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Background  The use of saliva in diagnosis of infectious diseases is an attractive alternative to procedures that involve blood drawing. It promises to reduce risks associated with accidental needle pricks and improve patient compliance particularly in malaria survey and drug efficacy studies. Quantification of parasitaemia is useful in establishing severity of disease and in assessing individual patient response to treatment. In current practice, microscopy is the recommended technique, despite its limitations. This study measured the levels of  Plasmodium falciparum  lactate dehydrogenase ( Pf LDH) in saliva of malaria patients and investigated the relationship with blood parasitaemia.    Methods  Matched pre-treatment blood and saliva samples were collected from patients at Msambweni District Hospital, Kenya. Parasitaemia was determined and only those confirmed to be  Plasmodium falciparum  mono-infected were recruited.  Pf LDH was quantified in saliva using a commercial ELISA kit. A total of 175 samples were collected. Relationship between blood parasitaemia and concentration of  Pf LDH in saliva was determined using Pearson correlation statistics. F test was used to determine whether there is a significant difference between levels of  Pf LDH in saliva of patients with moderate to high parasitaemia and those with low parasitaemia.    Results  One-hundred and seventy-five patient samples were positive for malaria by microscopy. Of these, 62 (35%) tested positive for  Pf LDH in saliva, 113 (65%) were false negatives. For those that tested positive, (53) 85% were from patients with moderate to high parasitaemia while 9 (15%) were from patients with low parasitaemia. A correlation co-efficient of 0.18 indicated a weak positive relationship between the concentration of  Pf LDH in saliva and blood parasitaemia. There was a marginal difference between levels of  Pf LDH in saliva of patients with moderate to high parasitaemia and those with low parasitaemia [F (1, 59) = 1.83, p = 0.1807].    Conclusion  The results indicate that there is a weak correlation between levels of  Pf LDH in saliva and blood parasitaemia. This is weak association could be as a result of low sensitivity of the assay used as well as presence of inhibitors and proteases in saliva. Further studies should be focused towards reducing the number of false negatives and developing a customised assay that is specific for detection of  Pf LDH in saliva.

malaria journal

Unclear association between levels of Plasmodium falciparum lactate dehydrogenase (PfLDH) in saliva of malaria patients and blood parasitaemia: diagnostic implications?