{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T02:48:01Z","timestamp":1792723681582,"version":"4.5.0"},"reference-count":25,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,11]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    The five major\n                    <jats:italic>Plasmodium<\/jats:italic>\n                    spp. that cause human malaria appear similar under light microscopy, which raises the possibility that misdiagnosis could routinely occur in clinical settings. Assessing the extent of misdiagnosis is of particular importance for monitoring\n                    <jats:italic>P. knowlesi<\/jats:italic>\n                    , which cocirculates with the other\n                    <jats:italic>Plasmodium<\/jats:italic>\n                    spp. We performed a systematic review and meta-analysis of studies comparing the performance of microscopy and polymerase chain reaction (PCR) for diagnosing malaria in settings with co-circulation of the five\n                    <jats:italic>Plasmodium<\/jats:italic>\n                    spp. We assessed the extent to which co-circulation of\n                    <jats:italic>Plasmodium<\/jats:italic>\n                    parasites affects diagnostic outcomes. We fit a Bayesian hierarchical latent class model to estimate variation in microscopy sensitivity and specificity measured against PCR as the gold standard. Mean sensitivity of microscopy was low, yet highly variable across\n                    <jats:italic>Plasmodium<\/jats:italic>\n                    spp., ranging from 65.7% (95% confidence interval: 48.1\u201380.3%) for\n                    <jats:italic>P. falciparum<\/jats:italic>\n                    to 0.525% (95% confidence interval 0.0210\u20133.11%) for\n                    <jats:italic>P. ovale.<\/jats:italic>\n                    Observed PCR prevalence was positively correlated with estimated microscopic sensitivity and negatively correlated with estimated microscopic specificity, though the strength of the associations varied by species. Our analysis suggests that cocirculation of\n                    <jats:italic>Plasmodium<\/jats:italic>\n                    spp. undermines the accuracy of microscopy. Sensitivity was considerably lower for\n                    <jats:italic>P. knowlesi<\/jats:italic>\n                    ,\n                    <jats:italic>P. malariae<\/jats:italic>\n                    , and\n                    <jats:italic>P. ovale<\/jats:italic>\n                    . The negative association between specificity and prevalence imply that less frequently encountered species may be misdiagnosed as more frequently encountered species. Together, these results suggest that the burden of\n                    <jats:italic>P. knowlesi<\/jats:italic>\n                    ,\n                    <jats:italic>P. malariae<\/jats:italic>\n                    , and\n                    <jats:italic>P. ovale<\/jats:italic>\n                    may be underappreciated in a clinical setting.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.21-1155","type":"journal-article","created":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T10:31:02Z","timestamp":1670841062000},"page":"61-68","source":"Crossref","is-referenced-by-count":6,"title":["The Impact of Emerging Plasmodium knowlesi on Accurate Diagnosis by Light Microscopy: A Systematic Review and Modeling Analysis"],"prefix":"10.4269","volume":"108","author":[{"given":"John H.","family":"Huber","sequence":"first","affiliation":[{"name":"Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Koepfli","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. 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