1921
Volume 97, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Most malaria testing is by rapid diagnostic tests (RDTs) that detect histidine-rich protein 2 (HRP2). Recently, several RDT manufacturers have developed highly sensitive RDTs (hsRDTs), promising a limit of detection (LOD) orders of magnitude lower than conventional RDTs. To model the added utility of hsRDTs, HRP2 concentration in Angolan outpatients was measured quantitatively using an ultrasensitive bead-based assay. The distribution of HRP2 concentration was bimodal in both afebrile and febrile patients. The conventional RDT was able to detect 81% of all HRP2-positive febrile patients and 52–77% of HRP2-positive afebrile patients. The added utility of hsRDTs was estimated to be greater in afebrile patients, where an hsRDT with a LOD of 200 pg/mL would detect an additional 50–60% of HRP2-positive persons compared with a conventional RDT with a LOD of 3,000 pg/mL. In febrile patients, the hsRDT would detect an additional 10–20% of cases. Conventional RDTs already capture the vast majority of symptomatic HRP2-positive individuals, and hsRDTs would have to reach a sufficiently low LOD approaching 200 pg/mL to provide added utility in identifying HRP2-positive, asymptomatic individuals.

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/content/journals/10.4269/ajtmh.17-0262
2017-10-11
2018-11-17
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References

  1. World Health Organization, 2010. Guidelines for the Treatment of Malaria, 2nd edition. Geneva, Switzerland: WHO.
  2. World Health Organization, 2015. World Malaria Report. Geneva, Switzerland: WHO.
  3. World Health Organization, 2015. Malaria Rapid Diagnostic Test Performance. Results of WHO Product Testing of Malaria RDTs: Round 6 (2014-2015). Geneva, Switzerland: WHO.
  4. Plucinski MM, ., 2017. Evaluating malaria case management at public health facilities in two provinces in Angola. Malar J 16: 186.[Crossref]
  5. Rogier E, ., 2017. Bead based immunoassay allows sub-picogram detection of histidine-rich protein 2 from Plasmodium falciparum and estimates reliability of malaria rapid diagnostic tests. PLoS One 12: e0172139.[Crossref]
  6. Kyabayinze DJ, Tibenderana JK, Odong GW, Rwakimari JB, Counihan H, , 2008. Operational accuracy and comparative persistent antigenicity of HRP2 rapid diagnostic tests for Plasmodium falciparum malaria in a hyperendemic region of Uganda. Malar J 7: 221.[Crossref]
  7. Aydin-Schmidt B, Mubi M, Morris U, Petzold M, Ngasala BE, Premji Z, Björkman A, Mårtensson A, , 2013. Usefulness of Plasmodium falciparum-specific rapid diagnostic tests for assessment of parasite clearance and detection of recurrent infections after artemisinin-based combination therapy. Malar J 12: 349.[Crossref]
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Supplementary Data

Supplemental Figure

  • Received : 30 Mar 2017
  • Accepted : 07 May 2017

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