Diagnosis of placental malaria in poorly fixed and processed placental tissue

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  • Liu, Yunhao
    • Affiliation: College of Arts and Sciences, Department of Statistics and Operations Research
  • Griffin, Jennifer B
    • Other Affiliation: RTI International, Research Triangle Park, NC, USA
  • Muehlenbachs, Atis
    • Other Affiliation: Department of Pathology, University of Washington, Seattle, WA, USA
  • Rogerson, Stephen J
    • Other Affiliation: Department of Medicine at Peter Doherty Institute, University of Melbourne, Melbourne, Australia
  • Bailis, Anya J
    • Other Affiliation: Division of Maternal–Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  • Sharma, Rajni
    • Other Affiliation: Immunopathology Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  • Sullivan, David J
    • Other Affiliation: W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
  • Tshefu, Antoinette K
    • Other Affiliation: Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
  • Landis, Sarah H
    • Other Affiliation: Glaxo- Smith-Kline, Worldwide Epidemiology, Uxbridge, Middlesex, UK
  • Kabongo, Jean-Marie M
    • Other Affiliation: Department of Medical Biology, Service of Pathology, University of Kinshasa Medical School and University Hospital, Kinshasa, Democratic Republic of the Congo
  • Taylor, Steve M
    • Other Affiliation: Division of Infectious Diseases & International Health and Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
  • Meshnick, Steven R.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Abstract Background 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). Methods 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). Results 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 %). Conclusions PCR and/or IHC are suitable diagnostics when the presence of formalin pigment substantially compromises placental histopathology.
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  • Article
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  • In Copyright
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  • Liu et al.
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  • English
Bibliographic citation
  • Malaria Journal. 2016 May 10;15(1):272
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  • BioMed Central

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