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Volume 22, Number 2—February 2016
Letter

Transdermal Diagnosis of Malaria Using Vapor Nanobubbles

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To the Editor: Establishing reliable noninvasive methods for diagnosis of malaria has been a challenge. Lukianova-Helb et al. should be applauded for developing such a method on the basis of hemozoin (Hz) detection (1). The authors reported a proof of principle and are preparing for “large-scale studies in humans” (2). Such large endeavors should be based on firm evidence, so it is surprising that the results presented were from a single patient, remarkable for the unusual quadruple drug treatment (2). In such a scenario, to compensate for the limited data, the results should be of convincing scientific quality.

However, the case described raises several doubts that could have been addressed, such as the reliability of the diagnosis if only a thin film and a rapid test were used (co-infection excluded) and why parasitemia was not determined at the time of the device test (instead of 4 hours before and 9 hours after). What developmental stages were the parasites in at the time of the evaluation (for example, already early trophozoites containing Hz or Hz-rich gametocytes)? Why was the patient not re-evaluated to find out if repeated measurements would become appropriately negative (test-of-cure)?

The methods and results used in the study contrast with the extraordinary numbers for the limit of detection (LOD): 0.0001% in human blood and 0.00034% in a rodent model (1,2). However, the LOD is a virtual, inferred parasitemia rate based on the detection of free Hz added to uninfected blood (1). An LOD can be obtained from serially diluted cultures or samples (3). In rodent models, detection of Hz tends to be much easier (4). Moreover, in Plasmodium falciparum infections, only immature forms have been observed, with little or no detectable Hz (5).

The prospects of a noninvasive test for malaria are exciting. However, in times of cost restraints, any diagnostic test or intervention should provide sufficiently convincing results before consideration of resource-intensive large-scale trials.

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Maria Rebelo, Rita Grenho, Agnes Orban, and Thomas HänscheidComments to Author 

Author affiliations: Instituto de Medicina Molecular, Lisbon, Portugal (M. Rebelo, R. Grenho, T. Hänscheid); Budapest University of Technology and Economics, Budapest, Hungary (A. Orban); MTA-BME Lendulet Magneto-optical Spectroscopy Research Group, Budapest (A. Orban)

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References

  1. Lukianova-Hleb  EY, Campbell  KM, Constantinou  PE, Braam  J, Olson  JS, Ware  RE, Hemozoin-generated vapor nanobubbles for transdermal reagent- and needle-free detection of malaria. Proc Natl Acad Sci U S A. 2014;111:9005. DOIPubMed
  2. Lukianova-Hleb  E, Bezek  S, Szigeti  R, Khodarev  A, Kelley  T, Hurrell  A, Transdermal diagnosis of malaria using vapor nanobubbles. Emerg Infect Dis. 2015;21:11227. DOIPubMed
  3. Orbán  Á, Butykai  Á, Molnár  A, Pröhle  Z, Fülöp  G, Zelles  T, Evaluation of a novel magneto-optical method for the detection of malaria parasites. PLoS ONE. 2014;9:e96981. DOIPubMed
  4. Rebelo  M, Tempera  C, Bispo  C, Andrade  C, Gardner  R, Shapiro  HM, Light depolarization measurements in malaria: A new job for an old friend. Cytometry A. 2015;87:43745. DOIPubMed
  5. Rebelo  M, Shapiro  HM, Amaral  T, Melo-Cristino  J, Hänscheid  T. Haemozoin detection in infected erythrocytes for Plasmodium falciparum malaria diagnosis-prospects and limitations. Acta Trop. 2012;123:5861. DOIPubMed

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Cite This Article

DOI: 10.3201/eid2202.151203

Medline reports the first author should be "Orbán A" not "Orbán Á" in reference 3 "Orbán, Butykai, Molnár, Pröhle, Fülöp, Zelles, et al., 2014".

Medline reports the first author should be "Orbán A" not "Orbán Á" in reference 3 "Orbán, Butykai, Molnár, Pröhle, Fülöp, Zelles, et al., 2014".

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Table of Contents – Volume 22, Number 2—February 2016

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Thomas Hänscheid, Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Av Prof Egas Moniz, P-1649-028 Lisbon, Portugal

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Page created: January 19, 2016
Page updated: January 19, 2016
Page reviewed: January 19, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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