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Objective  The main objective of this study was to compare the performance of nested PCR with expert microscopy as a means of detecting  Plasmodium  parasites during active malaria surveillance in western Thailand.    Methods  The study was performed from May 2000 to April 2002 in the village of Kong Mong Tha, located in western Thailand.  Plasmodium vivax  (PV) and  Plasmodium falciparum  (PF) are the predominant parasite species in this village, followed by  Plasmodium malariae  (PM) and  Plasmodium ovale  (PO). Each month, fingerprick blood samples were taken from each participating individual and used to prepare thick and thin blood films and for PCR analysis.    Results  PCR was sensitive (96%) and specific (98%) for malaria at parasite densities ≥ 500/μl; however, only 18% (47/269) of  P. falciparum - and 5% (20/390) of  P. vivax -positive films had parasite densities this high. Performance of PCR decreased markedly at parasite densities <500/μl, with sensitivity of only 20% for  P. falciparum  and 24% for  P. vivax  at densities <100 parasites/μl.    Conclusion  Although PCR performance appeared poor when compared to microscopy, data indicated that the discrepancy between the two methods resulted from poor performance of microscopy at low parasite densities rather than poor performance of PCR. These data are not unusual when the diagnostic method being evaluated is more sensitive than the reference method. PCR appears to be a useful method for detecting  Plasmodium  parasites during active malaria surveillance in Thailand.

Comparison of PCR and microscopy for the detection of asymptomatic malaria in a Plasmodium falciparum/vivax endemic area in Thailand