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Srivastava B, Sharma S, Swarnkar D, Ahmed N, Valecha N, Anvikar AR. Benefits of Lot Testing to Improve the Quality of Malaria Rapid Diagnostic Tests in India. Am J Trop Med Hyg 2024; 110:431-435. [PMID: 38350136 PMCID: PMC10919188 DOI: 10.4269/ajtmh.23-0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/02/2023] [Indexed: 02/15/2024] Open
Abstract
Since 2010, malaria rapid diagnostic tests (RDTs) are widely used to detect malaria. The Indian Council of Medical Research-National Institute of Malaria Research performed lot testing (LT) according to WHO procedures since 2016. Lot testing is performed to evaluate the lot-to-lot variation in performance of malaria RDTs. Four sets of positive quality control (QC) panels for P. falciparum (Pf) and P. vivax (Pv) and 10 negative panels tested RDTs. RDTs were reported as pass, failed, or deferred on the basis of WHO criteria. In the past 5 years, 275 lots containing 15,488 RDT kits for malaria diagnosis were subjected to LT. The monovalent RDTs (n = 1,216), based on either Pf histidine rich protein 2 (HRP2) or Pan-Plasmodium lactate dehydrogenase (Pan-pLDH) antigens, showed 90.4% sensitivity and 100% specificity, whereas RDTs based on HRP2 + Pan-pLDH or HRP2 + pLDH (n = 13,924) had sensitivity 95.6% and specificity 99.5%, respectively. RDTs based on PfHRP2 + Pv-pLDH + Pan-pLDH (n = 348) had 100% sensitivity and specificity. In a comparison between HRP2 + pLDH or HRP2 + Pan-pLDH to HRP2 + pLDH + Pan-pLDH RDTs, it was found that the sensitivity of PfHRP2 with Pan-pLDH RDTs (n = 2,382) was only 83%. Of the 275 lots analyzed, 15 lots of PfHRP2 with Pan-pLDH were deferred. The QC panel for Pf revealed a faint Pan band in the tested lots, which is a cause for concern. The results of deferred lots were reported to concerned government agencies. Quality-compromised RDTs may lead to an incorrect diagnosis. It is critical to have a QC system in place for effective malaria management.
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Affiliation(s)
- Bina Srivastava
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Supriya Sharma
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Deendayal Swarnkar
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Naseem Ahmed
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Neena Valecha
- Independent Malaria Technical Expert, New Delhi, India
| | - Anupkumar R. Anvikar
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
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Balmith M, Basson C, Brand SJ. The Malaria Burden: A South African Perspective. J Trop Med 2024; 2024:6619010. [PMID: 38434493 PMCID: PMC10907104 DOI: 10.1155/2024/6619010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/30/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024] Open
Abstract
Malaria is a deadly disease caused by protozoan pathogens of the Plasmodium parasite. Transmission to humans occurs through the bite of an infected female Anopheles mosquito. According to the World Health Organization (WHO), an estimated 247 million cases of malaria were recorded worldwide in 2021, with approximately 619 000 malaria deaths. The initial signs of malaria can be mild and challenging to diagnose due to the signs and symptoms being similar to those of other illnesses. The malaria burden remains largely concentrated in the WHO sub-Saharan African region and has been recognised as a significant contributor to morbidity and mortality. This review aims to contribute to the existing knowledge on malaria in South Africa, a region within sub-Saharan Africa, focusing on the epidemiology and life cycle of the malaria parasite as well as diagnostic approaches for detecting malaria. In addition, nonpharmacological and pharmacological interventions for treating and preventing malaria infections will also be discussed herein. While there has been a significant reduction in the global burden of this disease, malaria remains a public health issue in South Africa. As such, the implementation of effective preventative measures and strategies, early diagnosis, and appropriate treatment regimens are crucial to reducing the malaria burden in South Africa.
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Affiliation(s)
- Marissa Balmith
- Department of Pharmacology, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Charlise Basson
- Department of Physiology, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Sarel J. Brand
- Center of Excellence for Pharmaceutical Sciences, Department of Pharmacology, North-West University, Potchefstroom, South Africa
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Boualam MA, Corbara AG, Aboudharam G, Istria D, Signoli M, Costedoat C, Drancourt M, Pradines B. The millennial dynamics of malaria in the mediterranean basin: documenting Plasmodium spp. on the medieval island of Corsica. Front Med (Lausanne) 2023; 10:1265964. [PMID: 38143446 PMCID: PMC10739463 DOI: 10.3389/fmed.2023.1265964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction The lack of well-preserved material upon which to base the paleo-microbiological detection of Plasmodium parasites has prevented extensive documentation of past outbreaks of malaria in Europe. By trapping intact erythrocytes at the time of death, dental pulp has been shown to be a suitable tissue for documenting ancient intraerythrocytic pathogens such as Plasmodium parasites. Methods Total DNA and proteins extracted from 23 dental pulp specimens collected from individuals exhumed from the 9th to 13th century archaeological site in Mariana, Corsica, were analyzed using open-mind paleo-auto-immunohistochemistry and direct metagenomics, Plasmodium-targeting immunochromatography assays. All experiments incorporated appropriate negative controls. Results Paleo-auto-immunohistochemistry revealed the presence of parasites Plasmodium spp. in the dental pulp of nine teeth. A further immunochromatography assay identified the presence of at least one Plasmodium antigen in nine individuals. The nine teeth, for which the PfHRP-2 antigen specific of P. falciparum was detected, were also positive using paleo-autoimmunohistochemistry and metagenomics. Conclusion Dental pulp erythrocytes proved to be suitable for the direct paleomicrobiology documentation of malaria in nine individuals buried in medieval Corsica, in agreement with historical data. This provides additional information on the millennial dynamics of Plasmodium spp. in the Mediterranean basin.
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Affiliation(s)
- Mahmoud Abdelwadoud Boualam
- IHU Méditerranée Infection, Marseille, France
- Aix-Marseille Univ, Institut de recherche pour le développement , Microbes, Evolution, Phylogénie et Infection, IHU Méditerranée Infection, Marseille, France
| | - Anne-Gaëlle Corbara
- Aix-Marseille Univ, Centre national de la recherche scientifique, LA3M, Aix-en-Provence, France
| | - Gérard Aboudharam
- IHU Méditerranée Infection, Marseille, France
- Aix-Marseille Univ, Institut de recherche pour le développement , Microbes, Evolution, Phylogénie et Infection, IHU Méditerranée Infection, Marseille, France
| | - Daniel Istria
- Aix-Marseille Univ, Centre national de la recherche scientifique, LA3M, Aix-en-Provence, France
| | - Michel Signoli
- Aix-Marseille Université, Centre national de la recherche scientifique, Établissement français du sang, Anthropologie bio-culturelle, droit, éthique et santé, Marseille, France
| | - Caroline Costedoat
- Aix-Marseille Université, Centre national de la recherche scientifique, Établissement français du sang, Anthropologie bio-culturelle, droit, éthique et santé, Marseille, France
| | - Michel Drancourt
- IHU Méditerranée Infection, Marseille, France
- Aix-Marseille Univ, Institut de recherche pour le développement , Microbes, Evolution, Phylogénie et Infection, IHU Méditerranée Infection, Marseille, France
| | - Bruno Pradines
- IHU Méditerranée Infection, Marseille, France
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
- Aix-Marseille Univ, Institut de recherche pour le développement, Service de Santé des Armées, Assistance publique - Hôpitaux de Marseille, VITROME, Marseille, France
- Centre National de Référence du Paludisme, Marseille, France
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Soriano-Pérez MJ, Castillo-Fernández N, Lozano-Serrano AB, Luzón-García MP, Vázquez-Villegas J, Cabeza-Barrera MI, Borrego-Jiménez J, Giménez-López MJ, Salas-Coronas J. Estimation of parasitaemia in imported falciparum malaria using the results of a combined rapid diagnostic test. No big help from haematological parameters. Malar J 2023; 22:351. [PMID: 37974257 PMCID: PMC10655380 DOI: 10.1186/s12936-023-04781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Microscopy continues to be the mainstay for the evaluation of parasitaemia in malaria but requires laboratory support and microbiological experience. Other fast and simple methods are necessary. METHODS A retrospective observational study of imported malaria treated from July-2007 to December-2020 was carried out to evaluate the association between the degree of parasitaemia and both rapid diagnostic tests (RDT) reactivity patterns and haematological parameters. Plasmodium falciparum monoinfections diagnosed by peripheral blood smear and/or polymerase chain reaction (PCR),which also had a positive RDT result in the same blood sample, were included in the study. RESULTS A total of 273 patients were included. Most of them were male (n = 256; 93.8%) and visiting friends and relatives (VFR) travellers (n = 252; 92.3%). Patients with plasmodial lactate dehydrogenase (pLDH) or aldolase and histidine-rich protein 2 (HRP-2) co-reactivity (Pan/Pf pattern) had a parasitaemia range between 0 and 37% while those with just HRP-2 reactivity (P. falciparum pattern) had ranges between 0 and 1%. Not a single case of P. falciparum pattern was found for parasitaemia ranges greater than 1%, showing a negative predictive value of 100% for high parasitaemia. All the correlations between haematological parameters and parasitaemia resulted to be weak, with a maximum rho coefficient of -0.35 for lymphocytes and platelets, and of 0.40 for neutrophils-to-lymphocytes count ratio. Multivariate predictive models were constructed reflecting a poor predictive capacity. CONCLUSIONS The reactivity pattern of RDT allows a rapid semi-quantitative assessment of P. falciparum parasitaemia in travellers with imported malaria, discriminating patients with lower parasite loads. Haematological parameters were not able to estimate parasitaemia with sufficient precision.
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Affiliation(s)
- Manuel Jesús Soriano-Pérez
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - Nerea Castillo-Fernández
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain.
| | - Ana Belén Lozano-Serrano
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - María Pilar Luzón-García
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - José Vázquez-Villegas
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - María Isabel Cabeza-Barrera
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - Jaime Borrego-Jiménez
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | | | - Joaquín Salas-Coronas
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
- Department of Nursing, Physiotherapy and Medicine. Faculty of Health Sciences, University of Almeria, Almeria, Spain
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Nguyen ST, Du D, Wychrij D, Cain MD, Wu Q, Klein RS, Russo I, Goldberg DE. Histidine-rich protein II nanoparticle delivery of heme iron load drives endothelial inflammation in cerebral malaria. Proc Natl Acad Sci U S A 2023; 120:e2306318120. [PMID: 37307435 PMCID: PMC10293821 DOI: 10.1073/pnas.2306318120] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/19/2023] [Indexed: 06/14/2023] Open
Abstract
Histidine-rich protein II (HRPII) is secreted by Plasmodium falciparum during the blood stage of malaria infection. High plasma levels of HRPII are associated with cerebral malaria, a severe and highly fatal complication of malaria. HRPII has been shown to induce vascular leakage, the hallmark of cerebral malaria, in blood-brain barrier (BBB) and animal models. We have discovered an important mechanism for BBB disruption that is driven by unique features of HRPII. By characterizing serum from infected patients and HRPII produced by P. falciparum parasites in culture, we found that HRPII exists in large multimeric particles of 14 polypeptides that are richly laden with up to 700 hemes per particle. Heme loading of HRPII is required for efficient binding and internalization via caveolin-mediated endocytosis in hCMEC/D3 cerebral microvascular endothelial cells. Upon acidification of endolysosomes, two-thirds of the hemes are released from acid-labile binding sites and metabolized by heme oxygenase 1, generating ferric iron and reactive oxygen species. Subsequent activation of the NLRP3 inflammasome and IL-1β secretion resulted in endothelial leakage. Inhibition of these pathways with heme sequestration, iron chelation, or anti-inflammatory drugs protected the integrity of the BBB culture model from HRPII:heme. Increased cerebral vascular permeability was seen after injection of young mice with heme-loaded HRPII (HRPII:heme) but not with heme-depleted HRPII. We propose that during severe malaria infection, HRPII:heme nanoparticles in the bloodstream deliver an overwhelming iron load to endothelial cells to cause vascular inflammation and edema. Disrupting this process is an opportunity for targeted adjunctive therapies to reduce the morbidity and mortality of cerebral malaria.
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Affiliation(s)
- Suong T. Nguyen
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO63110
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO63110
| | - Daniel Du
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO63110
| | - Daniel Wychrij
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO63110
| | - Matthew D. Cain
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO63110
| | - Qingping Wu
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO63110
| | - Robyn S. Klein
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO63110
| | - Ilaria Russo
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO63110
| | - Daniel E. Goldberg
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO63110
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO63110
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Urine and Saliva: Relevant Specimens for Malaria Diagnosis? Diagnostics (Basel) 2022; 12:diagnostics12122989. [PMID: 36552996 PMCID: PMC9777261 DOI: 10.3390/diagnostics12122989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Blood remains the specimen of preference for malaria diagnosis, whether it is for microscopic, nucleic acid-based or biomarker detection of Plasmodium present in a patient. However, concerning the disadvantages of blood drawing, specimens that can be non-invasively collected under non-hygienic settings would come in handy for malaria diagnosis in endemic areas with limited resources. Although the current approaches using saliva or urine might not be as sensitive and specific as using blood, the potential of these two specimens should not be underestimated and efforts in developing diagnostic methods for Plasmodium detection specifically in these two specimens should continue without giving up. This review not only compiles and summarizes the sensitivity and specificity achieved by various detection approaches when using these samples for malaria diagnosis, it also intends to enhance the possibility of using saliva and urine for diagnostic purposes by describing how Plasmodium nucleic acid and antigens may likely be present in these samples. This review may hopefully encourage and motivate researchers in developing saliva- and urine-based diagnostic methods for Plasmodium detection to facilitate the control and eradication of malaria. In summary, the presence of Plasmodium DNA and antigens in urine and saliva makes these two specimens relevant and useful for malaria diagnosis.
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Agbana HB, Rogier E, Lo A, Abukari Z, Jones S, Gyan B, Aidoo M, Amoah LE. Detecting asymptomatic carriage of Plasmodium falciparum in southern Ghana: utility of molecular and serological diagnostic tools. Malar J 2022; 21:57. [PMID: 35183178 PMCID: PMC8858553 DOI: 10.1186/s12936-022-04078-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background Asymptomatic malaria infections can serve as potential reservoirs for malaria transmission. The density of parasites contained in these infections range from microscopic to submicroscopic densities, making the accurate detection of asymptomatic parasite carriage highly dependent on the sensitivity of the tools used for the diagnosis. This study sought to evaluate the sensitivities of a variety of molecular and serological diagnostic tools at determining the prevalence of asymptomatic Plasmodium falciparum parasite infections in two communities with varying malaria parasite prevalence. Methods Whole blood was collected from 194 afebrile participants aged between 6 and 70 years old living in a high (Obom) and a low (Asutsuare) malaria transmission setting of Ghana. Thick and thin blood smears, HRP2 based malaria rapid diagnostic test (RDT) and filter paper dried blood spots (DBS) were prepared from each blood sample. Genomic DNA was extracted from the remaining blood and used in Plasmodium specific photo-induced electron transfer polymerase chain reaction (PET-PCR) and Nested PCR, whilst the HRP2 antigen content of the DBS was estimated using a bead immunoassay. A comparison of malaria parasite prevalence as determined by each method was performed. Results Parasite prevalence in the high transmission site of Obom was estimated at 71.4%, 61.9%, 60%, 37.8% and 19.1% by Nested PCR, the HRP2 bead assay, PET-PCR, HRP2-RDT and microscopy respectively. Parasite prevalence in the low transmission site of Asutsuare was estimated at 50.1%, 11.2%, 5.6%, 0% and 2.2% by Nested PCR, the HRP2 bead assay, PET-PCR, RDT and microscopy, respectively. The diagnostic performance of Nested PCR, PET-PCR and the HRP2 bead assay was similar in Obom but in Asutsuare, Nested PCR had a significantly higher sensitivity than PET-PCR and the HRP2 bead assay, which had similar sensitivity. Conclusions Nested PCR exhibited the highest sensitivity by identifying the highest prevalence of asymptomatic P. falciparum in both the high and low parasite prevalence settings. However, parasite prevalence estimated by the HRP2 bead assay and PET-PCR had the highest level of inter-rater agreement relative to all the other tools tested and have the advantage of requiring fewer processing steps relative to Nested PCR and producing quantitative results. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04078-w.
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Kong A, Wilson SA, Ah Y, Nace D, Rogier E, Aidoo M. HRP2 and HRP3 cross-reactivity and implications for HRP2-based RDT use in regions with Plasmodium falciparum hrp2 gene deletions. Malar J 2021; 20:207. [PMID: 33926477 PMCID: PMC8086288 DOI: 10.1186/s12936-021-03739-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/19/2021] [Indexed: 01/29/2023] Open
Abstract
Background The Plasmodium falciparum antigen histidine rich protein 2 (HRP2) is a preferred target for malaria rapid diagnostic tests (RDTs) because of its abundant production by the parasite and thermal stability. As a result, a majority of RDTs procured globally target this antigen. However, previous reports from South America and recent reports from sub-Saharan Africa and Asia indicate that certain P. falciparum parasites have deletions of the gene coding for HRP2. The HRP2 antigen is paralogous to another P. falciparum antigen HRP3 and some antibodies to HRP2 cross-react with HRP3. Multiple parasites have been described with deletions of one or both hrp2 and hrp3 genes. It is unclear how the various combinations of hrp2 and hrp3 deletion genotypes affect clinical sensitivity of HRP2-based RDTs. Methods Cross-reactivity between HRP2 and HRP3 was tested on malaria RDTs using culture-adapted P. falciparum parasites with both hrp2 and hrp3 intact or with one or both genes deleted. Ten-fold serial dilutions of four culture-adapted P. falciparum parasites [3D7 (hrp2+/hrp3+), Dd2 (hrp2−/hrp3+), HB3 (hrp2+/hrp3−) and 3BD5 (hrp2−/hrp3−)] ranging from 100,000 to 0.01 parasites/µL were prepared. HRP2, Plasmodium lactate dehydrogenase (pLDH) and aldolase concentrations were determined for the diluted samples using a multiplex bead assay. The samples were subsequently tested on three RDT products designed to detect P. falciparum by HRP2 alone or in combination with pLDH. Results At parasite densities of approximately 1000 parasites/µL, parasites that expressed either hrp2 or hrp3 were detected by all three RDTs. Multiplex based antigen measurement using HRP2- conjugated beads demonstrated higher antigen concentration when both hrp2 and hrp3 genes were intact (3D7 parasites, 47.9 ng/ml) compared to HB3 (3.02 ng/mL) and Dd2 (0.20 ng/mL) strains that had one gene deleted. 3D7 at 10 parasites/µL (0.45 ng/mL) was reactive on all three RDT products whereas none of the other parasites were reactive at that density. Conclusions Above a certain antigen threshold, HRP3 cross-reactivity on HRP2-based RDTs is sufficient to mask the effects of deletions of hrp2 only. Studies of hrp2 deletion and its effects on HRP2-based RDTs must be studied alongside hrp3 deletions and include clinical sample reactivity on HRP2-based tests.
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Affiliation(s)
- Amy Kong
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Scott A Wilson
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.,The CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, GA, 30308, USA
| | - Yong Ah
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.,The CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, GA, 30308, USA
| | - Douglas Nace
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Eric Rogier
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Michael Aidoo
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.
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Gass K. Time for a diagnostic sea-change: Rethinking neglected tropical disease diagnostics to achieve elimination. PLoS Negl Trop Dis 2020; 14:e0008933. [PMID: 33382694 PMCID: PMC7774841 DOI: 10.1371/journal.pntd.0008933] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Katherine Gass
- Task Force for Global Health, Decatur, Georgia, United States of America
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10
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Gatton ML, Chaudhry A, Glenn J, Wilson S, Ah Y, Kong A, Ord RL, Rees-Channer RR, Chiodini P, Incardona S, Cheng Q, Aidoo M, Cunningham J. Impact of Plasmodium falciparum gene deletions on malaria rapid diagnostic test performance. Malar J 2020; 19:392. [PMID: 33148265 PMCID: PMC7640408 DOI: 10.1186/s12936-020-03460-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Malaria rapid diagnostic tests (RDTs) have greatly improved access to diagnosis in endemic countries. Most RDTs detect Plasmodium falciparum histidine-rich protein 2 (HRP2), but their sensitivity is seriously threatened by the emergence of pfhrp2-deleted parasites. RDTs detecting P. falciparum or pan-lactate dehydrogenase (Pf- or pan-LDH) provide alternatives. The objective of this study was to systematically assess the performance of malaria RDTs against well-characterized pfhrp2-deleted P. falciparum parasites. Methods Thirty-two RDTs were tested against 100 wild-type clinical isolates (200 parasites/µL), and 40 samples from 10 culture-adapted and clinical isolates of pfhrp2-deleted parasites. Wild-type and pfhrp2-deleted parasites had comparable Pf-LDH concentrations. Pf-LDH-detecting RDTs were also tested against 18 clinical isolates at higher density (2,000 parasites/µL) lacking both pfhrp2 and pfhrp3. Results RDT positivity against pfhrp2-deleted parasites was highest (> 94%) for the two pan-LDH-only RDTs. The positivity rate for the nine Pf-LDH-detecting RDTs varied widely, with similar median positivity between double-deleted (pfhrp2/3 negative; 63.9%) and single-deleted (pfhrp2-negative/pfhrp3-positive; 59.1%) parasites, both lower than against wild-type P. falciparum (93.8%). Median positivity for HRP2-detecting RDTs against 22 single-deleted parasites was 69.9 and 35.2% for HRP2-only and HRP2-combination RDTs, respectively, compared to 96.0 and 92.5% for wild-type parasites. Eight of nine Pf-LDH RDTs detected all clinical, double-deleted samples at 2,000 parasites/µL. Conclusions The pan-LDH-only RDTs evaluated performed well. Performance of Pf-LDH-detecting RDTs against wild-type P. falciparum does not necessarily predict performance against pfhrp2-deleted parasites. Furthermore, many, but not all HRP2-based RDTs, detect pfhrp2-negative/pfhrp3-positive samples, with implications for the HRP2-based RDT screening approach for detection and surveillance of HRP2-negative parasites.
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Affiliation(s)
| | - Alisha Chaudhry
- Queensland University of Technology, Brisbane, QLD, Australia
| | | | | | - Yong Ah
- The CDC Foundation, Atlanta, GA, USA
| | - Amy Kong
- Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - Peter Chiodini
- Hospital for Tropical Diseases, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - Sandra Incardona
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Diseases Institute (FORMERLY Australian Army Malaria Institute), Brisbane, QLD, Australia
| | - Michael Aidoo
- Centers for Disease Control and Prevention, Atlanta, USA
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Mehlotra RK, Howes RE, Cramer EY, Tedrow RE, Rakotomanga TA, Ramboarina S, Ratsimbasoa AC, Zimmerman PA. Plasmodium falciparum Parasitemia and Band Sensitivity of the SD Bioline Malaria Ag P.f/Pan Rapid Diagnostic Test in Madagascar. Am J Trop Med Hyg 2020; 100:1196-1201. [PMID: 30834883 DOI: 10.4269/ajtmh.18-1013] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Current malaria rapid diagnostic tests (RDTs) contain antibodies against Plasmodium falciparum-specific histidine-rich protein 2 (PfHRP2), Plasmodium lactate dehydrogenase (pLDH), and aldolase in various combinations. Low or high parasite densities/target antigen concentrations may influence the accuracy and sensitivity of PfHRP2-detecting RDTs. We analyzed the SD Bioline Malaria Ag P.f/Pan RDT performance in relation to P. falciparum parasitemia in Madagascar, where clinical Plasmodium vivax malaria exists alongside P. falciparum. Nine hundred sixty-three samples from patients seeking care for suspected malaria infection were analyzed by RDT, microscopy, and Plasmodium species-specific, ligase detection reaction-fluorescent microsphere assay (LDR-FMA). Plasmodium infection positivity by these diagnostics was 47.9%, 46.9%, and 58%, respectively. Plasmodium falciparum-only infections were predominant (microscopy, 45.7%; LDR-FMA, 52.3%). In all, 16.3% of P. falciparum, 70% of P. vivax, and all of Plasmodium malariae, Plasmodium ovale, and mixed-species infections were submicroscopic. In 423 P. falciparum mono-infections, confirmed by microscopy and LDR-FMA, the parasitemia in those who were positive for both the PfHRP2 and pan-pLDH test bands was significantly higher than that in those who were positive only for the PfHRP2 band (P < 0.0001). Plasmodium falciparum parasitemia in those that were detected as P. falciparum-only infections by microscopy but P. falciparum mixed infections by LDR-FMA also showed similar outcome by the RDT band positivity. In addition, we used varying parasitemia (3-0.0001%) of the laboratory-maintained 3D7 strain to validate this observation. A positive pLDH band in high P. falciparum-parasitemic individuals may complicate diagnosis and treatment, particularly when the microscopy is inconclusive for P. vivax, and the two infections require different treatments.
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Affiliation(s)
- Rajeev K Mehlotra
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rosalind E Howes
- Nuffield Department of Medicine, Oxford Big Data Institute, University of Oxford, Oxford, United Kingdom.,Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Estee Y Cramer
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Riley E Tedrow
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Tovonahary A Rakotomanga
- Faculty of Sciences, University of Antananarivo, Antananarivo, Madagascar.,National Malaria Control Program, Ministry of Health, Antananarivo, Madagascar
| | - Stéphanie Ramboarina
- Faculty of Sciences, University of Antananarivo, Antananarivo, Madagascar.,Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Arsène C Ratsimbasoa
- Faculty of Sciences, University of Antananarivo, Antananarivo, Madagascar.,National Malaria Control Program, Ministry of Health, Antananarivo, Madagascar
| | - Peter A Zimmerman
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
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12
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Cunningham J, Jones S, Gatton ML, Barnwell JW, Cheng Q, Chiodini PL, Glenn J, Incardona S, Kosack C, Luchavez J, Menard D, Nhem S, Oyibo W, Rees-Channer RR, Gonzalez I, Bell D. A review of the WHO malaria rapid diagnostic test product testing programme (2008-2018): performance, procurement and policy. Malar J 2019; 18:387. [PMID: 31791354 PMCID: PMC6889598 DOI: 10.1186/s12936-019-3028-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
Malaria rapid diagnostic tests (RDTs) emerged in the early 1990s into largely unregulated markets, and uncertain field performance was a major concern for the acceptance of tests for malaria case management. This, combined with the need to guide procurement decisions of UN agencies and WHO Member States, led to the creation of an independent, internationally coordinated RDT evaluation programme aiming to provide comparative performance data of commercially available RDTs. Products were assessed against Plasmodium falciparum and Plasmodium vivax samples diluted to two densities, along with malaria-negative samples from healthy individuals, and from people with immunological abnormalities or non-malarial infections. Three measures were established as indicators of performance, (i) panel detection score (PDS) determined against low density panels prepared from P. falciparum and P. vivax wild-type samples, (ii) false positive rate, and (iii) invalid rate, and minimum criteria defined. Over eight rounds of the programme, 332 products were tested. Between Rounds 1 and 8, substantial improvements were seen in all performance measures. The number of products meeting all criteria increased from 26.8% (11/41) in Round 1, to 79.4% (27/34) in Round 8. While products submitted to further evaluation rounds under compulsory re-testing did not show improvement, those voluntarily resubmitted showed significant increases in P. falciparum (p = 0.002) and P. vivax PDS (p < 0.001), with more products meeting the criteria upon re-testing. Through this programme, the differentiation of products based on comparative performance, combined with policy changes has been influential in the acceptance of malaria RDTs as a case-management tool, enabling a policy of parasite-based diagnosis prior to treatment. Publication of product testing results has produced a transparent market allowing users and procurers to clearly identify appropriate products for their situation, and could form a model for introduction of other, broad-scale diagnostics.
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Affiliation(s)
- Jane Cunningham
- World Health Organization (WHO), Global Malaria Programme, 20 Appia Avenue, 1211, Geneva, Switzerland.
| | - Sophie Jones
- Independent Consultant, Bedford Hill, Balham, London, SW12 9HR, UK.,Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Bldg. 23, Room 10-169, 1600 Clifton Road, Mailstop D-67, Atlanta, GA, 30329, USA
| | - Michelle L Gatton
- School of Public Health and Social Work, Queensland University of Technology (QUT), 2 George St, Brisbane, QLD, Australia
| | - John W Barnwell
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, 30329, USA
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Disease Institute (ADFMIDI), Gallipoli Barracks Enoggera, 4051, Brisbane, Australia
| | - Peter L Chiodini
- Department of Clinical Parasitology, Hospital for Tropical Diseases (HTD), Mortimer Market Centre, Mortimer Market, Capper St, Fitzrovia, London, UK.,London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Jeffrey Glenn
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Bldg. 23, Room 10-169, 1600 Clifton Road, Mailstop D-67, Atlanta, GA, 30329, USA
| | - Sandra Incardona
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Building B, Level 0, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Cara Kosack
- Médecins Sans Frontières (MSF), Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands
| | - Jennifer Luchavez
- Parasitology Department of the Research Institute of Tropical Medicine (RITM), 9002 Research Dr, Alabang, Muntinlupa, The Philippines
| | - Didier Menard
- Laboratoire d'Epidémiologie Moléculaire du Paludisme, Institut Pasteur du Cambodge, Monivong Boulevard, PO 983, Phnom Penh, Cambodia
| | - Sina Nhem
- Laboratoire d'Epidémiologie Moléculaire du Paludisme, Institut Pasteur du Cambodge, Monivong Boulevard, PO 983, Phnom Penh, Cambodia
| | - Wellington Oyibo
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos (UL), Private Mail Bag 12003, Lagos, Nigeria
| | - Roxanne R Rees-Channer
- Department of Clinical Parasitology, Hospital for Tropical Diseases (HTD), Mortimer Market Centre, Mortimer Market, Capper St, Fitzrovia, London, UK.,Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Building B, Level 0, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Iveth Gonzalez
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Building B, Level 0, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - David Bell
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Building B, Level 0, Chemin des Mines 9, 1202, Geneva, Switzerland
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Ultrasensitive and label-free biosensor for the detection of Plasmodium falciparum histidine-rich protein II in saliva. Sci Rep 2019; 9:17495. [PMID: 31767887 PMCID: PMC6877566 DOI: 10.1038/s41598-019-53852-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/06/2019] [Indexed: 11/08/2022] Open
Abstract
Malaria elimination is a global public health priority. To fulfil the demands of elimination diagnostics, we have developed an interdigitated electrode sensor platform targeting the Plasmodium falciparum Histidine Rich Protein 2 (PfHRP2) protein in saliva samples. A protocol for frequency-specific PfHRP2 detection in phosphate buffered saline was developed, yielding a sensitivity of 2.5 pg/mL based on change in impedance magnitude of the sensor. This protocol was adapted and optimized for use in saliva with a sensitivity of 25 pg/mL based on change in resistance. Further validation demonstrated detection in saliva spiked with PfHRP2 from clinical isolates in 8 of 11 samples. With a turnaround time of ~2 hours, the label-free platform based on impedance sensors has the potential for miniaturization into a point-of-care diagnostic device for malaria elimination.
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14
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Low YK, Chan J, Soraya GV, Buffet C, Abeyrathne CD, Huynh DH, Skafidas E, Kwan P, Rogerson SJ. Development of an Ultrasensitive Impedimetric Immunosensor Platform for Detection of Plasmodium Lactate Dehydrogenase. SENSORS 2019; 19:s19112446. [PMID: 31146340 PMCID: PMC6603725 DOI: 10.3390/s19112446] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 11/20/2022]
Abstract
Elimination of malaria is a global health priority. Detecting an asymptomatic carrier of Plasmodium parasites to receive treatment is an important step in achieving this goal. Current available tools for detection of malaria parasites are either expensive, lacking in sensitivity for asymptomatic carriers, or low in throughput. We investigated the sensitivity of an impedimetric biosensor targeting the malaria biomarker Plasmodium lactate dehydrogenase (pLDH). Following optimization of the detection protocol, sensor performance was tested using phosphate-buffered saline (PBS), and then saliva samples spiked with pLDH at various concentrations. The presence of pLDH was determined by analyzing the sensor electrical properties before and after sample application. Through comparing percentage changes in impedance magnitude, the sensors distinguished pLDH-spiked PBS from non-spiked PBS at concentrations as low as 250 pg/mL (p = 0.0008). Percentage changes in impedance magnitude from saliva spiked with 2.5 ng/mL pLDH trended higher than those from non-spiked saliva. These results suggest that these biosensors have the potential to detect concentrations of pLDH up to two logs lower than currently available best-practice diagnostic tools. Successful optimization of this sensor platform would enable more efficient diagnosis of asymptomatic carriers, who can be targeted for treatment, contributing to the elimination of malaria.
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Affiliation(s)
- Yu Kong Low
- Department of Medicine, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, 792 Elizabeth Street, Melbourne, VIC 3000, Australia.
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria 3050, Australia.
| | - Jianxiong Chan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria 3050, Australia.
| | - Gita V Soraya
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria 3050, Australia.
- Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia.
| | - Christelle Buffet
- Department of Medicine, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, 792 Elizabeth Street, Melbourne, VIC 3000, Australia.
| | - Chathurika D Abeyrathne
- Department of Electrical and Electronic Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia.
| | - Duc H Huynh
- Department of Electrical and Electronic Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia.
| | - Efstratios Skafidas
- Department of Electrical and Electronic Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia.
| | - Patrick Kwan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria 3050, Australia.
| | - Stephen J Rogerson
- Department of Medicine, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, 792 Elizabeth Street, Melbourne, VIC 3000, Australia.
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15
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Algorithms for sequential interpretation of a malaria rapid diagnostic test detecting two different targets of Plasmodium species to improve diagnostic accuracy in a rural setting (Nanoro, Burkina Faso). PLoS One 2019; 14:e0211801. [PMID: 30759130 PMCID: PMC6373946 DOI: 10.1371/journal.pone.0211801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022] Open
Abstract
Background Malaria rapid diagnostic tests (RDT) have limitations due to the persistence of histidine-rich protein 2 (HRP2) antigen after treatment and low sensitivity of Plasmodium lactate dehydrogenase (pLDH) based RDTs. To improve the diagnosis of malaria in febrile children, two diagnostic algorithms, based on sequential interpretation of a malaria rapid diagnostic test detecting two different targets of Plasmodium species and followed by expert microscopy, were evaluated. Methods Two diagnostic algorithms were evaluated using 407 blood samples collected between April and October 2016 from febrile children and the diagnostic accuracy of both algorithms was determined. Algorithm 1: The result of line T1-HRP2 were read first; if negative, malaria infection was considered to be absent. If positive, confirmation was done with the line T2-pLDH. If T2-pLDH test was negative, the malaria diagnosis was considered as “inconclusive” and microscopy was performed; Algorithm 2: The result of line T2-pLDH were read first; if positive, malaria infection was considered to be present. If negative, confirmation was done with the line T1-HRP2. If T1-HRP2 was positive the malaria diagnosis was considered as “inconclusive” and microscopy was performed. In absence of malaria microscopy, a malaria infection was ruled out in children with an inconclusive diagnostic test result when previous antimalarial treatment was reported. Results For single interpretation, the sensitivity of PfHRP2 was 98.4% and the specificity was 74.2%, and for the pLDH test the sensitivity was 89.3% and the specificity was 98.8%. Malaria was accurately diagnosed using both algorithms in 84.5% children. The algorithms with the two-line malaria RDT classified the test results into two groups: conclusive and inconclusive results. The diagnostic accuracy for conclusive results was 98.3% using diagnostic algorithm 1 and 98.6% using algorithm 2. The sensitivity and specificity for the conclusive results were 98.2% and 98.4% for algorithm 1, and 98.6% and 98.4% for algorithm 2, respectively. There were 63 (15.5%) children who had an “inconclusive” result for whom expert microscopy was needed. In children with inconclusive results (PfHRP2+/pLDH- only) previous antimalarial treatment was reported in 16 children with malaria negative microscopy (16/40; 40%) and 1 child with malaria positive microscopy (1/23; 4.3%). Conclusion The strategy of sequential interpretation of two-line malaria RDT can improve the diagnosis of malaria. However, some cases will still require confirmative testing with microscopy or additional investigations on previous antimalarial treatment.
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16
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Quakyi IA, Adjei GO, Sullivan DJ, Laar A, Stephens JK, Owusu R, Winch P, Sakyi KS, Coleman N, Krampa FD, Essuman E, Aubyn VNA, Boateng IA, Borteih BB, Vanotoo L, Tuakli J, Addison E, Bart-Plange C, Sorvor F, Adjei AA. Diagnostic capacity, and predictive values of rapid diagnostic tests for accurate diagnosis of Plasmodium falciparum in febrile children in Asante-Akim, Ghana. Malar J 2018; 17:468. [PMID: 30547795 PMCID: PMC6295071 DOI: 10.1186/s12936-018-2613-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 12/05/2018] [Indexed: 12/04/2022] Open
Abstract
Background This study seeks to compare the performance of HRP2 (First Response) and pLDH/HRP2 (Combo) RDTs for falciparum malaria against microscopy and PCR in acutely ill febrile children at presentation and follow-up. Methods This is an interventional study that recruited children < 5 years who reported to health facilities with a history of fever within the past 72 h or a documented axillary temperature of 37.5 °C. Using a longitudinal approach, recruitment and follow-up of participants was done between January and May 2012. Based on results of HRP2-RDT screening, the children were grouped into one of the following three categories: (1) tested positive for malaria using RDT and received anti-malarial treatment (group 1, n = 85); (2) tested negative for malaria using RDT and were given anti-malarial treatment by the admitting physician (group 2, n = 74); or, (3) tested negative for malaria using RDT and did not receive any anti-malarial treatment (group 3, n = 101). Independent microscopy, PCR and Combo-RDT tests were done for each sample on day 0 and all follow-up days. Results Mean age of the study participants was 22 months and females accounted for nearly 50%. At the time of diagnosis, the mean body temperature was 37.9 °C (range 35–40.1 °C). Microscopic parasite density ranged between 300 and 99,500 parasites/µL. With microscopy as gold standard, the sensitivity of HRP2 and Combo-RDTs were 95.1 and 96.3%, respectively. The sensitivities, specificities and predictive values for RDTs were relatively higher in microscopy-defined malaria cases than in PCR positive-defined cases. On day 0, participants who initially tested negative for HRP2 were positive by microscopy (n = 2), Combo (n = 1) and PCR (n = 17). On days 1 and 2, five of the children in this group (initially HRP2-negative) tested positive by PCR alone. On day 28, four patients who were originally HRP2-negative tested positive for microscopy (n = 2), Combo (n = 2) and PCR (n = 4). Conclusion The HRP2/pLDH RDTs showed comparable diagnostic accuracy in children presenting with an acute febrile illness to health facilities in a hard-to-reach rural area in Ghana. Nevertheless, discordant results recorded on day 0 and follow-up visits using the recommended RDTs means improved malaria diagnostic capability in malaria-endemic regions is necessary.
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Affiliation(s)
- Isabella A Quakyi
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - George O Adjei
- Centre for Tropical Clinical Pharmacology and Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Amos Laar
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Judith K Stephens
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Richmond Owusu
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Peter Winch
- Department of International Health, Social and Behavioural Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Kwame S Sakyi
- Department of Public and Environmental Wellness, Oakland University, 3101 Human Health Building, 433 Meadow Brook Rd, Rochester, MI, 48309-4452, USA
| | - Nathaniel Coleman
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Francis D Krampa
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Edward Essuman
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Vivian N A Aubyn
- National Malaria Control Programme, Ministry of Health, Accra, Ghana
| | - Isaac A Boateng
- Asante-Akim Central Municipal Health Directorate, Ghana Health Services, Konongo, Ghana
| | - Bernard B Borteih
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Linda Vanotoo
- Regional Health Directorate, Ghana Health Services, Accra, Ghana
| | | | | | | | - Felix Sorvor
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Andrew A Adjei
- Worldwide Universities Network, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
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17
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Gunasekera WDAW, Premaratne R, Weerasena O, Premawansa W, Handunnetti S, Fernando S. Utility of pf/pan RDT for diagnosis in the prevention of re-establishment of malaria in Sri Lanka. Pathog Glob Health 2018; 112:360-367. [PMID: 30355068 PMCID: PMC6300746 DOI: 10.1080/20477724.2018.1536855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The utility of CareStartTM Malaria Pf/PAN (HRP2/pLDH) Ag Combo Test, in detecting non-endemic clinical malaria cases was evaluated in Sri Lanka, a country in prevention of re-establishment of malaria following elimination. RDT, microscopy and nested PCR were performed for 350 suspected malaria patients recruited prospectively. There were 173 PCR confirmed malaria patients and 177 PCR negative subjects. Plasmodium falciparum amounted to 48% of infections with 44% P. vivax, 6% P. ovale and 2% P. malariae. Performance characteristics of RDTs and microscopy were compared with nested PCR. Sensitivity and specificity of RDT with 95% confidence intervals (CI) were as follows: any malaria infection 95.95% (CI = 91.84-98.36) and 94.92% (CI = 90.57-97.65); P. falciparum 100% (CI = 95.65-100) and 97.00% (CI = 94.18-98.70) and other species 92.22% (CI = 84.63-96.82) and 99.62% (97.88-99.99) respectively. A significant difference between sensitivities of HRP2 (100%, CI = 95.65-100) and pan pLDH line (68.67%, CI = 57.56-78.41) was seen for P. falciparum, parasite densities less than 1000 parasites/microliter being detected only by HRP2. Sensitivity and specificity of microscopy with 95% CI were as follows: any malaria infection, 94.22% (CI = 89.63-97.19) and 99.44% (CI = 96.89-99.99); P. falciparum 89.16% (CI = 80.40-94.90) and 99.63% (CI = 97.94-99.99); other species 98.89% (CI = 93.96-99.97) and 100% (CI = 98.59-100) respectively. The low sensitivity of pan specific pLDH for P. falciparum, P. ovale and P. malariae should be taken in to consideration when using this RDT as a point of care test when and wherever microscopy facilities are not readily available. Considering the low sensitivity of microscopy for P. falciparum, it is preferable to perform both tests, when malaria is highly suspected.
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Affiliation(s)
| | - R.G. Premaratne
- World Health Organization –Regional Office for South East Asia, New Delhi, India
| | - O.V.D.S.J. Weerasena
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | - W.S. Premawansa
- Department of Zoology and Environmental Science, Faculty of Science, University of Colombo, Colombo, Sri Lanka
| | - S.M. Handunnetti
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | - S.D. Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Shittu O, Opeyemi OA, Ajibaye O, Omotesho BO, Fakayode O. Evaluation of the Clinical Proficiency of RDTs, Microscopy and Nested PCR in the Diagnosis of Symptomatic Malaria in Ilorin, North-Central, Nigeria. Open Access Maced J Med Sci 2018; 6:1032-1040. [PMID: 29983797 PMCID: PMC6026432 DOI: 10.3889/oamjms.2018.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/20/2018] [Accepted: 04/30/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND: Accurate laboratory diagnosis of suspected malaria is the hallmark to the control of the disease. AIM: The clinical proficiency of commercial Rapid Diagnostic test kits (RDTs) using nested PCR as quality control was evaluated among patients attending two public healthcare providing institutions in Ilorin, Kwara state, North-Central, Nigeria. METHOD: A cross-sectional evaluation of finger prick blood samples of volunteer patients were accessed for malaria parasites with pLDH, HRP2, Pf, Pf/PAN and nested PCR molecular assays. The data derived were analysed using standard formulae for diagnostic accuracy, and the obtained predictive values were subjected to a comparison with one-way analysis of variance (ANOVA). RESULT: Three hundred and sixty-eight (368) patients comprising 203 (55%) females and 165 (45%) males participated in this study. Routine microscopy revealed that 54 (32.7%) males and 80 (39.4%) was infected with Plasmodium falciparum. SD Bioline (pLDH) 47.4%; Carestart Malaria (HRP2) 49.8% recorded low sensitivities. Micropoint (pfPAN) 82.8% and Micropoint (Mal. Pf) 64.4% recorded a high sensitivity. SD Bioline (pLDH) 67.4%; Carestart Malaria (HRP2) 85.9%; Micropoint (PfPAN) 62.2% and Micropoint (Mal. Pf) 86.7% had high specificities. The positive predictive value (PPV) ranged from 67.7% to 85.94%, while the negative predictive values (NPV) of 64.4% for SD Bioline (pLDH); 86.7% for Carestart Malaria (HRP2); 89.3% for Micropoint (pfPAN) and 58.5% for Micropoint (Mal. Pf). Agarose gel analysis of P. falciparumssrRNA gene (206 bp) for 28 specimens containing 10% concordant and discordant samples showed that all 12 negative specimens for RDTs and routine microscopy were truly negative for nPCR. However, the remaining 16 specimens were positive for nPCR and showed discrepancies with routine microscopy and RDTs. Cohen’s interrater diagnostic measure analysis revealed that the weighted kappa for the RDTs was moderate 0.417 (p=0.027), 95%CI (0.756, 0.078) and good for nPCR 0.720 (p < 0.001), 95%CI (0.963, 0.477). The area under the curve (AUC) specify that nPCR has been more effective than the RDTs (nPCRAUC = 0.875; p < 0.001 and RDTsAUC = 0.708; p = 0.063). CONCLUSION: A thorough large-scale quality control is advocated on all commercial RDTs being used in most sub-Saharan African countries. This is to avoid double jeopardy consequent upon misdiagnosis on unidentified positive cases serving as pool reservoir for the insect vector and cyclical infection and re-infection of the populace.
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Affiliation(s)
- Olalere Shittu
- Parasitology Unit, Department of Zoology, University of Ilorin, Ilorin, Nigeria
| | | | - Olusola Ajibaye
- Biochemistry and Nutrition Unit, Nigeria Institute of Medical Research, Lagos, Nigeria
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19
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Druetz T. Evaluation of direct and indirect effects of seasonal malaria chemoprevention in Mali. Sci Rep 2018; 8:8104. [PMID: 29802375 PMCID: PMC5970148 DOI: 10.1038/s41598-018-26474-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/10/2018] [Indexed: 01/24/2023] Open
Abstract
Randomized controlled trials have established that seasonal malaria chemoprevention (SMC) in children is a promising strategy to reduce malaria transmission in Sahelian West Africa. This strategy was recently introduced in a dozen countries, and about 12 million children received SMC in 2016. However, evidence on SMC effectiveness under routine programme conditions is sparse. We aim to measure the effects of the nationwide SMC programme in Mali on the prevalence of malaria and anemia in children 6-59 months. We used data from the 2015 nationally representative malaria indicator survey. A post-test only with non-randomized control group study was designed. We fitted a generalized structural equation model that controlled for potential bias on observed and non-observed variables (endogenous treatment effect model). Having received SMC reduced by 44% (95% CI [0.39-0.49]) the risk of having a positive rapid diagnostic test for malaria. In addition, the programme indirectly reduced by 18% the risk of moderate-to-severe anemia (95% CI [0.15-0.21]). SMC in Mali has substantial protective effects under routine nationwide programme conditions. Endogenous treatment effects analyses can contribute to rigorously measuring the effectiveness of health programmes and to bridging a widening gap in evaluation methods to measure progress towards achieving malaria elimination.
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Affiliation(s)
- Thomas Druetz
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University, New Orleans, USA.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada.
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20
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Das S, Peck RB, Barney R, Jang IK, Kahn M, Zhu M, Domingo GJ. Performance of an ultra-sensitive Plasmodium falciparum HRP2-based rapid diagnostic test with recombinant HRP2, culture parasites, and archived whole blood samples. Malar J 2018; 17:118. [PMID: 29549888 PMCID: PMC5857316 DOI: 10.1186/s12936-018-2268-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/09/2018] [Indexed: 11/30/2022] Open
Abstract
Background As malaria endemic countries shift from control to elimination, the proportion of low density Plasmodium falciparum infections increases. Current field diagnostic tools, such as microscopy and rapid diagnostic tests (RDT), with detection limits of approximately 100–200 parasites/µL (p/µL) and 800–1000 pg/mL histidine-rich protein 2 (HRP2), respectively, are unable to detect these infections. A novel ultra-sensitive HRP2-based Alere™ Malaria Ag P.f RDT (uRDT) was evaluated in laboratory conditions to define the test’s performance against recombinant HRP2 and native cultured parasites. Results The uRDT detected dilutions of P. falciparum recombinant GST-W2 and FliS-W2, as well as cultured W2 and ITG, diluted in whole blood down to 10–40 pg/mL HRP2, depending on the protein tested. uRDT specificity was 100% against 123 archived frozen whole blood samples. Rapid test cross-reactivity with HRP3 was investigated using pfhrp2 gene deletion strains D10 and Dd2, pfhrp3 gene deletion strain HB3, and controls pfhrp2 and pfhrp3 double deletion strain 3BD5 and pfhrp2 and pfhrp3 competent strain ITG. The commercial Standard Diagnostics, Inc. BIOLINE Malaria Ag P.f RDT (SD-RDT) and uRDT detected pfhrp2 positive strains down to 49 and 3.13 p/µL, respectively. The pfhrp2 deletion strains were detected down to 98 p/µL by both tests. Conclusion The performance of the uRDT was variable depending on the protein, but overall showed a greater than 10-fold improvement over the SD-RDT. The uRDT also exhibited excellent specificity and showed the same cross-reactivity with HRP3 as the SD-RDT. Together, the results support the uRDT as a more sensitive HRP2 test that could be a potentially effective tool in elimination campaigns. Further clinical evaluations for this purpose are merited.
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Affiliation(s)
- Smita Das
- Diagnostics Program, PATH, Seattle, WA, USA.
| | | | | | | | - Maria Kahn
- Diagnostics Program, PATH, Seattle, WA, USA
| | - Meilin Zhu
- Diagnostics Program, PATH, Seattle, WA, USA
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21
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Druetz T, Corneau-Tremblay N, Millogo T, Kouanda S, Ly A, Bicaba A, Haddad S. Impact Evaluation of Seasonal Malaria Chemoprevention under Routine Program Implementation: A Quasi-Experimental Study in Burkina Faso. Am J Trop Med Hyg 2017; 98:524-533. [PMID: 29260654 PMCID: PMC5929206 DOI: 10.4269/ajtmh.17-0599] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Seasonal malaria chemoprevention (SMC) for children < 5 is a strategy that is gaining popularity in West African countries. Although its efficacy to reduce malaria incidence has been demonstrated in trials, the effects of SMC implemented in routine program conditions, outside of experimental contexts, are unknown. In 2014 and 2015, a survey was conducted in 1,311 households located in Kaya District (Burkina Faso) where SMC had been recently introduced. All children < 72 months were tested for malaria and anemia. A pre–post study with control group was designed to measure SMC impact during high transmission season. A difference-in-differences approach was coupled in the analysis with propensity score weighting to control for observable and time-invariant nonobservable confounding factors. SMC reduced the parasitemia point and period prevalence by 3.3 and 24% points, respectively; this translated into protective effects of 51% and 62%. SMC also reduced the likelihood of having moderate to severe anemia by 32%, and history of recent fever by 46%. Self-reported coverage for children at the first cycle was 83%. The SMC program was successfully added to a package of interventions already in place. To our knowledge, with prevalence < 10% during the peak of the transmission season, this is the first time that malaria can be reported as hypo-endemic in a sub-Sahelian setting in Burkina Faso. SMC has great potential, and along with other interventions, it could contribute to approaching the threshold where elimination strategies will be envisioned in Burkina Faso.
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Affiliation(s)
- Thomas Druetz
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | | | - Tieba Millogo
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Antarou Ly
- Department of Preventive and Social Medicine, Faculty of Medicine, Laval University, Quebec City, Canada
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Slim Haddad
- Department of Preventive and Social Medicine, Faculty of Medicine, Laval University, Quebec City, Canada
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22
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Boyce R, Reyes R, Matte M, Ntaro M, Mulogo E, Siedner MJ. Use of a Dual-Antigen Rapid Diagnostic Test to Screen Children for Severe Plasmodium falciparum Malaria in a High-Transmission, Resource-Limited Setting. Clin Infect Dis 2017; 65:1509-1515. [PMID: 29020298 PMCID: PMC5850632 DOI: 10.1093/cid/cix592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/30/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In rural areas, many patients with malaria seek care at peripheral health facilities or community case management programs. While this strategy is effective for the management of uncomplicated malaria, severe malaria necessitates prompt detection and referral to facilities with adequate resources. METHODS In this prospective, observational cohort study, we assessed the accuracy of a dual-band (histidine-rich protein-2/pan-lactate dehydrogenase [HRP2/pLDH]) rapid diagnostic test (RDT) to differentiate uncomplicated from severe malaria. We included children aged <12 years who presented to a rural clinic in western Uganda with a positive HRP2 or HRP2/pLDH RDT. We estimated the test characteristics of a dual-antigen (HRP2+/pLDH+) band positive RDT compared to World Health Organization-defined clinical and laboratory criteria to detect severe malaria. RESULTS A total of 2678 children underwent testing for malaria with an RDT, and 83 (9.0%) satisfied criteria for severe malaria. The sensitivity and specificity of a HRP2+/pLDH+ result for severe malaria was 97.6% (95% confidence interval [CI], 90.8%-99.6%) and 75.6% (95% CI, 73.8%-77.4%), respectively. An HRP2+/pLDH+ result was significantly more sensitive (97.6% vs 68.7%, P < .001) for the detection of severe malaria compared to algorithms that incorporate screening for danger signs. CONCLUSIONS A positive dual-antigen (HRP2/pLDH) RDT has higher sensitivity than the use of clinical manifestations to detect severe malaria, making it a promising tool in the triage of children with malaria in low-resource settings. Additional work is needed to operationalize diagnostic and treatment algorithms that include dual-antigen RDTs to avoid over referral.
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Affiliation(s)
| | - Raquel Reyes
- General Medicine & Clinical Epidemiology, University of North Carolina at Chapel Hill
| | - Michael Matte
- Department of Community Health, Mbarara University of Science & Technology, Uganda; and
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science & Technology, Uganda; and
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science & Technology, Uganda; and
| | - Mark J Siedner
- Department of Medicine, Harvard Medical School, and Massachusetts General Hospital, Boston
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Bauer WS, Gulka CP, Silva-Baucage L, Adams NM, Haselton FR, Wright DW. Metal Affinity-Enabled Capture and Release Antibody Reagents Generate a Multiplex Biomarker Enrichment System that Improves Detection Limits of Rapid Diagnostic Tests. Anal Chem 2017; 89:10216-10223. [DOI: 10.1021/acs.analchem.7b01513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Westley S. Bauer
- Department
of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - Christopher P. Gulka
- Department
of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - Lidalee Silva-Baucage
- Department
of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - Nicholas M. Adams
- Department
of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - Frederick R. Haselton
- Department
of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - David W. Wright
- Department
of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States
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24
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Bauer WS, Richardson KA, Adams NM, Ricks KM, Gasperino DJ, Ghionea SJ, Rosen M, Nichols KP, Weigl BH, Haselton FR, Wright DW. Rapid concentration and elution of malarial antigen histidine-rich protein II using solid phase Zn(II) resin in a simple flow-through pipette tip format. BIOMICROFLUIDICS 2017; 11:034115. [PMID: 28652885 PMCID: PMC5457299 DOI: 10.1063/1.4984788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/18/2017] [Indexed: 05/31/2023]
Abstract
Rapid diagnostic tests (RDTs) designed to function at the point of care are becoming more prevalent in malaria diagnostics because of their low cost and simplicity. While many of these tests function effectively with high parasite density samples, their poor sensitivity can often lead to misdiagnosis when parasitemia falls below 100 parasites/μl. In this study, a flow-through pipette-based column was explored as a cost-effective means to capture and elute more Plasmodium falciparum histidine-rich protein II (HRPII) antigen, concentrating the biomarker available in large-volume lysed whole blood samples into volumes compatible with Plasmodium falciparum-specific RDTs. A systematic investigation of immobilized metal affinity chromatography divalent metal species and solid phase supports established the optimal design parameters necessary to create a flow-through column incorporated into a standard pipette tip. The bidirectional flow inherent to this format maximizes mixing efficiency so that in less than 5 min of sample processing, the test band signal intensity was increased up to a factor of twelve from HRPII concentrations as low as 25 pM. In addition, the limit of detection per sample was decreased by a factor of five when compared to the RDT manufacturer's suggested protocol. Both the development process and commercial viability of this application are explored, serving as a potential model for future applications.
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Affiliation(s)
- Westley S Bauer
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Kelly A Richardson
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Nicholas M Adams
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - Keersten M Ricks
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
| | - David J Gasperino
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Simon J Ghionea
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Mathew Rosen
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Kevin P Nichols
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | - Bernhard H Weigl
- Intellectual Ventures Laboratory, 14360 SE Eastgate Way, Bellevue, Washington 98007, USA
| | | | - David W Wright
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, USA
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25
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Kozycki CT, Umulisa N, Rulisa S, Mwikarago EI, Musabyimana JP, Habimana JP, Karema C, Krogstad DJ. False-negative malaria rapid diagnostic tests in Rwanda: impact of Plasmodium falciparum isolates lacking hrp2 and declining malaria transmission. Malar J 2017; 16:123. [PMID: 28320390 PMCID: PMC5359811 DOI: 10.1186/s12936-017-1768-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Rapid diagnostic tests (RDTs) for histidine rich protein 2 (HRP2) are often used to determine whether persons with fever should be treated with anti-malarials. However, Plasmodium falciparum parasites with a deletion of the hrp2 gene yield false-negative RDTs and there are concerns the sensitivity of HRP2-based RDTs may fall when the intensity of transmission decreases. Methods This observational study enrolled 9226 patients at three health centres in Rwanda from April 2014 to April 2015. It then compared the sensitivity of RDTs based on HRP2 and the Plasmodium lactate dehydrogenase (pLDH) to microscopy (thick smears) for the diagnosis of malaria. PCR was used to determine whether deletions of the histidine-rich central repeat region of the hrp2 gene (exon 2) were associated with false-negative HRP2-based RDTs. Results In comparison to microscopy, the sensitivity and specificity of HRP2- and pLDH-based RDTs were 89.5 and 86.2% and 80.2 and 94.3%, respectively. When the results for both RDTs were combined, sensitivity rose to 91.8% and specificity was 85.7%. Additionally, when smear positivity fell from 46 to 3%, the sensitivity of the HRP2-based RDT fell from 88 to 67%. Of 370 samples with false-negative HRP2 RDT results for which PCR was performed, 140 (38%) were identified as P. falciparum by PCR. Of the isolates identified as P. falciparum by PCR, 32 (23%) were negative for the hrp2 gene based on PCR. Of the 32 P. falciparum isolates negative for hrp2 by PCR, 17 (53%) were positive based on the pLDH RDT. Conclusion This prospective study of RDT performance coincided with a decline in the intensity of malaria transmission in Kibirizi (fall in slide positivity from 46 to 3%). This decline was associated with a decrease in HRP2 RDT sensitivity (from 88 to 67%). While P. falciparum isolates without the hrp2 gene were an important cause of false-negative HRP2-based RDTs, most were identified by the pLDH-based RDT. Although WHO does not recommend the use of combined HRP2/pLDH testing in sub-Saharan Africa, these results suggest that combination HRP2/pLDH-based RDTs could reduce the impact of false-negative HRP2-based RDTs for detection of symptomatic P. falciparum malaria. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1768-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Noella Umulisa
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda.,Maternal and Child Survival Programme, Jhpiego, Kigali, Rwanda
| | - Stephen Rulisa
- School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Emil I Mwikarago
- National Reference Laboratory, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | | | - Jean Pierre Habimana
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Corine Karema
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Quality and Equity Healthcare, Kigali, Rwanda
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26
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Gatton ML, Dunn J, Chaudhry A, Ciketic S, Cunningham J, Cheng Q. Implications of Parasites Lacking Plasmodium falciparum Histidine-Rich Protein 2 on Malaria Morbidity and Control When Rapid Diagnostic Tests Are Used for Diagnosis. J Infect Dis 2017; 215:1156-1166. [DOI: 10.1093/infdis/jix094] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/14/2017] [Indexed: 01/01/2023] Open
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27
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Audu R, Anto BP, Koffuor GA, Abruquah AA, Buabeng KO. Malaria rapid diagnostic test evaluation at private retail pharmacies in Kumasi, Ghana. J Res Pharm Pract 2016; 5:175-80. [PMID: 27512708 PMCID: PMC4966236 DOI: 10.4103/2279-042x.185723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Malaria rapid diagnostic test (MRDT) provides a good alternative to malaria microscopy diagnosis, particularly in resource-constrained settings. This study therefore evaluated MRDT in private retail pharmacies (PRPs) as a critical step in community case malaria management. Methods: In a prospective, cross-over, validation survey at six PRPs in the Ashanti Region of Ghana, 1200 patients presenting with fever in the preceding 48 h were sampled. Fingerstick blood samples were collected for preparation of thick and thin blood films for malaria microscopy. Categorized patients (600 each) went through the processes of MRDT or presumptive diagnosis (PD) of malaria. The malaria disease prevalence of the study area was established. Selectivity (Se), specificity (Sp), positive predictive value (PPV) along with false discovery rate (FDR), and negative predictive value (NPV) along with the false omission rate (FOR), and diagnostic odds ratio (DOR) of MRDT were then calculated. Findings: While 43.0% tested positive using the MRDT, 57.0% tested negative. However, 62.0% MRDT-negative patients in addition to all the MRDT positives were given artemether-lumefantrine. Of those diagnosed by PD, 98.2% were prescribed with an antimalarial (microscopy however confirmed only 70.3% as positive). Se and Sp of the MRDT were 90.68 ± 11.18% and 98.68 ± 1.19%, respectively. Malaria prevalence was estimated to be 43.3%. PPV was 98.0%, FDR was 2.0%, NPV was 98.0%, FOR was 2.0%, and DOR was 2366.43. Conclusion: Results highlighted good performance of MRDTs at PRPs which could inform decision toward its implementation.
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Affiliation(s)
- Rauf Audu
- Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Kama Health Service, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Berko Panyin Anto
- Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - George Asumeng Koffuor
- Department of Pharmacology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Kwame Ohene Buabeng
- Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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28
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Alareqi LMQ, Mahdy MAK, Lau YL, Fong MY, Abdul-Ghani R, Ali AA, Cheong FW, Tawfek R, Mahmud R. Field evaluation of a PfHRP-2/pLDH rapid diagnostic test and light microscopy for diagnosis and screening of falciparum malaria during the peak seasonal transmission in an endemic area in Yemen. Malar J 2016; 15:49. [PMID: 26821911 PMCID: PMC4730713 DOI: 10.1186/s12936-016-1103-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a public health threat in Yemen, with 149,451 cases being reported in 2013. Of these, Plasmodium falciparum represents 99%. Prompt diagnosis by light microscopy (LM) and rapid diagnostic tests (RTDs) is a key element in the national strategy of malaria control. The heterogeneous epidemiology of malaria in the country necessitates the field evaluation of the current diagnostic strategies, especially RDTs. Thus, the present study aimed to evaluate LM and an RDT, combining both P. falciparum histidine-rich protein-2 (PfHRP-2) and Plasmodium lactate dehydrogenase (pLDH), for falciparum malaria diagnosis and survey in a malaria-endemic area during the transmission season against nested polymerase chain reaction (PCR) as the reference method. METHODS A household-based, cross-sectional malaria survey was conducted in Mawza District, a malaria-endemic area in Taiz governorate. A total of 488 participants were screened using LM and PfHRP-2/pLDH RDT. Positive samples (160) and randomly selected negative samples (52) by both RDT and LM were further analysed using 18S rRNA-based nested PCR. RESULTS The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the RDT were 96.0% (95% confidence interval (CI): 90.9-98.3), 56.0% (95% CI: 44.7-66.8), 76.3% (95% CI: 69.0-82.3), and 90.4% (95% CI: 78.8-96.8), respectively. On the other hand, LM showed sensitivity of 37.6% (95% CI: 29.6-46.3), specificity of 97.6% (95% CI: 91.7-99.7), PPV of 95.9% (95% CI: 86.3-98.9), and NPV of 51.3% (95% CI: 43.2-59.2). The sensitivity of LM dropped to 8.5% for detecting asymptomatic malaria. Malaria prevalence was 32.8% (32.1 and 37.5% for ≥10 and <10 years, respectively) with the RDT compared with 10.7% (10.8 and 9.4% for age groups of ≥10 and <10 years, respectively) with LM. Among asymptomatic malaria individuals, LM and RDT-based prevalence rates were 1.6 and 25.6%, respectively. However, rates of 88.2 and 94.1% of infection with P. falciparum were found among patients who reported fever in the 48 h prior to the survey by LM and PfHRP-2/pLDH RDT, respectively. CONCLUSIONS The PfHRP-2/pLDH RDT shows high sensitivity for the survey of falciparum malaria even for asymptomatic malaria cases. Although the RDT had high sensitivity, its high false-positivity rate limits its utility as a single diagnostic tool for clinical diagnosis of malaria. On the other hand, low sensitivity of LM indicates that a high proportion of malaria cases is missed, underestimating the true prevalence of malaria in the community. Higher NPV of PfHRP-2/pLDH RDT than LM can give a straightforward exclusion of malaria among febrile patients, helping to avoid unnecessary presumptive treatments.
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Affiliation(s)
- Lina M Q Alareqi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Mohammed A K Mahdy
- Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Mun-Yik Fong
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Rashad Abdul-Ghani
- Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Arwa A Ali
- Yemeni-Swedish Hospital, Ministry of Public Health and Population, Taiz, Yemen.
| | - Fei-Wen Cheong
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Rehab Tawfek
- Yemeni-Swedish Hospital, Ministry of Public Health and Population, Taiz, Yemen.
| | - Rohela Mahmud
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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29
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Boyce R, Reyes R, Ntaro M, Mulogo E, Matte M, Boum Y, Siedner MJ. Association between HRP-2/pLDH rapid diagnostic test band positivity and malaria-related anemia at a peripheral health facility in Western Uganda. J Glob Health 2015. [PMID: 26207181 PMCID: PMC4512262 DOI: 10.7189/jogh.05.020402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The detection of severe malaria in resource–constrained settings is often difficult because of requirements for laboratory infrastructure and/or clinical expertise. The aim of this study, therefore, was to explore the utility of a multiple antigen (HRP–2/pLDH) rapid diagnostic test (RDT) as a low–cost, surrogate marker of patients at high risk for complications of severe malaria. We reviewed programmatic data at a peripheral health center in Western Uganda. Available demographic and clinical data on all individuals presenting to the center who underwent an RDT for suspected malaria infection were reviewed. We fit logistic regression models to identify correlates of two outcomes of interest: 1) severe malaria–related anemia, defined here as hemoglobin ≤7g/dL and 2) receipt of parenteral quinine. 1509 patients underwent malaria testing with an SD FK60 RDT during the observation period. A total of 637 (42%) RDTs were positive for at least one species of malaria, of which 326 (51%) exhibited a single HRP–2 band and 307 (48%) exhibited both HRP–2 and pLDH bands, while 4 exhibited only a single pLDH band. There was a trend towards more severe anemia in patients with a HRP–2/pLDH positive RDT compared to a HRP–2 only RDT (β = –0.99 g/dl, 95% CI –1.99 to 0.02, P = 0.055). A HRP–2/pLDH positive RDT was associated with an increased risk of severe malaria–related anemia compared to a negative RDT (adjusted odds ratio (AOR) 18.8, 95% CI 4.32 to 82.0, P < 0.001) and to a HRP–2 only RDT (AOR 2.46, 95% CI 0.75 to 8.04, P = 0.14). There was no significant association between RDT result and the administration of parenteral quinine. These results offer preliminary evidence that specific patterns of antigen positivity on RDTs could be utilized to identify patients at an increased risk for complications of severe malaria.
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Affiliation(s)
- Ross Boyce
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Raquel Reyes
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Michael Matte
- Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Yap Boum
- Epicentre Mbarara Research Center, Mbarara, Uganda
| | - Mark J Siedner
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
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