Journal
MALARIA JOURNAL
Volume 16, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s12936-017-1780-5
Keywords
Malaria rapid diagnostic test; HRP2; pLDH; Analytical sensitivity
Categories
Funding
- Bill and Melinda Gates Foundation [OPP1116774, OPP1148226]
- National Institute for Health Research University College London Hospitals Biomedical Research Centre
- US Public Health Service Grant [U19AI089681]
- Belgian Directorate General for Development FA3-III [95502]
- Bill and Melinda Gates Foundation [OPP1116774, OPP1148226] Funding Source: Bill and Melinda Gates Foundation
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Background: Rapid diagnostic tests (RDTs) are today the most widely used method for malaria diagnosis and are recommended, alongside microscopy, for the confirmation of suspected cases before the administration of anti-malarial treatment. The diagnostic performance of RDTs, as compared to microscopy or PCR is well described but the actual analytical sensitivity of current best-in-class tests is poorly documented. This value is however a key performance indicator and a benchmark value needed to developed new RDTs of improved sensitivity. Methods: Thirteen RDTs detecting either the Plasmodium falciparum histidine rich protein 2 (HRP2) or the plasmodial lactate dehydrogenase (pLDH) antigens were selected from the best performing RDTs according to the WHO-FIND product testing programme. The analytical sensitivity of these products was evaluated using a range of reference materials including P. falciparum and Plasmodium vivax whole parasite samples as well as recombinant proteins. Results: The best performing HRP2-based RDTs could detect all P. falciparum cultured samples at concentrations as low as 0.8 ng/mL of HRP2. The limit of detection of the best performing pLDH-based RDT specifically detecting P. vivax was 25 ng/mL of pLDH. Conclusion: The analytical sensitivity of P. vivax and Pan pLDH-based RDTs appears to vary considerably from product to product, and improvement of the limit-of-detection for P. vivax detecting RDTs is needed to match the performance of HRP2 and Pf pLDH-based RDTs for P. falciparum. Different assays using different reference materials produce different values for antigen concentration in a given specimen, highlighting the need to establish universal reference assays.
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