Journal
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE
Volume 86, Issue 2, Pages 194-198Publisher
AMER SOC TROP MED & HYGIENE
DOI: 10.4269/ajtmh.2012.10-0665
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Funding
- World Bank/World Health Organization [TDR 920571, TDR 920644]
- National Institutes of Health (National Institute of Allergy and Infectious Disease) [P50 AI 39469]
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We identified 480 persons with positive thick smears for asexual Plasmodium falciparum parasites, of whom 454 had positive rapid diagnostic tests (RDTs) for the histidine-rich protein 2 (HRP2) product of the hrp2 gene and 26 had negative tests. Polymerase chain reaction (PCR) amplification for the histidine-rich repeat region of that gene was negative in one-half (10/22) of false-negative specimens available, consistent with spontaneous deletion. False-negative RDTs were found only in persons with asymptomatic infections, and multiplicities of infection (MOIs) were lower in persons with false-negative RDTs (both P < 0.001). These results show that parasites that fail to produce HRP2 can cause patent bloodstream infections and false-negative RDT results. The importance of these observations is likely to increase as malaria control improves, because lower MOIs are associated with false-negative RDTs and false-negative RDTs are more frequent in persons with asymptomatic infections. These findings suggest that the use of HRP2-based RDTs should be reconsidered.
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