Malaria rapid diagnostic tests: challenges and prospects

Abstract

In the last decade, there has been an upsurge of interest in developing malaria rapid diagnostic test (RDT) kits for the detection of Plasmodium species. Three antigens-Plasmodium falciparum histidine-rich protein 2 (PfHRP2), plasmodial aldolase and plasmodial lactate dehydrogenase (pLDH)-are currently used for RDTs. Tests targeting HRP2 contribute to more than 90 % of the malaria RDTs in current use. However, the specificities, sensitivities, numbers of false positives, numbers of false negatives and temperature tolerances of these tests vary considerably, illustrating the difficulties and challenges facing current RDTs. This paper describes recent developments in malaria RDTs, reviewing RDTs detecting PfHRP2, pLDH and plasmodial aldolase. The difficulties associated with RDTs, such as genetic variability in the Pfhrp2 gene and the persistence of antigens in the bloodstream following the elimination of parasites, are discussed. The prospect of overcoming the problems associated with current RDTs with a new generation of alternative malaria antigen targets is also described.

Leaves from the Tree Poincianella pluviosa as a Renewable Source of Antiplasmodial Compounds against Chloroquine-Resistant Plasmodium falciparum

“…Five species of Plasmodium are able to infect humans, Plasmodium falciparum being considered the most dangerous. 4 Some clinical manifestations such as fever, chills, mild anemia and diarrheas are associated with malaria. 3,5 According to World Health Organization (WHO)-established protocols, 2 the treatment of uncomplicated Plasmodium falciparum malaria involves artemisininbased combination therapy with drugs such as mefloquine, piperaquine or the sulfadoxine/pyrimethamine combination.…”

Prozone-like phenomenon in travellers with fatal malaria: report of two cases

“…Genetic variation of the HRP-2 gene is common but the diversity of proteins is not a major cause of variation in sensitivities of RDTs [6]. HRP-2 gene deletion is less common but has already been described in isolates from Peru, Brazil, India and Mali [6]. HRP-2 genotyping is not performed by our laboratory, so we cannot completely exclude HRP-2 genetic variation as a cause of falsenegative results.…”

“…Another possible explanation in case report 2 is the HRP-2 gene absence or genetic polymorphism. Genetic variation of the HRP-2 gene is common but the diversity of proteins is not a major cause of variation in sensitivities of RDTs [6]. HRP-2 gene deletion is less common but has already been described in isolates from Peru, Brazil, India and Mali [6].…”

Evaluation of Malaria Diagnoses Using a Handheld Light Microscope in a Community-Based Setting in Rural Côte d'Ivoire

“…Ideally, the two diagnostic tests are meant to be used in a complementary manner, as each has benefits and limitations. 1,3,4 Malaria RDTs are designed for rapid, point-of-care malaria diagnoses; however, they are not ideal for quantifying parasitemia. These tests are designed to determine the presence or absence of infection and to dichotomize cases as either Plasmodium falciparum or a non-P. falciparum malaria species.…”