4.7 Article

Performance of a Histidine Rich Protein-2 Based (First Response) and a p-Lactate Dehydrogenase-based (Optimal) Rapid Diagnostic Test for Diagnosis of Malaria in Patients With Pediatric Sickle Cell Disease

Journal

CLINICAL INFECTIOUS DISEASES
Volume 75, Issue 3, Pages 435-441

Publisher

OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciab977

Keywords

rapid diagnostic test; HRP-2; p-LDH; malaria; sickle cell disease

Funding

  1. Consultative Research Committee for Development Research (FFU, DANIDA), Danish Ministry of Foreign Affairs, Denmark [09-080RH]
  2. Building Stronger Universities project, DANIDA Fellowship Centre, through University of Ghana [BSU-3-UG]

Ask authors/readers for more resources

The accuracy of rapid diagnostic tests (RDTs) for malaria diagnosis in patients with sickle cell disease (SCD) was evaluated in this study. The HRP-2-based RDTs showed high sensitivity but lower specificity, making them suitable for initiating treatment in cases with unclear symptoms. The LDH-based RDTs were more suitable as a confirmatory test in low-parasitemic subgroups.
Background Rapid diagnostic tests (RDTs) have been extensively evaluated and play an important role in malaria diagnosis. However, the accuracy of RDTs for malaria diagnosis in patients with sickle cell disease (SCD) is unknown. Methods We compared the performance of a histidine rich protein 2 (HRP-2)-based RDT (First Response) and a lactate dehydrogenase (LDH)-based RDT (Optimal) with routine microscopy as reference standard in 445 children with SCD and an acute febrile illness in Accra, Ghana. Results The overall sensitivity, specificity, and positive and negative predictive values of the HRP-2-based RDTs were 100%, 95.7%, 73.8%, and 100%, respectively. Comparable values for the LDH-based RDTs were 91.7%, 99.5%, 95.7%, and 99.0%, respectively. A total of 423 results were true in both tests, 1 result was false in both tests, 16 results were false in the HRP-2 test only, and 5 were false in the LDH test only (McNemar test, P = .03). At follow-up, 73.7% (28/38), 52.6% (20/38), 48.6% (17/35), and 13.2% (5/38) of study participants were HRP-2 positive on days 14, 28, 35, and 42, respectively, compared with 0%, 2.6% (1/38), 2.9% (1/35), and 2.6% (1/38) for LDH. Conclusion The HRP2-based RDT fulfilled World Health Organization criteria for malaria diagnosis in patients with SCD and may provide diagnostic evidence for treatment to begin in cases in which treatment would otherwise have begun presumptively based on symptoms, whereas LDH-based RDTs may be more suitable as a confirmatory test in low-parasitemic subgroups, such as patients with SCD. We studied the reliability of rapid diagnostic tests for malaria in 445 febrile patients with sickle cell disease in Ghana. HRP2-based tests had 100% sensitivity compared with 91.7% for LDH-based tests, whereas specificity was lower (95.7% vs. 99.5%) for HRP2-based tests.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.7
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available