Comparison of Giemsa Stain, Liu's Stain and Wright-Giemsa Stain in Malaria Microscopy Diagnosis

DOI: 10.6524/EB.202503_41(5).0001

Jen-Jen Hsu, Shih-Fen Hsu, Shu-Ying Li, Yi-Wen Lai, Chih-Rou Chiou

2025 Vol.41 NO.5

Correspondence Author： Shu-Ying Li

Abstract：

    Malaria continues to be a significant global public health concern, characterized by its severe and life-threatening nature. Plasmodium falciparum, the most dangerous species, can result in cerebral malaria with a mortality rate exceeding 10%. Because of the rapid disease progression and the fatal symptoms, a fast and correct diagnosis is crucial for malaria treatment and the prevention of community-wide transmission.
    Microscopy with blood smear has been considered the “gold standard” for malaria diagnosis. In this study, we compared three staining methods, namely Giemsa stain, Liu's stain, and Wright-Giemsa stain, commonly used in domestic and international diagnostic laboratories. We collected blood smears from 16 malaria cases to assess staining characteristics, including features like nuclei, cytoplasm, pigments, parasite morphology within red blood cells, Schüffner's dots, and Maurer's clefts.
    We found that Giemsa staining offered the most comprehensive identification of all malaria parasite morphology, but it was relatively time-consuming. However, considering that Taiwan has been malaria-free since 1965, experiencing no local malaria infection, and fewer than ten imported cases were reported in the last decade, not all hospitals maintained the Giemsa staining solution. Instead, Liu's staining and Wright-Giemsa staining methods were commonly preferred due to their simplicity and speed while still enabling species-level identification of Plasmodium parasites. Liu’s stain can better identify Plasmodium to species level and facilitate rapid diagnosis and therapy.