JOURNAL OF CLINICAL MICROBIOLOGY, Feb. 2005, p. 1011 Vol. 43, No.

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0095-1137/05/$08.00⫹0 doi:10.1128/JCM.43.2.1011.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Ineffectiveness of the Binax NOW Malaria Test for Diagnosis of

Plasmodium ovale Malaria
Malaria remains the most dangerous tropical disease for the and 1 was positive for P. malariae by microscopic examination
French troops deployed overseas. In 2003, 768 cases in the French (Table 1). PCR was used to detect all the infections and con-
army were declared along with an increase of incidence of 400% firm all microscopic identifications. The Binax NOW malaria

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in comparison with 2002, mainly due to the Licorne peacekeeping test detected all cases of P. vivax infection (9 of 9) but only 3 of
operation in Ivory Coast. In order to ensure fast diagnosis in the the 12 cases of P. ovale infection (25%). The test was positive
field, a rapid immunochromatographic test (NOW malaria test; in the only case of P. malariae infection. With P. falciparum, 89
Binax, Portland, Oreg.) has been provided to military doctors. cases were positive, and two false positives and one false neg-
This test detects the Plasmodium falciparum-specific HRP2 anti- ative were found.
gen and a panmalarial aldolase common to all species. The assay Considering these data, it seems that the Binax NOW ma-
is sensitive for the detection of P. falciparum (1) and Plasmodium laria test is not reliable for the detection of P. ovale infection.
vivax (2) but, in our experience, is poorly sensitive for the detec- This has been previously described in a study including nine
tion of Plasmodium ovale, a species involved in cases of malaria cases of P. ovale infection (2). The inability of the rapid im-
among the French troops in western Africa. munochromatographic test to detect P. ovale has been also
Between November 2002 and August 2004, 114 samples observed with the ICT Malaria P.f/P.v test (3, 4). The main
from patients presenting a malaria attack were analyzed in the explanation for the failure of the assay was low parasite den-
laboratory of the French military hospital of Bégin (Saint- sity, but in this study all infections due to P. ovale were de-
Mande, France). The Plasmodium species identified were P. tected by microscopic examination. The inaccuracy could be
falciparum (n ⫽ 93), P. ovale (n ⫽ 12), P. vivax (n ⫽ 9), and P. due to low production of the aldolase by P. ovale or, as sup-
malariae (n ⫽ 1). For each specimen, thin and thick blood posed by Mason et al., to regional variations in the genetic
films, the Binax NOW malaria test, and a specific SYBR green determinants of ICT panmalarial antigen (5). In case of sus-
real-time PCR using the Lightcycler instrument (Roche Diag- picion of malaria challenge, the diagnosis of infection with P.
nostics, Meylan, France) were used for diagnosis. This tech- ovale must not be elicited, and blood smear examination re-
nique is considered the “gold standard” in our laboratory. mains necessary for the elimination of the diagnosis.
Sequences used for the design of primers were the 18S RNA
genes of the four species (Table 1), which have been previously
REFERENCES
validated (data not shown). Thin and thick blood films were
stained with a rapid coloration set (Diff-Quick; Dade Behring, 1. Cavallo, J. D., E. Hernandez, P. Gerome, T. Debord, and R. Le Vagueresse.
1997. Serum HRP-2 antigens and imported Plasmodium falciparum malaria:
Newark, Del.) and examined by two experienced microscopists comparison of ParaSight-F and ICT malaria P.f. Med. Trop. 57:353–356.
during 20 min. The rapid immunochromatographic test was 2. Farcas, G. A., K. J. Zhong, F. E. Lovegrove, C. M. Graham, and K. C. Kain.
used according to the manufacturer’s recommendations. 2003. Evaluation of the Binax NOW ICT test versus polymerase chain reac-
Among the 22 patients infected with non-P. falciparum spe- tion and microscopy for the detection of malaria in returned travellers. Am. J.
Trop. Med. Hyg. 69:589–592.
cies, 9 were positive for P. vivax, 12 were positive for P. ovale, 3. Grobush, M. P., T. Hanscheid, T. Zoller, T. Jelinek, and G. D. Burchard.
2002. Rapid immunochrommatographic malaria antigen detection unreliable
for detecting Plasmodium malariae and Plasmodium ovale. Eur. J. Clin. Mi-
crobiol. Infect. Dis. 21:818–820.
4. Iqbal, J., N. Khalid, and P. Hira. 2002. Comparison of two commercial assays
with expert microscopy for confirmation of symptomatically diagnosed ma-
TABLE 1. Comparison of Binax NOW malaria test versus laria. J. Clin. Microbiol. 40:4675–4678.
microscopic examination and PCR 5. Mason, D. P., F. Kawamoto, K. Lin, A. Laoboonchai, and C. Wongsrichanalai.
2002. A comparison of two rapid field immunochromatographic tests to expert
No. of positive results microscopy in the diagnosis of malaria. Acta Trop. 82:51–59.
Organism (n) Antigenemia
Microscopy PCRa Christine Bigaillon*
assay
Eléonore Fontan
P. vivax (9) 9 9 9 Jean-Didier Cavallo
P. ovale (12) 12 3 12 Eric Hernandez
P. malariae (1) 1 1 1 Laboratory of Medical Microbiology
P. falciparum (93) 89 92 93
André Spiegel
a
The forward and reverse primer sequences were, respectively, as follows: North Department of Epidemiology and Public Health
for P. vivax, GAT ACT TCG TAT CGA CTT TGT GC (PVF) and CAA TCT HIA Bégin
AAG AAT AAA CTC CGA AGA GA (PVR); for P. ovale CCC TAT TCT TCT
94163 Saint-Mande Cedex, France
TAA TTC GCA (POF) and AGT GGA GGA AAA CTA TA (POR); for P.
malariae, TGT TTT TTT TAA TAA AAA CGT TCT TTT CC (PMF) and ACT
TTT CAG TGG AGG AAA ACT ATA TAT TCT (PMR); and for P. falcipa- *Phone: 33 1 43 98 47 33
rum, CTT TTG GCT TTA ATA CGC TTC (PFF) and TGA AGG AAG CAA Fax: 33 1 43 98 53 36
TCT AAA AGT CAC (PFR). E-mail: hia-begin-biologie@worldonline.fr

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