Assessing the performance of only HRP2 and HRP2 with pLDH based rapid diagnostic tests for the diagnosis of malaria in middle Ghana, Africa (original) (raw)
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Research Square (Research Square), 2023
Background: Rapid and precise laboratory diagnosis is essential for effectively diagnosing and managing malaria patients. Malaria rapid diagnostic tests (mRDTs) play a critical role in malaria diagnosis in resource-constrained settings with limited access to labs and trained staff. The efficiency of two mRDTs (HRP2 and pLDH) was compared against microscopy, the gold standard for malaria diagnosis, in this study. Methods: In a cross-sectional study, 308 participants were tested for malaria parasites using two mRDTs and blood smear microscopy as the gold standard. STATA software version 17 was used for data analysis. Results: Out of the 308 participants, 82 tested positive for HRP2 mRDT (26.62% (95% CI: 21.97-31.86) positivity rate, 73.38% (95% CI: 68.14-78.83) negativity rate), and 99 tested positive for pLDH mRDT (32.14% (95% CI: 27.14-37.59) positivity rate, 67.86% (95% CI: 62.41-72.86) negativity rate). Using microscopy as the gold standard, the sensitivity, specificity, PPV, and NPV were determined. For HRP2 mRDT, sensitivity was 77.78% (95%CI: 73.13-82.42), specificity 97.61% (95%CI: 95.90-99.31), PPV 93.90% (95%CI: 91.23-96.56), and NPV 90.27% (95%CI: 86.96-93.58). For pLDH mRDT, the sensitivity was 94.95% (95% CI: 92.50-97.40), specificity was 97.61% (95% CI: 95.90-99.31), PPV was 94.95% (95% CI: 92.50-97.40), and NPV was 97.61% (95% CI: 95.90-99.31). The dominant malaria species was Plasmodium falciparum (74.7%), followed by Plasmodium vivax (12.1%) and Plasmodium ovale (1%). Mixed infections of plasmodium falciparum and plasmodium vivax (7.1%) and plasmodium falciparum and plasmodium ovale (5.1%) were also observed. Conclusion: There was no significant difference in the positivity rate, negativity rate, specificity or PPV in both mRDTs. However, a significant difference in the NPV and sensitivity of HRP2 and pLDH mRDTs was observed where HRP2's sensitivity was below the WHO recommendation of ≥95% in this study population; thus, there is a need to improve the sensitivity of this mRDT kit. In our study, most malaria infections were caused by Plasmodium falciparum, followed by P. vivax and P. ovale. We therefore recommend the use of pLDH mRDTs over HRP2 mRDTs based on the results of our study.
Malaria Journal, 2019
Background Rapid diagnostic tests (RDT) for malaria are common, but their performance varies. Tests using histidine-rich protein 2 (HRP2) antigen are most common, and many have high sensitivity. HRP2 tests can remain positive for weeks after treatment, limiting their specificity and usefulness in high-transmission settings. Tests using Plasmodium lactate dehydrogenase (pLDH) have been less widely used but have higher specificity, mostly due to a much shorter time to become negative. Methods A prospective, health centre-based, diagnostic evaluation of two malaria RDTs was performed in rural Niger during the high malaria transmission season (3–28 October, 2017) and during the low transmission season (28 January–31 March, 2018). All children under 5 years of age presenting with fever (axillary temperature > 37.5 °C) or history of fever in the previous 24 h were eligible. Capillary blood was collected by finger prick. The SD Bioline HRP2 (catalog: 05FK50) and the CareStart pLDH(pan) ...
Malaria Journal
Background Rapid diagnostic tests (RDT) for malaria are the primary tool for malaria diagnosis in sub-Saharan Africa but the utility of the most commonly used histidine-rich protein 2 (HRP2) antigen-based tests is limited in high transmission settings due to the long duration of positivity after successful malaria treatment. HRP2 tests are also threatened by the emergence of Plasmodium that do not carry pfhrp2 or pfhrp 3 genes. Plasmodium lactate dehydrogenase (pLDH)-based tests are promising alternatives, but less available. This study assessed the performances of HRP2 and pLDH(pan) tests under field conditions. Methods The study performed a prospective facility-based diagnostic evaluation of two malaria RDTs in Aweil, South Sudan, during the high transmission season. Capillary blood by fingerprick was collected from 800 children under 15 years of age with fever and no signs of severity. SD Bioline HRP2 and CareStart pLDH(pan) RDTs were performed in parallel, thick and thin smears ...
Factors Affecting the Performance of HRP2-Based Malaria Rapid Diagnostic Tests
Tropical Medicine and Infectious Disease
The recent COVID-19 pandemic has profoundly impacted global malaria elimination programs, resulting in a sharp increase in malaria morbidity and mortality. To reduce this impact, unmet needs in malaria diagnostics must be addressed while resuming malaria elimination activities. Rapid diagnostic tests (RDTs), the unsung hero in malaria diagnosis, work to eliminate the prevalence of Plasmodium falciparum malaria through their efficient, cost-effective, and user-friendly qualities in detecting the antigen HRP2 (histidine-rich protein 2), among other proteins. However, the testing mechanism and management of malaria with RDTs presents a variety of limitations. This paper discusses the numerous factors (including parasitic, host, and environmental) that limit the performance of RDTs. Additionally, the paper explores outside factors that can hinder RDT performance. By understanding these factors that affect the performance of HRP2-based RDTs in the field, researchers can work toward creat...