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It is morphologically similar to the human malaria parasite <jats:italic>Plasmodium malariae<\/jats:italic>, so molecular detection should be used to clearly discriminate between these <jats:italic>Plasmodium<\/jats:italic> species. This study aimed to quantify the rate at which <jats:italic>P. knowlesi<\/jats:italic> is misidentified as <jats:italic>P. malariae<\/jats:italic> by microscopy in endemic and non-endemic areas.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The protocol of this systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID\u2009=\u2009CRD42020204770). Studies reporting the misidentification of <jats:italic>P. knowlesi<\/jats:italic> as <jats:italic>P. malariae<\/jats:italic> by microscopy and confirmation of this by molecular methods in MEDLINE, Web of Science and Scopus were reviewed. The risk of bias in the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). The pooled prevalence and 95% confidence interval (CI) of the misidentification of <jats:italic>P. knowlesi<\/jats:italic> as <jats:italic>P. malariae<\/jats:italic> by microscopy were estimated using a random effects model. Subgroup analysis of the study sites was performed to demonstrate any differences in the misidentification rates in different areas. Heterogeneity across the included studies was assessed and quantified using Cochran\u2019s Q and I<jats:sup>2<\/jats:sup> statistics, respectively. Publication bias in the included studies was assessed using the funnel plot, Egger\u2019s test and contour-enhanced funnel plot.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among 375 reviewed studies, 11 studies with a total of 1569 confirmed <jats:italic>P. knowlesi<\/jats:italic> cases in humans were included. Overall, the pooled prevalence of the misidentification of <jats:italic>P. knowlesi<\/jats:italic> as <jats:italic>P. malariae<\/jats:italic> by microscopy was estimated at 57% (95% CI 37\u201377%, I<jats:sup>2<\/jats:sup>: 99.3%). Subgroup analysis demonstrated the highest rate of misidentification in Sawarak, Malaysia (87%, 95% CI 83\u201390%, I<jats:sup>2<\/jats:sup>: 95%), followed by Sabah, Malaysia (85%, 95% CI 79\u201392%, I<jats:sup>2<\/jats:sup>: 85.1%), Indonesia (16%, 95% CI 6\u201338%), and then Thailand (4%, 95% CI 2\u20139%, I<jats:sup>2<\/jats:sup>: 95%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Although the World Health Organization (WHO) recommends that all <jats:italic>P. malariae<\/jats:italic>-positive diagnoses made by microscopy in <jats:italic>P. knowlesi<\/jats:italic> endemic areas be reported as <jats:italic>P. malariae<\/jats:italic>\/<jats:italic>P. knowlesi<\/jats:italic> malaria, the possibility of microscopists misidentifying <jats:italic>P. knowlesi<\/jats:italic> as <jats:italic>P. malariae<\/jats:italic> is a diagnostic challenge. The use of molecular techniques in cases with <jats:italic>malariae<\/jats:italic>-like <jats:italic>Plasmodium<\/jats:italic> with high parasite density as determined by microscopy could help identify human <jats:italic>P. knowlesi<\/jats:italic> cases in non-endemic countries.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12936-021-03714-1","type":"journal-article","created":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T10:03:40Z","timestamp":1617962620000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Quantification of the misidentification of Plasmodium knowlesi as Plasmodium malariae by microscopy: an analysis of 1569 P. knowlesi cases"],"prefix":"10.1186","volume":"20","author":[{"given":"Aongart","family":"Mahittikorn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick Ramirez","family":"Masangkay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwuntida Uthaisar","family":"Kotepui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni De Jesus","family":"Milanez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9172-3615","authenticated-orcid":false,"given":"Manas","family":"Kotepui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,9]]},"reference":[{"key":"3714_CR1","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1128\/CMR.00079-12","volume":"26","author":"B Singh","year":"2013","unstructured":"Singh B, Daneshvar C. 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