Molecular diagnosis of malaria in the field: development of a novel 1-step nucleic acid lateral flow immunoassay for the detection of all 4 human Plasmodium spp. and its evaluation in Mbita, Kenya

Microscopy is frequently used for malaria diagnosis, but at low parasitemia, it becomes less sensitive and time consuming. Molecular tools allow for specific/sensitive diagnosis, but current formats, such as polymerase chain reaction (PCR) combined with gel electrophoresis and real-time PCR assays, are difficult to implement in resource-poor settings. Development of a simple, fast, sensitive, and specific detection system, nucleic acid lateral flow immunoassay (NALFIA) for amplified pan-Plasmodium PCR products, is described. The NALFIA lower detection limit is 0.3 to 3 parasites/μL, 10-fold more sensitive than gel electrophoresis analysis. Evaluating 650 clinically suspected malaria cases with the pan-Plasmodium assay under field conditions (rural Kenya) revealed that NALFIA detected more positives than microscopy (agreement, 95%; κ value = 0.85), and there was an excellent agreement between gel electrophoresis and NALFIA (98.5%; κ value = 0.96). In conclusion, NALFIA is more sensitive than microscopy and a good alternative to detect PCR products while circumventing using electricity or expensive equipment, making NALFIA the 1st step toward molecular field diagnosis.