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Am J Trop Med Hyg. 2012 Feb;86(2):194-8. doi: 10.4269/ajtmh.2012.10-0665.

False-negative rapid diagnostic tests for malaria and deletion of the histidine-rich repeat region of the hrp2 gene.

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  • 1Mali-Tulane Tropical Medicine Research Center, Faculty of Medicine, Pharmacy, and Dentistry, University of Bamako, Bamako, Mali. okoita@icermali.org

Abstract

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.

PMID:
22302847
[PubMed - indexed for MEDLINE]
PMCID:
PMC3269266
Free PMC Article
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