False-negative malaria rapid diagnostic tests in Rwanda: impact of Plasmodium falciparum isolates lacking hrp2 and declining malaria transmission

Malaria Journal - Tập 16 - Trang 1-11 - 2017
Christina T. Kozycki1, Noella Umulisa2,3, Stephen Rulisa4, Emil I. Mwikarago5, Jean Pierre Musabyimana5, Jean Pierre Habimana2, Corine Karema2,6,7,8, Donald J. Krogstad1
1Tulane University Health Science Center, New Orleans, USA
2Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
3Maternal and Child Survival Programme, Jhpiego, Kigali, Rwanda
4School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
5National Reference Laboratory, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
6Swiss Tropical and Public Health Institute, Basel, Switzerland
7University of Basel, Basel, Switzerland
8Quality and Equity Healthcare, Kigali, Rwanda

Tóm tắt

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. 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. 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. 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.

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Malaria Journal

Tập 16

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