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Higgins M, Kristan M, Collins EL, Messenger LA, Dombrowski JG, Vanheer LN, Nolder D, Drakeley CJ, Stone W, Mahamar A, Bousema T, Delves M, Bandibabone J, N'Do S, Bantuzeko C, Zawadi B, Walker T, Sutherland CJ, Marinho CRF, Cameron MM, Clark TG, Campino S. A Pan Plasmodium lateral flow recombinase polymerase amplification assay for monitoring malaria parasites in vectors and human populations. Sci Rep 2024; 14:20165. [PMID: 39215071 PMCID: PMC11364753 DOI: 10.1038/s41598-024-71129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
Robust diagnostic tools and surveillance are crucial for malaria control and elimination efforts. Malaria caused by neglected Plasmodium parasites is often underestimated due to the lack of rapid diagnostic tools that can accurately detect these species. While nucleic-acid amplification technologies stand out as the most sensitive methods for detecting and confirming Plasmodium species, their implementation in resource-constrained settings poses significant challenges. Here, we present a Pan Plasmodium recombinase polymerase amplification lateral flow (RPA-LF) assay, capable of detecting all six human infecting Plasmodium species in low resource settings. The Pan Plasmodium RPA-LF assay successfully detected low density clinical infections with a preliminary limit of detection between 10-100 fg/µl for P. falciparum. When combined with crude nucleic acid extraction, the assay can serve as a point-of-need tool for molecular xenomonitoring. This utility was demonstrated by screening laboratory-reared Anopheles stephensi mosquitoes fed with Plasmodium-infected blood, as well as field samples of An. funestus s.l. and An. gambiae s.l. collected from central Africa. Overall, our proof-of-concept Pan Plasmodium diagnostic tool has the potential to be applied for clinical and xenomonitoring field surveillance, and after further evaluation, could become an essential tool to assist malaria control and elimination.
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Affiliation(s)
- Matthew Higgins
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Mojca Kristan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Human Malaria Transmission Facility, LSHTM, Keppel Street, London, WC1E 7HT, UK
| | - Emma L Collins
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Louisa A Messenger
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Environmental & Occupational Health, School of Public Health, University of Nevada, Las Vegas, USA
| | - Jamille G Dombrowski
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Leen N Vanheer
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Debbie Nolder
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Malaria Reference Laboratory, UK Health Security Agency, LSHTM, London, WC1E 7HT, UK
| | - Christopher J Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - William Stone
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Almahamoudou Mahamar
- Malaria Research & Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Science, Techniques and Technologies (USTT), Bamako, Mali
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Michael Delves
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Janvier Bandibabone
- Laboratoire d'Entomologie Médicale Et Parasitologie, Centre de Recherche en Sciences Naturelles (CRSN/Lwiro), Sud‑Kivu, Democratic Republic of the Congo
| | - Sévérin N'Do
- Médecins Sans Frontières (MSF) OCBA, Barcelona, Spain
- Institut de Recherche en Sciences de La Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Chimanuka Bantuzeko
- Centre de Recherche en Sciences Naturelles de Lwiro, Sud-Kivu, Democratic Republic of the Congo
- Université Officielle de Bukavu (UOB), Bukavu, Democratic Republic of the Congo
| | - Bertin Zawadi
- Centre de Recherche en Sciences Naturelles de Lwiro, Sud-Kivu, Democratic Republic of the Congo
| | - Thomas Walker
- School of Life Sciences, University of Warwick, Coventry, UK
| | - Colin J Sutherland
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Human Malaria Transmission Facility, LSHTM, Keppel Street, London, WC1E 7HT, UK
- Malaria Reference Laboratory, UK Health Security Agency, LSHTM, London, WC1E 7HT, UK
| | - Claudio R F Marinho
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Mary M Cameron
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Faculty of Epidemiology and Population Health, LSHTM, Keppel Street, London, WC1E 7HT, UK
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK.
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Tilahun A, Yimer M, Gelaye W, Tegegne B, Endalamaw D, Estifanos F, Abebaw A, Abere A. Comparison of malaria diagnostic methods for detection of asymptomatic Plasmodium infections among pregnant women in northwest Ethiopia. BMC Infect Dis 2024; 24:492. [PMID: 38745114 PMCID: PMC11092159 DOI: 10.1186/s12879-024-09369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Malaria in pregnancy remains a major public health problem in the globe, especially in sub-Saharan Africa. In malaria endemic areas, most pregnant women remain asymptomatic, but malaria could still cause complications on the mother and her offspring; as well as serve as reservoirs to transmit infection. Despite these effects, no attention is given to the diagnosis of asymptomatic Plasmodium infections (APIs) using highly sensitive and specific laboratory diagnostic tools in Ethiopia. Therefore, the goal of this study was to compare the performance of Rapid Diagnostic Test (RDT), microscopy and real-time polymerase chain reaction (RT-PCR) to detect APIs among pregnant women. METHODS A health facility based cross -sectional study was conducted among pregnant women attending antenatal care at Fendeka town health facilities Jawi district, northwest Ethiopia from February to March, 2019. A total of 166 participants were enrolled by using convenient sampling technique. Socio-demographic features were collected using a semi structured questionnaire. Dried blood spot (DBS) samples were collected for molecular analysis. Asymptomatic Plasmodium infection on pregnant women was diagnosed using RDT, microscopy and RT-PCR. Descriptive statistics were used to determine the prevalence of APIs. Method comparison was performed, and Cohen's kappa coefficient (k) was used to determine the degree of agreement among the diagnostic methods. Parasite densities were also calculated. RESULTS The prevalence of API was 9.6%, 11.4% and 18.7% using RDT, microscopy and RT-PCR, respectively. The overall proportion of API was 19.3%. Sensitivity of the RDT was 83.3% as compared with microscopy. Rapid Diagnostic Test and microscopy also showed sensitivity of 50% and 60%, respectively, as compared with RT-PCR. The mean parasite density was 3213 parasites/µl for P falciparum and 1140 parasites/µl of blood for P. vivax. CONCLUSION Prevalence of API in the study area was high. Both RDT and microscopy had lower sensitivity when compared with RT-PCR. Therefore, routine laboratory diagnosis of API among pregnant women should be given attention and done with better sensitive and specific laboratory diagnostic tools.
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Affiliation(s)
- Adane Tilahun
- Department of Medical Laboratory Science, College of Medicine and Health sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Mulat Yimer
- Department of Medical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Woynshet Gelaye
- Department of Medical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | | | | | - Abtie Abebaw
- Department of Medical Laboratory Science, College of Medicine and Health sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Aberham Abere
- School of Biomedical and Laboratory Sciences, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia
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Ikegbunam M, Maurer M, Abone H, Ezeagwuna D, Sandri TL, Esimone C, Ojurongbe O, Woldearegai TG, Kreidenweiss A, Held J, Fendel R. Evaluating Malaria Rapid Diagnostic Tests and Microscopy for Detecting Plasmodium Infection and Status of Plasmodium falciparum Histidine-Rich Protein 2/3 Gene Deletions in Southeastern Nigeria. Am J Trop Med Hyg 2024; 110:902-909. [PMID: 38531105 PMCID: PMC11066366 DOI: 10.4269/ajtmh.23-0690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/12/2023] [Indexed: 03/28/2024] Open
Abstract
Delays in malaria diagnosis increase treatment failures and deaths. In endemic regions, standard diagnostic methods are microscopy and malaria rapid diagnostic tests (mRDTs) detecting Plasmodium falciparum histidine-rich protein 2/3 (PFHRP2/PFHRP3), but gene deletions can allow certain parasites to remain undetected. We enlisted a cohort comprising 207 symptomatic individuals, encompassing both children and adults, at a hospital in Nnewi, Nigeria. The prevalence of parasites was determined using a highly sensitive, species-specific quantitative polymerase chain reaction (SS-qPCR). Within a subset of 132 participants, we assessed the sensitivity and specificity of microscopy and HRP2-mRDTs in comparison to SS-qPCR for the detection of P. falciparum. We also investigated the prevalence of pfhrp2/pfhrp3 gene deletions. Greater sensitivity was achieved with mRDTs (95%) compared with microscopy (77%). Also, mRDTs exhibited greater specificity (68%) than microscopy (44%). The positive predictive value of mRDTs (89%) surpassed that of microscopy (80%), suggesting a greater probability of accurately indicating the presence of infection. The negative predictive value of mRDTs (82%) was far greater than microscopy (39%). Of the 165 P. falciparum-positive samples screened for pfhrp2/pfhrp3 gene deletions, one gene deletion was detected in one sample. Regarding infection prevalence, 84% were positive for Plasmodium spp. (by reverse transcription [RT]-qPCR), with P. falciparum responsible for the majority (97%) of positive cases. Thus, exclusive reliance on microscopy in endemic areas may impede control efforts resulting from false negatives, underscoring the necessity for enhanced training and advocating for high-throughput molecular testing such as RT-qPCR or qPCR at referral centers to address limitations.
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Affiliation(s)
- Moses Ikegbunam
- Department of Pharmaceutical Microbiology and Biotechnology, Nnamdi Azikiwe University, Awka, Nigeria
- Molecular Research Foundation for Students and Scientist, Nnamdi Azikiwe University, Awka, Nigeria
| | - Maike Maurer
- Institute of Tropical Medicine, University of Tübingen, Germany
| | - Harrison Abone
- Department of Pharmaceutical Microbiology and Biotechnology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Dorothy Ezeagwuna
- Departement of Parasitology and Entomology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Thaisa Lucas Sandri
- Institute of Tropical Medicine, University of Tübingen, Germany
- Synovo GmbH, Tübingen, Germany
| | - Charles Esimone
- Department of Pharmaceutical Microbiology and Biotechnology, Nnamdi Azikiwe University, Awka, Nigeria
- Molecular Research Foundation for Students and Scientist, Nnamdi Azikiwe University, Awka, Nigeria
| | - Olusola Ojurongbe
- Department of Medical Microbiology & Parasitology, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
| | - Tamirat Gebru Woldearegai
- Institute of Tropical Medicine, University of Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
- Center de Recherches Médicales de Lambaréné (CERMEL), Gabon
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
- Center de Recherches Médicales de Lambaréné (CERMEL), Gabon
| | - Rolf Fendel
- Institute of Tropical Medicine, University of Tübingen, Germany
- German Center for Infection Research (DZIF), Tübingen, Germany
- Center de Recherches Médicales de Lambaréné (CERMEL), Gabon
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Akafity G, Kumi N, Ashong J. Diagnosis and management of malaria in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:3-15. [PMID: 38263976 PMCID: PMC10800773 DOI: 10.1016/j.jointm.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/17/2023] [Accepted: 09/02/2023] [Indexed: 01/25/2024]
Abstract
Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year. Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia, where the disease is endemic. In non-endemic areas, malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination programs. Severe malaria often requires intensive care unit admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. Intensive care management includes prompt diagnosis and early initiation of effective antimalarial therapy, recognition of complications, and appropriate supportive care. However, the lack of diagnostic capacities due to limited advances in equipment, personnel, and infrastructure presents a challenge to the effective diagnosis and management of malaria. This article reviews the clinical classification, diagnosis, and management of malaria as relevant to critical care clinicians, highlighting the role of diagnostic capacity, treatment options, and supportive care.
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Affiliation(s)
- George Akafity
- Department of Research, Monitoring, and Evaluation, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Nicholas Kumi
- Intensive Care Unit, Department of Critical Care and Anesthesia, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joyce Ashong
- Department of Paediatrics and Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana
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5
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Zhang X, Jiang J, Sui Y, Yan H, Xia J, Liu Y, Sun L, Wang X, Marfurt J, Lu S, Li S, Ruan W, Wang D. Evaluation of performance for malaria diagnosis in health facilities by five provincial reference laboratories of China. Front Public Health 2023; 11:1243642. [PMID: 37841716 PMCID: PMC10569120 DOI: 10.3389/fpubh.2023.1243642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction The provincial malaria diagnosis reference laboratories review and assess malaria cases diagnosed in health facilities for supporting the malaria elimination efforts and preventing re-transmission of imported malaria. The study aimed to evaluate the detection capability of malaria diagnosis in China from 2014 to 2021. Methods Data on malaria cases reported in the provincial-level administrative divisions (PLADs) of Anhui, Henan, Hubei, Guangxi, and Zhejiang from 2014 to 2021 were collected and analyzed. Results In total, 5,770 malaria cases were reported from 2014 to 2021, and 99.05% (5,715/5,770) were submitted to the provincial malaria diagnosis reference laboratories. The median time between malaria cases being reported and the samples being received by reference laboratories was 6 days (Interquartile range, IQR:3-12 days) from 2017 to 2021. Diagnosis of 5,680 samples in the laboratory were confirmed by provincial reference laboratories, including 3,970 cases of Plasmodium falciparum, 414 of P. vivax, 1,055 of P. ovale, 158 of P. malariae, 1 of P. knowlesi, and 82 of mixed infections. Plasmodium species of 5,141 confirmed cases were consistent with the initial diagnosis, with a species accuracy rate of 90.53% (5,141/5,679). The accuracy of P. falciparum diagnosis in health facilities was higher than that of non-falciparum species. The inconsistency between microscopy and nested polymerase chain reaction (nPCR) results of confirmatory diagnosis was mainly in malaria-positive versus malaria-negative cases, as well as in mixed versus single infection cases. Conclusion The provincial malaria diagnosis reference laboratories have played an important role in ensuring the accuracy and reliability of Plasmodium diagnosis in health facilities. However, the results of this study imply that capacity training for the identification of Plasmodium species in health facilities is warranted.
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Affiliation(s)
- Xuan Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jingjing Jiang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Yuan Sui
- Brown School, Washington University, St. Louis, MO, United States
| | - Hui Yan
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Jing Xia
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Ying Liu
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Lingcong Sun
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Xiaoxiao Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jutta Marfurt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Shenning Lu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, China
| | - Shizhu Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, China
| | - Wei Ruan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Duoquan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, China
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Olukosi AY, Ajibaye O, Omoniwa O, Oresanya O, Oluwagbemiga AO, Ujuju C, Ekholuenetale M, Maxwell K, Sutherland CJ, Tibenderana JK, Beshir KB. Baseline prevalence of molecular marker of sulfadoxine/pyrimethamine resistance in Ebonyi and Osun states, Nigeria: amplicon deep sequencing of dhps-540. J Antimicrob Chemother 2023; 78:788-791. [PMID: 36680454 PMCID: PMC9978573 DOI: 10.1093/jac/dkad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chemoprevention plays an important role in malaria control strategy. Perennial malaria chemoprevention (PMC) using sulfadoxine/pyrimethamine (SP) is a WHO-approved strategy to combat malaria in young children and may lead to drug pressure. Introducing SP-PMC may therefore be compromised due to the emergence of Plasmodium falciparum resistant to SP, particularly mutation at K540E of the dihydropteroate synthase (dhps) gene. Molecular surveillance of resistance markers can support assessment of antimalarial efficacy and effectiveness. High prevalence of 540E is associated with reduced effectiveness of SP, and areas with more than 50% prevalence are considered unsuitable for intermittent preventative treatment in pregnancy (IPTp) implementation. Assessing 540E prevalence is an important undertaking before implementation of SP-PMC. METHODS We conducted a rapid surveillance of dhps-540E to assess the suitability of SP as PMC in field studies from Ebonyi and Osun states in Nigeria. We used an in-house developed amplicon deep-sequencing method targeting part of the dhps gene. RESULTS Our data reveal that 18.56% of individuals evaluated carried the 540E mutation mixed with the WT K540. Mutant variant 540E alone was not found, and 80% of isolates harboured only WT (K540). Clonal analysis of the sequencing data shows a very low proportion of 540E circulating in both states. CONCLUSIONS Our data show that both states are suitable for SP-PMC implementation and, based on this finding, SP-PMC was implemented in Osun in 2022. Continuous monitoring of 540E will be required to ensure the chemoprevention effectiveness of SP in Nigeria.
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Affiliation(s)
- Adeola Y Olukosi
- Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, Edmond Crescent, 101212 Yaba, Lagos, Nigeria
| | - Olusola Ajibaye
- Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, Edmond Crescent, 101212 Yaba, Lagos, Nigeria
| | - Omowunmi Omoniwa
- Malaria Consortium, 33 Pope John Paul II St, Maitama 904101, Abuja, Nigeria
| | - Olusola Oresanya
- Malaria Consortium, 33 Pope John Paul II St, Maitama 904101, Abuja, Nigeria
| | - Aina O Oluwagbemiga
- Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, Edmond Crescent, 101212 Yaba, Lagos, Nigeria
| | - Chinazo Ujuju
- Malaria Consortium, 33 Pope John Paul II St, Maitama 904101, Abuja, Nigeria
| | | | - Kolawole Maxwell
- Malaria Consortium, 33 Pope John Paul II St, Maitama 904101, Abuja, Nigeria
| | - Colin J Sutherland
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, , London WC1E 7HT, UK
| | - James K Tibenderana
- Malaria Consortium Headquarters, The Green House, 244-254 Cambridge Heath Road, London E2 9DA, UK
| | - Khalid B Beshir
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, , London WC1E 7HT, UK
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Perez-Ugarte A, Rubio Maturana C, Silgado A, Zarzuela Serrat F, Goterris L, Paredes-Carmona F, Sulleiro E. Unexpected false-negative result in a traveller's malaria diagnosis. J Travel Med 2023; 30:6775350. [PMID: 36300508 DOI: 10.1093/jtm/taac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022]
Abstract
A 4-year-old traveller returned from Senegal with symptoms compatible with malaria. Plasmodium falciparum HRP-2 antigen detection was negative, whereas panmalarial aldolase was positive. Microscopy confirmed the presence of P. falciparum trophozoites with parasitaemia of 16%. Discarding other causes of false-negative antigen detection, this is a rare case of prozone effect.
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Affiliation(s)
- Arantxa Perez-Ugarte
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona 08035, España
| | - Carles Rubio Maturana
- Microbiology Department, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona 08035, España
| | - Aroa Silgado
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona 08035, España
- CIBERINFEC, ISCIII- CIBER Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Francesc Zarzuela Serrat
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona 08035, España
| | - Lidia Goterris
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona 08035, España
| | | | - Elena Sulleiro
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona 08035, España
- CIBERINFEC, ISCIII- CIBER Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
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8
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Martiáñez-Vendrell X, Skjefte M, Sikka R, Gupta H. Factors Affecting the Performance of HRP2-Based Malaria Rapid Diagnostic Tests. Trop Med Infect Dis 2022; 7:265. [PMID: 36288006 PMCID: PMC9611031 DOI: 10.3390/tropicalmed7100265] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
The recent COVID-19 pandemic has profoundly impacted global malaria elimination programs, resulting in a sharp increase in malaria morbidity and mortality. To reduce this impact, unmet needs in malaria diagnostics must be addressed while resuming malaria elimination activities. Rapid diagnostic tests (RDTs), the unsung hero in malaria diagnosis, work to eliminate the prevalence of Plasmodium falciparum malaria through their efficient, cost-effective, and user-friendly qualities in detecting the antigen HRP2 (histidine-rich protein 2), among other proteins. However, the testing mechanism and management of malaria with RDTs presents a variety of limitations. This paper discusses the numerous factors (including parasitic, host, and environmental) that limit the performance of RDTs. Additionally, the paper explores outside factors that can hinder RDT performance. By understanding these factors that affect the performance of HRP2-based RDTs in the field, researchers can work toward creating and implementing more effective and accurate HRP2-based diagnostic tools. Further research is required to understand the extent of these factors, as the rapidly changing interplay between parasite and host directly hinders the effectiveness of the tool.
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Affiliation(s)
- Xavier Martiáñez-Vendrell
- Molecular Virology Laboratory, Department of Medical Microbiology, LUMC Center for Infectious Diseases (LU-CID), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands or
| | - Malia Skjefte
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Ruhi Sikka
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, Mathura 281406, UP, India
| | - Himanshu Gupta
- Department of Biotechnology, Institute of Applied Sciences & Humanities, GLA University, Mathura 281406, UP, India
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9
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Kaaya RD, Amour C, Matowo JJ, Mosha FW, Kavishe RA, Beshir KB. Genetic Sequence Variation in the Plasmodium falciparum Histidine-Rich Protein 2 Gene from Field Isolates in Tanzania: Impact on Malaria Rapid Diagnosis. Genes (Basel) 2022; 13:1642. [PMID: 36140809 PMCID: PMC9498557 DOI: 10.3390/genes13091642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/26/2022] [Accepted: 09/09/2022] [Indexed: 12/04/2022] Open
Abstract
Malaria rapid diagnosis test (RDT) is crucial for managing the disease, and the effectiveness of detection depends on parameters such as sensitivity and specificity of the RDT. Several factors can affect the performance of RDT. In this study, we focused on the pfhrp2 sequence variation and its impact on RDTs targeted by antigens encoded by Plasmodium falciparum histidine-rich protein 2 (pfhrp2). Field samples collected during cross-sectional surveys in Tanzania were sequenced to investigate the pfhrp2 sequence diversity and evaluate the impact on HRP2-based RDT performance. We observed significant mean differences in amino acid repeats between current and previous studies. Several new amino acid repeats were found to occur at different frequencies, including types AAY, AHHAHHAAN, and AHHAA. Based on the abundance of types 2 and 7 amino acid repeats, the binary predictive model was able to predict RDT insensitivity by about 69% in the study area. About 85% of the major epitopes targeted by monoclonal antibodies (MAbs) in RDT were identified. Our study suggested that the extensive sequence variation in pfhrp2 can contribute to reduced RDT sensitivity. The correlation between the different combinations of amino acid repeats and the performance of RDT in different malaria transmission settings should be investigated further.
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Affiliation(s)
- Robert D. Kaaya
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
- Pan-African Malaria Vector Research Consortium, Moshi P.O. Box 2240, Tanzania
| | - Caroline Amour
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
| | - Johnson J. Matowo
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
- Pan-African Malaria Vector Research Consortium, Moshi P.O. Box 2240, Tanzania
| | - Franklin W. Mosha
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
- Pan-African Malaria Vector Research Consortium, Moshi P.O. Box 2240, Tanzania
| | - Reginald A. Kavishe
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2240, Tanzania
| | - Khalid B. Beshir
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Arias-Alpízar K, Sánchez-Cano A, Prat-Trunas J, Sulleiro E, Bosch-Nicolau P, Salvador F, Oliveira I, Molina I, Sánchez-Montalvá A, Baldrich E. Magnetic Bead Handling Using a Paper-Based Device for Quantitative Point-of-Care Testing. BIOSENSORS 2022; 12:680. [PMID: 36140066 PMCID: PMC9496280 DOI: 10.3390/bios12090680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
Microfluidic paper-based analytical devices (μPADs) have been extensively proposed as ideal tools for point-of-care (POC) testing with minimal user training and technical requirements. However, most μPADs use dried bioreagents, which complicate production, reduce device reproducibility and stability, and require transport and storage under temperature and humidity-controlled conditions. In this work, we propose a μPAD produced using an affordable craft-cutter and stored at room temperature, which is used to partially automate a single-step colorimetric magneto-immunoassay. As a proof-of-concept, the μPAD has been applied to the quantitative detection of Plasmodium falciparum lactate dehydrogenase (Pf-LDH), a biomarker of malaria infection. In this system, detection is based on a single-step magneto-immunoassay that consists of a single 5-min incubation of the lysed blood sample with immuno-modified magnetic beads (MB), detection antibody, and an enzymatic signal amplifier (Poly-HRP). This mixture is then transferred to a single-piece paper device where, after on-chip MB magnetic concentration and washing, signal generation is achieved by adding a chromogenic enzyme substrate. The colorimetric readout is achieved by the naked eye or using a smartphone camera and free software for image analysis. This μPAD afforded quantitative Pf-LDH detection in <15 min, with a detection limit of 6.25 ng mL−1 when the result was interpreted by the naked eye and 1.4 ng mL−1 when analysed using the smartphone imaging system. Moreover, the study of a battery of clinical samples revealed concentrations of Pf-LDH that correlated with those provided by the reference ELISA and with better sensitivity than a commercial rapid diagnostic test (RDT). These results demonstrate that magneto-immunoassays can be partly automated by employing a μPAD, achieving a level of handling that approaches the requirements of POC testing.
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Affiliation(s)
- Kevin Arias-Alpízar
- Diagnostic Nanotools Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Ana Sánchez-Cano
- Diagnostic Nanotools Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Judit Prat-Trunas
- Diagnostic Nanotools Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | - Elena Sulleiro
- Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
- International Health Unit Vall d’Hebron-Drassanes, Vall d’Hebron Hospital Universitari, PROSICS Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28028 Madrid, Spain
| | - Pau Bosch-Nicolau
- International Health Unit Vall d’Hebron-Drassanes, Vall d’Hebron Hospital Universitari, PROSICS Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28028 Madrid, Spain
| | - Fernando Salvador
- International Health Unit Vall d’Hebron-Drassanes, Vall d’Hebron Hospital Universitari, PROSICS Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28028 Madrid, Spain
| | - Inés Oliveira
- International Health Unit Vall d’Hebron-Drassanes, Vall d’Hebron Hospital Universitari, PROSICS Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28028 Madrid, Spain
| | - Israel Molina
- International Health Unit Vall d’Hebron-Drassanes, Vall d’Hebron Hospital Universitari, PROSICS Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28028 Madrid, Spain
| | - Adrián Sánchez-Montalvá
- Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
- International Health Unit Vall d’Hebron-Drassanes, Vall d’Hebron Hospital Universitari, PROSICS Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28028 Madrid, Spain
| | - Eva Baldrich
- Diagnostic Nanotools Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28028 Madrid, Spain
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11
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Beshir KB, Parr JB, Cunningham J, Cheng Q, Rogier E. Screening strategies and laboratory assays to support Plasmodium falciparum histidine-rich protein deletion surveillance: where we are and what is needed. Malar J 2022; 21:201. [PMID: 35751070 PMCID: PMC9233320 DOI: 10.1186/s12936-022-04226-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
Rapid diagnostic tests (RDTs) detecting Plasmodium falciparum histidine-rich protein 2 (HRP2) have been an important tool for malaria diagnosis, especially in resource-limited settings lacking quality microscopy. Plasmodium falciparum parasites with deletion of the pfhrp2 gene encoding this antigen have now been identified in dozens of countries across Asia, Africa, and South America, with new reports revealing a high prevalence of deletions in some selected regions. To determine whether HRP2-based RDTs are appropriate for continued use in a locality, focused surveys and/or surveillance activities of the endemic P. falciparum population are needed. Various survey and laboratory methods have been used to determine parasite HRP2 phenotype and pfhrp2 genotype, and the data collected by these different methods need to be interpreted in the appropriate context of survey and assay utilized. Expression of the HRP2 antigen can be evaluated using point-of-care RDTs or laboratory-based immunoassays, but confirmation of a deletion (or mutation) of pfhrp2 requires more intensive laboratory molecular assays, and new tools and strategies for rigorous but practical data collection are particularly needed for large surveys. Because malaria diagnostic strategies are typically developed at the national level, nationally representative surveys and/or surveillance that encompass broad geographical areas and large populations may be required. Here is discussed contemporary assays for the phenotypic and genotypic evaluation of P. falciparum HRP2 status, consider their strengths and weaknesses, and highlight key concepts relevant to timely and resource-conscious workflows required for efficient diagnostic policy decision making.
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Affiliation(s)
- Khalid B Beshir
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Diseases, Keppel Street, London, WC1E 7HT, UK
| | - Jonathan B Parr
- Division of Infectious Diseases and Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jane Cunningham
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Qin Cheng
- Drug Resistance and Diagnostics, Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30029, USA.
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12
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Deletions of the Plasmodium falciparum histidine-rich protein 2/3 genes are common in field isolates from north-eastern Tanzania. Sci Rep 2022; 12:5802. [PMID: 35388127 PMCID: PMC8987040 DOI: 10.1038/s41598-022-09878-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Plasmodium falciparum parasites lacking histidine-rich protein 2 and 3 (pfhrp2/3) genes have been reported in several parts of the world. These deletions are known to compromise the effectiveness of HRP2-based malaria rapid diagnostic tests (HRP2-RDT). The National Malaria Control Programme (NMCP) in Tanzania adopted HRP2-RDTs as a routine tool for malaria diagnosis in 2009 replacing microscopy in many Health facilities. We investigated pfhrp2/3 deletions in 122 samples from two areas with diverse malaria transmission intensities in Northeastern Tanzania. Pfhrp2 deletion was confirmed in 1.6% of samples while pfhrp3 deletion was confirmed in 50% of samples. We did not find parasites with both pfhrp2 and pfhrp3 deletions among our samples. Results from this study highlight the need for systematic surveillance of pfhrp2/3 deletions in Tanzania to understand their prevalence and determine their impact on the performance of mRDT.
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13
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Rogers CL, Bain BJ, Garg M, Fernandes S, Mooney C, Chiodini PL. British Society for Haematology guidelines for the laboratory diagnosis of malaria. Br J Haematol 2022; 197:271-282. [PMID: 35262915 DOI: 10.1111/bjh.18092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Claire L Rogers
- The London School of Hygiene and Tropical Medicine, London, UK
| | - Barbara J Bain
- St Mary's Hospital Campus of Imperial College London, London, UK
| | - Mamta Garg
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Peter L Chiodini
- The London School of Hygiene and Tropical Medicine, London, UK.,The Hospital for Tropical Diseases, London, UK
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