Diagnostic accuracy of ICT- rapid diagnostic tests versus microscopy for malaria: A City-wide study from Karachi
DOI:
https://doi.org/10.55629/pakjpathol.v37i1.980Abstract
ABSTRACT
Objective: To assess the diagnostic accuracy of an Immunochromatographic Rapid Diagnostic Test (ICT-RDT) for the diagnosis of malaria, by comparing it with microscopy as the gold standard.
Material and Methods: A cross-sectional diagnostic accuracy study was conducted from July 20th to November 5th, 2025, at Karachi Institute of Medical Sciences and the Diagnostic and Research Laboratory, Liaquat University of Medical and Health Sciences, Karachi. Suspected malaria patients were enrolled. Venous blood samples were used for microscopy (thick and thin smears) and ICT-based RDT (HRP2/pLDH). Diagnostic indices (sensitivity, specificity, PPV, NPV) were calculated and compared with microscopy.
Results: Of the 341 enrolled patients, 218 (63.9%) had malaria parasite on microscopy. Majority of cases showed Plasmodium vivax (P. vivax) 195 (89.4%), followed by Plasmodium falciparum (P. falciparum) 18(8.2%) and mixed infections 5(2.2%). The ICT-RDT demonstrated a high diagnostic performance with a sensitivity of 94.49%, a specificity of 95.93%, and an accuracy of 95.0%. Sensitivity did not differ significantly between P. vivax and P. falciparum (92.8% vs. 95.6%). However, specificity (96.5% vs. 99.3%, p=0.022) and diagnostic accuracy (94.4% vs. 99.1%, p=0.0005) were significantly higher for P. falciparum. Mixed infections frequently appeared as single-species bands on RDTs.
Conclusion: In this study, the ICT-RDT demonstrated excellent overall performance with high diagnostic accuracy and proved to be a reliable frontline tool for routine clinical practice. However, the tendency to misclassify mixed infections as single-species bands requires careful interpretation.
Keywords: Immunohistographic test, Malaria rapid diagnostic test, Microscopy
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