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Volume 22, Number 2—February 2016

Transdermal Diagnosis of Malaria Using Vapor Nanobubbles

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In Response: The letter by Rebelo et al. (1) that questions our previously described noninvasive malaria diagnostics (2,3) misinterprets both articles. The main objection comes to our alleged call for “large-scale studies in humans”; no such statement appeared in our 2014 article (2), and in the 2015 article (3), we clearly stated that large-scale studies will be considered after the optimization of a new prototype and improving its sensitivity. The authors’ final questioning of our eligibility for resources is a nonscientific opinion.

Concerning the quality of the standard clinical diagnosis, both thin blood film analysis and rapid diagnostic test results were obtained in a certified US clinical laboratory and returned consistent data. The lack of re-evaluation of the patient and the diagnostic timing are indeed limitations but were caused by the clinical restrictions. Our goal in the 2015 article (3) was to demonstrate the first noninvasive diagnosis of malaria in a human, which was achieved. The additional parameters discussed in the letter were not the subject of this study. Their letter further misinterprets our 2014 study, stating that parasitemia was virtual in that article; in fact, we studied actual infections among mice (2).

The criticism of Rebelo et al. might have been fueled by their own limited detection of hemozoin with flow cytometry and microscopy (4), in which they used parasite cultures and an unspecified number of malaria patients. That the methods they used might not have performed well does not mean that the novel technology we described, based upon a different mechanism, would have the same limitations in detecting hemozoin.

In conclusion, we agree with the need for optimization of the technology and additional testing. We are currently developing and testing our technology in a malaria-endemic country. Nevertheless, the letter by Rebello et al. does not alter the fact that our novel noninvasive malaria diagnostic technology worked in a human.


Ekaterina Lukianova-Hleb, Sarah Bezek, Reka Szigeti, Alexander Khodarev, Thomas Kelley, Andrew Hurrell, Michail Berba, Nirbhay Kumar, Umberto D’Alessandro, and Dmitri Lapotko
Author affiliations: Rice University, Houston, Texas, USA (E. Lukianova-Hleb, D. Lapotko); Baylor College of Medicine, Houston (S. Bezek, R. Szigeti); Ben Taub General Hospital, Harris Health System, Houston (S. Bezek, R. Szigeti); X Instruments LLC, Fremont, California, USA (A. Khodarev); Precision Acoustics Ltd, Dorset, England, UK (T. Kelley, A. Hurrell); Standa UAB, Vilnius, Lithuania (M. Berba); Tulane University, New Orleans, Louisiana, USA (N. Kumar); Medical Research Council, Banjul, The Gambia (U. D’Alessandro); London School of Hygiene and Tropical Medicine, London, UK (U. D’Alessandro)



  1. Rebelo  M, Grenho  R, Orban  A, Hänscheid  T. Transdermal diagnosis of malaria using vapor nanobubbles. [letter]. Emerg Infect Dis. 2016;22:343.
  2. 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. DOIPubMedGoogle Scholar
  3. 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. DOIPubMedGoogle Scholar
  4. 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 . DOIPubMedGoogle Scholar


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DOI: 10.3201/eid2202.151829

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

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.