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Likelihood Ratio (LR) in Emergency Medicine


Malaria or just fever?

Clinical Scenario

A 35 y/o man is brought to the ED by friends and left there alone, he has high fever, he is from Ghana and he has just arrived, he speaks english not so well and he is confused and agitated, so anamnesis is very difficult and you catch a only word “malaria”, you also know that africans often calls malaria every fever, but …
Clinical examination is normal except for the agitation state, but fever is very high (40,5°C), he has not headhache, no cough, no abdominal pain. It is night and microbiologist is not available for malaria microscopy test and you decide to perform, for the first time in your life, the rapid test…it is negative…

Can you trust it or the patient?


The sensitivity and specificity of rapid tests depend on antigen used and parassitemia, but in general they perform very well and could replace or extend standard microscopy. New interesting studies are performed with the use of combined test with encouraging results.


Katharine Abba et al
Rapid diagnostic tests for diagnosing uncomplicated P. falciparum malaria in endemic countries 
Cochrane Infectious Diseases Group Published Online: 6 JUL 2011

Mohon et al. 
Evaluation of the OnSite (Pf/Pan) rapid diagnostic test for diagnosis of clinical malaria 
Malaria Journal 2012 

Heutmekers et al
Evaluation of the malaria rapid diagnostic test SDFK90: detection of both PfHRP2 and Pf-pLDH 
Malaria Journal 2012 

Sun Xiaodong et al 
Diagnostic performance of CareStartTM malaria HRP2/pLDH (Pf/pan) combo test versus standard microscopy on falciparum and vivax malaria between China-Myanmar endemic borders 
Malaria Journal 2013

Ilenia Spallino


  1. How much cost?
    Better way to diagnosis of malaria is direct examination on thin and thick blood drop...
    But I am a Tropicalist... :-)

    So, when people come with fever, don't forget ask "unde venis?"

    (Sorry for my terrible english)

  2. Hi Piergiorgio, thank you very much for your comment, yes, gold standard is microscopy test, but you need an expert to perform it, and in some hospital it is not 24h available, anyway in most studies microscopy was used as a reference method with comparable results. It should costs about 2 €, but maybe it depends on the type.

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