期刊
TROPICAL MEDICINE & INTERNATIONAL HEALTH
卷 17, 期 5, 页码 550-557出版社
WILEY
DOI: 10.1111/j.1365-3156.2012.02975.x
关键词
malaria; pregnancy; Plasmodium falciparum; diagnostic tests; antigen persistence; treatment follow-up; paludisme; malaria; grossesse; Plasmodium falciparum; tests de diagnostic; persistance des antigenes; suivi du traitement; Malaria; Embarazo; Plasmodium falciparum; pruebas diagnosticas; persistencia de antigeno; seguimiento del tratamiento
资金
- Foundation for Innovative New Diagnostics (FIND)
- PREGACT trial in Burkina Faso
Objectives To evaluate persistence of several Plasmodium antigens in pregnant women after treatment and compare diagnostics during treatment follow-up. methods Thirty-two pregnant women (N = 32) with confirmed malaria infection by a histidine-rich protein 2 (HRP2)-based rapid diagnostic test (RDT) and microscopy were followed for 28 days after artemisinin-based combination therapy (ACT). A Plasmodium lactate dehydrogenase (pLDH)-based RDT and two ELISAs based on the detection of dihydrofolate reductase-thymidylate synthase (DHFRTS) and haeme detoxification protein (HDP) were compared with each other and to RT-PCR at each visit. results The mean visit number (95% confidence interval) on which the HRP2-based RDT was still positive after treatment was 3.4 (2.7-4.1) visits with some patients still positive at day 28. This is significantly later than the pLDH-based RDT [0.84 (0.55-1.1)], microscopy (median 1, range 1-3), DHFR-TS-ELISA [1.7 (1.1-2.3)] and RT-PCR (median 2, range 1-5) (P < 0.05), but not significantly later than HDP-ELISA [2.1 (1.6-2.7)]. Lower gravidity and higher parasite density at day 0 resulted in significantly longer positive results with most tests (P < 0.05). conclusions HRP2 can persist up to 28 days after ACT treatment; therefore, this test is not suitable for treatment follow-up in pregnant women and can generate problems when using this test during intermittent preventive treatment (IPTp). DHFR-TS is less persistent than HRP2, making it a potentially interesting target for diagnosis.
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