R. (2007). Malaria in Pregnancy: Linking Immunity and Pathogenesis to Prevention. Am J Trop Med Hyg 77: 14-22 [Abstract] [Full Text]  
  • Parekh, F. K., Hernandez, J. N., Krogstad, D. J., Casapia, W. M., Branch, O. H. (2007). Prevalence and Risk of Plasmodium falciparum and P. vivax Malaria among Pregnant Women Living in the Hypoendemic Communities of the Peruvian Amazon. Am J Trop Med Hyg 77: 451-457 [Abstract] [Full Text]  
  • BENET, A., KHONG, T. Y., URA, A., SAMEN, R., LORRY, K., MELLOMBO, M., TAVUL, L., BAEA, K., ROGERSON, S. J., CORTES, A. (2006). PLACENTAL MALARIA IN WOMEN WITH SOUTH-EAST ASIAN OVALOCYTOSIS.. Am J Trop Med Hyg 75: 597-604 [Abstract] [Full Text]  
  • COTTRELL, G., MARY, J.-Y., BARRO, D., COT, M. (2005). IS MALARIAL PLACENTAL INFECTION RELATED TO PERIPHERAL INFECTION AT ANY TIME OF PREGNANCY?. Am J Trop Med Hyg 73: 1112-1118 [Abstract] [Full Text]  


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