2014
DOI: 10.1128/jcm.01797-14
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False-Positive Results for Rapid Diagnostic Tests for Malaria in Patients with Rheumatoid Factor

Abstract: c Four different rapid diagnostic tests (RDTs) for malaria were evaluated by testing 82 healthy control patients, 89 Plasmodium vivax-infected patients, and 92 rheumatoid factor (RF)-positive nonmalaria patients. The false-positive rate ranged from 2.2% to 13% in RF-positive patients. High RF levels are associated with malaria RDT false positivity. M alaria remains a major global health problem in tropical and subtropical countries, with high morbidity and mortality and extensive economic loss (1). Malaria rap… Show more

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Cited by 57 publications
(50 citation statements)
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“…Major limitations with the existing RDTs lie with their high degree of false-negatives in some malaria elimination settings, occurring due to their high detection limits (>100 parasites/μL),high frequency of target sequence deletion in certain regions, as well as the so-called "hook” or “prozone” effect occurring in high antigenaemic cases[2129]. False positive outcomes are also common due to antibody cross-reactivity to blood rheumatoid factor and other tropical infections [3033], and because of the long median clearance times of approximately 28 and 7 days for the frequently targeted P . falciparum histidine-rich protein II( Pf HRP2) and Plasmodium species-specific lactate dehydrogenase (pLDH) antigens, respectively[34, 35].…”
Section: Introductionmentioning
confidence: 99%
“…Major limitations with the existing RDTs lie with their high degree of false-negatives in some malaria elimination settings, occurring due to their high detection limits (>100 parasites/μL),high frequency of target sequence deletion in certain regions, as well as the so-called "hook” or “prozone” effect occurring in high antigenaemic cases[2129]. False positive outcomes are also common due to antibody cross-reactivity to blood rheumatoid factor and other tropical infections [3033], and because of the long median clearance times of approximately 28 and 7 days for the frequently targeted P . falciparum histidine-rich protein II( Pf HRP2) and Plasmodium species-specific lactate dehydrogenase (pLDH) antigens, respectively[34, 35].…”
Section: Introductionmentioning
confidence: 99%
“…Furthermore, it likely prevents the transfer of LFA interferents, such as autoantibodies associated with human rheumatoid factor, and human anti-mouse antibodies that induce false positive test results. 46 The deposition of a small number of beads also provides a theoretical maximum HRP2 binding and delivery capacity that would provide tolerance against the hook effect phenomenon known to give false negative results. 47 .…”
Section: Discussionmentioning
confidence: 99%
“…This is a qualitative test utilizing lateral-flow immunochromatography to detect malaria-specific antigens (1-3). In brief, the manufacturer provides a nitrocellulose membrane impregnated with monoclonal (capture) antibodies for Plasmodium falciparum-specific antigen (histidinerich protein 2; HRP-2), pan-malaria antigen (aldolase), and an internal control (2)(3)(4). Aldolase antigen detects multiple Plasmodium species (falciparum, vivax, ovale, malariae) but cannot provide species-level identification (2,3).…”
Section: Discussionmentioning
confidence: 99%
“…In addition, false-positive MRDT results have been reported in cases of chronic hepatitis C, toxoplasmosis, human African trypanosomiasis, dengue, leishmaniasis, Chagas disease, and schistosomiasis (3,4). The most common cause of false positives is attributed to rheumatoid factor (RF) (3,4). Other heterophile antibodies should be considered potential causes of false-positive results in all immunoassays (5).…”
Section: Discussionmentioning
confidence: 99%
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