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Although many improvements have been achieved, these solutions remain too expensive for most laboratories and clinics in developing countries. The low range HORIBA Medical Haematology Analyzer, Yumizen H550, now provides dedicated flags \u2018vivax malaria\u2019 and \u2018dengue fever\u2019 in routine blood testing, developed through machine learning methods, to be used as a screening tool for malaria and dengue fever in endemic areas. This study sought to evaluate the effectiveness of these flags under real clinical conditions.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 1420 samples were tested using the Yumizen H550 Haematology Analyzer, including 1339 samples from febrile patients among whom 202 were infected with malaria parasites (<jats:italic>Plasmodium vivax<\/jats:italic> only: 182, <jats:italic>Plasmodium falciparum<\/jats:italic> only: 18, both: 2), 210 were from febrile dengue infected patients, 3 were from afebrile dengue infected patients and 78 were samples from healthy controls, in an outpatient laboratory clinic in Mumbai, India. Microscopic examination was carried out as the confirmatory reference method for detection of malarial parasite, species identification and assessing parasitaemia based on different stages of parasite life cycle. Rapid diagnostic malarial antigen tests were used for additional confirmation. For dengue infection, NS1 antigen detection by ELISA was used as a diagnostic marker.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>For the automated vivax malaria flag, the original manufacturer\u2019s cut off yielded a sensitivity and specificity of 65.2% and 98.9% respectively with the ROC AUC of 0.9. After optimization of cut-off value, flag performance improved to 72% for sensitivity and 97.9% specificity. Additionally it demonstrated a positive correlation with increasing levels of parasitaemia. For the automated dengue fever flag it yielded a ROC AUC of 0.82 with 79.3% sensitivity and 71.5% specificity.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The results demonstrate a possibility of the effective use of automated infectious flags for screening vivax malaria and dengue infection in a clinical setting.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12936-020-03502-3","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T20:03:53Z","timestamp":1606161833000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Performance evaluation of machine learning-based infectious screening flags on the HORIBA Medical Yumizen H550 Haematology Analyzer for vivax malaria and dengue fever"],"prefix":"10.1186","volume":"19","author":[{"given":"Parag","family":"Dharap","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9662-7400","authenticated-orcid":false,"given":"Sebastien","family":"Raimbault","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,23]]},"reference":[{"key":"3502_CR1","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1007\/s004360050173","volume":"82","author":"MG Zalis","year":"1996","unstructured":"Zalis MG, Ferreira-da-Cruz MF, Balthazar-Guedes HC, Banic DM, Alecrim W, Souza JM, et al. 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Sebastien Raimbault is an employee of HORIBA Medical.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}},{"value":"This study, registered as reference IEC \/ 19 \/ 01, has received approval on 6th June 2019 for retrospective analysis from INDEPENDENT ETHICS COMMITTEE (IEC), Reg No. 1433 \/ 1999 G.B.B.S.D., ETHICS COMMITTEE REGISTRATION No. ECR \/ 196 \/ Indt \/ MH \/ 2014 issued under Rule 122 DD of Drugs & Cosmetics Rule 1945. Waiver of Informed consent had been requested and has been granted as protocol was meeting the following criteria: The research presents no more than \u201cminimal risk\u201d of harm to subjects. The waiver or alteration will not adversely affect the rights and welfare of the subjects. The research could not practicably be carried out without the waiver or alteration. The results of instrument generated suspect flags, though indicate the possibility of existence of an abnormality, are only for the technical assistance of laboratory personnel & are never directly conveyed to the clinician or patient without verification. Therefore, they do not have impact on the referring clinician\u2019s judgment or on the patient's state of mind.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"429"}}