Enhancing safety of rapid and accurate malaria diagnosis in patients at risk for viral haemorrhagic fever

Background: Malaria and viral haemorrhagic fever (VHF) have overlapping symptomatology, creating clinical and diagnostic challenges within, and in travellers returning from, co-endemic areas. Rapid and accurate malaria diagnosis is critical, yet complicated by safety measures required for VHF. Methods: Diagnostic accuracies of the rapid Alethia Malaria loop-mediated isothermal amplification (LAMP) assay and EasyNAT Malaria cross-primer assay (CPA) were assessed for the detection of malaria in whole blood mixed with guanidine isothiocyanate (GITC)-based virucidal DNA/RNA Shield buffer. Results: Both the LAMP assay and the CPA performed excellent and detected DNA of Plasmodium spp. in all 47 mixtures. All mixtures without Plasmodium spp. DNA (n = 5) tested negative in both assays. Technical detection limit of both assays for P. falciparum was between 0.005 and 0.0005 parasites per microlitre of mixture. Conclusions: Rapid and accurate malaria diagnosis remains possible on whole blood mixed with this virucidal buffer. The buffer is available in blood collection tubes, which allows for enhanced safety of sample handling from bedside to bench. These tubes can be used in patients with high suspicion of malaria, but in whom VHF cannot be completely excluded.