Clinical symptoms listed above, when associated with travel to countries that have identified malarial risk, suggest malaria as a diagnosis. Malaria tests are not routinely ordered by most physicians in developed countries so recognition of travel history is essential.
The classic and most used test is the blood smear on a microscope slide that is stained (Giemsa stain) to show the parasites inside red blood cells. Although this test is easily done, correct results are dependent on the technical skill of the lab technician who prepares and examines the slides with a microscope. Other tests based on immunologic principles exist, including RDT's (rapid diagnostic tests) approved for use in the U.S. in 2007 and the polymerase chain reaction (PCR) tests. These are not yet widely available and are more expensive than the traditional Giemsa blood smear. Some investigators suggest such immunologic based tests be confirmed with a Giemsa blood smear.
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