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Molina-de la Fuente I, Tahita MC, Bérenger K, Ta Tang TH, García L, González V, Benito A, Hübschen JM, Tinto H, Berzosa P. Malaria diagnosis challenges and pfhrp2 and pfhrp3 gene deletions using pregnant women as sentinel population in Nanoro region, Burkina Faso. Pathog Glob Health 2024:1-11. [PMID: 39140699 DOI: 10.1080/20477724.2024.2388489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
Malaria in pregnancy causes adverse consequences and prompt and accurate diagnosis is essential for case management. In malaria endemic countries, diagnosis is mainly based on rapid diagnostic tests (RDT) and microscopy. However, increasing reports of false negatives caused by low parasitemia and pfhrp2/3 deletions raise concerns about HRP2-based RDT usefulness. This study aimed to assess RDT and microscopy performance and to describe pfhrp2/3 deletions in a cohort of 418 pregnant women in Burkina Faso. Malaria was diagnosed using RDT and microscopy and blood samples were collected during antenatal care visits. Diagnostic results were compared to PCR as gold standard. Pfhrp2 and pfhrp3 deletions were characterized for patients with confirmed P. falciparum infection. RDT had better sensitivity (76%) but lower specificity (83%) than microscopy (sensitivity = 57%; specificity = 98%). Low parasitemia (<150 parasites/µL), especially in multigravidae, was the principal factor causing false negatives by both methods. Moreover, pfhrp2 deletion frequency among overall false negatives by RDT was 21.43%. Higher frequency of deletions was found among all samples, independently of RDT result, for example around 2% of samples had double deletions meaning that the majority of deletions had no effect on RDT testing. Finally, it was found higher pfhrp2 deletion in women with lower uterine height during the first trimester. Wider and National surveillance study of deletions is recommended among pregnant women and in Burkina Faso.
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Affiliation(s)
- Irene Molina-de la Fuente
- Department of Biomedicine and Biotechnology, School of Pharmacy, University of Alcalá, Madrid, Spain
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
| | - Marc Christian Tahita
- Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
- Institut de Recherche en Sciences de la Sante/Direction Régionale du Centre-Ouest, Bobo Dioulasso, Burkina Faso
| | - Kabore Bérenger
- Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
- Institut de Recherche en Sciences de la Sante/Direction Régionale du Centre-Ouest, Bobo Dioulasso, Burkina Faso
| | - Thuy Huong Ta Tang
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
| | - Luz García
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
| | - Vicenta González
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
| | - Agustín Benito
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
| | - Judith M Hübschen
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
- Institut de Recherche en Sciences de la Sante/Direction Régionale du Centre-Ouest, Bobo Dioulasso, Burkina Faso
| | - Pedro Berzosa
- Malaria and Neglected Tropical Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
- CIBERINFEC - CIBER Infectious Diseases (ISCIII), Madrid, Spain
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Bally DR, Santos SDS, Arregue DC, de Mattos MK, Suárez-Mutis MC. High Frequency of Deletions in the pfhrp2 and pfhrp3 Genes of Plasmodium falciparum in the Middle Rio Negro Region of the Brazilian Amazon. Trop Med Infect Dis 2024; 9:149. [PMID: 39058191 PMCID: PMC11281371 DOI: 10.3390/tropicalmed9070149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
Several countries are reporting natural populations of P. falciparum with deletions in the pfhrp2/3 genes that can lead to false-negative results in rapid diagnostic tests. To investigate the prevalence of deletion in the pfhrp2/3 genes in the Rio Negro basin in the Brazilian Amazon and identify whether there is clinical differentiation between individuals infected by these parasites, clinical samples collected from 2003 to 2016 were analyzed from symptomatic and asymptomatic P. falciparum-infected individuals. The molecular deletion of pfhrp2 and pfhrp3 genes was evaluated using the protocols recommended by the WHO. From 82 samples used, 28 (34.2%) had a single deletion in pfhrp2, 19 (23.2%) had a single deletion in pfhrp3, 15 (18.3%) had a double deletion (pfhrp2/3), and 20 (24.4%) did not have a deletion in either gene. In total, 29.3% of individuals had an asymptomatic plasmodial infection and were 3.64 times more likely to have parasites with a double deletion (pfhrp2/3) than patients with clinical malaria (p = 0.02). The high prevalence of parasites with pfhrp2/3 deletions shows the need to implement a surveillance program in this area. Deletions in parasites may be associated with the clinical pattern of the disease in this area. More studies must be carried out to elucidate these findings.
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Affiliation(s)
- Daniela Romero Bally
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil; (D.R.B.); (S.d.S.S.); (D.C.A.); (M.K.d.M.)
- Post-Graduation Program in Tropical Medicine, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Simone da Silva Santos
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil; (D.R.B.); (S.d.S.S.); (D.C.A.); (M.K.d.M.)
| | - Diego Calafate Arregue
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil; (D.R.B.); (S.d.S.S.); (D.C.A.); (M.K.d.M.)
| | - Mariana Kelly de Mattos
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil; (D.R.B.); (S.d.S.S.); (D.C.A.); (M.K.d.M.)
| | - Martha C. Suárez-Mutis
- Laboratório de Doenças Parasitárias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil; (D.R.B.); (S.d.S.S.); (D.C.A.); (M.K.d.M.)
- Post-Graduation Program in Tropical Medicine, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro 21040-900, Brazil
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Mshani IH, Jackson FM, Mwanga RY, Kweyamba PA, Mwanga EP, Tambwe MM, Hofer LM, Siria DJ, González-Jiménez M, Wynne K, Moore SJ, Okumu F, Babayan SA, Baldini F. Screening of malaria infections in human blood samples with varying parasite densities and anaemic conditions using AI-Powered mid-infrared spectroscopy. Malar J 2024; 23:188. [PMID: 38880870 PMCID: PMC11181574 DOI: 10.1186/s12936-024-05011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Effective testing for malaria, including the detection of infections at very low densities, is vital for the successful elimination of the disease. Unfortunately, existing methods are either inexpensive but poorly sensitive or sensitive but costly. Recent studies have shown that mid-infrared spectroscopy coupled with machine learning (MIRs-ML) has potential for rapidly detecting malaria infections but requires further evaluation on diverse samples representative of natural infections in endemic areas. The aim of this study was, therefore, to demonstrate a simple AI-powered, reagent-free, and user-friendly approach that uses mid-infrared spectra from dried blood spots to accurately detect malaria infections across varying parasite densities and anaemic conditions. METHODS Plasmodium falciparum strains NF54 and FCR3 were cultured and mixed with blood from 70 malaria-free individuals to create various malaria parasitaemia and anaemic conditions. Blood dilutions produced three haematocrit ratios (50%, 25%, 12.5%) and five parasitaemia levels (6%, 0.1%, 0.002%, 0.00003%, 0%). Dried blood spots were prepared on Whatman™ filter papers and scanned using attenuated total reflection-Fourier Transform Infrared (ATR-FTIR) for machine-learning analysis. Three classifiers were trained on an 80%/20% split of 4655 spectra: (I) high contrast (6% parasitaemia vs. negative), (II) low contrast (0.00003% vs. negative) and (III) all concentrations (all positive levels vs. negative). The classifiers were validated with unseen datasets to detect malaria at various parasitaemia levels and anaemic conditions. Additionally, these classifiers were tested on samples from a population survey in malaria-endemic villages of southeastern Tanzania. RESULTS The AI classifiers attained over 90% accuracy in detecting malaria infections as low as one parasite per microlitre of blood, a sensitivity unattainable by conventional RDTs and microscopy. These laboratory-developed classifiers seamlessly transitioned to field applicability, achieving over 80% accuracy in predicting natural P. falciparum infections in blood samples collected during the field survey. Crucially, the performance remained unaffected by various levels of anaemia, a common complication in malaria patients. CONCLUSION These findings suggest that the AI-driven mid-infrared spectroscopy approach holds promise as a simplified, sensitive and cost-effective method for malaria screening, consistently performing well despite variations in parasite densities and anaemic conditions. The technique simply involves scanning dried blood spots with a desktop mid-infrared scanner and analysing the spectra using pre-trained AI classifiers, making it readily adaptable to field conditions in low-resource settings. In this study, the approach was successfully adapted to field use, effectively predicting natural malaria infections in blood samples from a population-level survey in Tanzania. With additional field trials and validation, this technique could significantly enhance malaria surveillance and contribute to accelerating malaria elimination efforts.
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Affiliation(s)
- Issa H Mshani
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania.
- School of Biodiversity, One Health and Veterinary Medicine, The University of Glasgow, Glasgow, UK.
| | - Frank M Jackson
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania
| | - Rehema Y Mwanga
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania
| | - Prisca A Kweyamba
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Emmanuel P Mwanga
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, The University of Glasgow, Glasgow, UK
| | - Mgeni M Tambwe
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania
| | - Lorenz M Hofer
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Doreen J Siria
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, The University of Glasgow, Glasgow, UK
| | - Mario González-Jiménez
- School of Biodiversity, One Health and Veterinary Medicine, The University of Glasgow, Glasgow, UK
- School of Chemistry, The University of Glasgow, Glasgow, G128QQ, UK
| | - Klaas Wynne
- School of Chemistry, The University of Glasgow, Glasgow, G128QQ, UK
| | - Sarah J Moore
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
- School of Life Sciences and Biotechnology, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
| | - Fredros Okumu
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, The University of Glasgow, Glasgow, UK
- School of Life Sciences and Biotechnology, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
- School of Public Health, The University of the Witwatersrand, Park Town, Johannesburg, South Africa
| | - Simon A Babayan
- School of Biodiversity, One Health and Veterinary Medicine, The University of Glasgow, Glasgow, UK
| | - Francesco Baldini
- Environmental Health, and Ecological Sciences Department, Ifakara Health Institute, Morogoro, United Republic of Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, The University of Glasgow, Glasgow, UK
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Sohail A, Barry A, Auburn S, Cheng Q, Lau CL, Lee R, Price RN, Furuya-Kanamori L, Bareng P, McGuinness SL, Leder K. Imported malaria into Australia: surveillance insights and opportunities. J Travel Med 2024; 31:taad164. [PMID: 38127641 PMCID: PMC10998534 DOI: 10.1093/jtm/taad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Malaria continues to pose a significant burden in endemic countries, many of which lack access to molecular surveillance. Insights from malaria cases in travellers returning to non-endemic areas can provide valuable data to inform endemic country programmes. To evaluate the potential for novel global insights into malaria, we examined epidemiological and molecular data from imported malaria cases to Australia. METHODS We analysed malaria cases reported in Australia from 2012 to 2022 using National Notifiable Disease Surveillance System data. Molecular data on imported malaria cases were obtained from literature searches. RESULTS Between 2012 and 2022, 3204 malaria cases were reported in Australia. Most cases (69%) were male and 44% occurred in young adults aged 20-39 years. Incidence rates initially declined between 2012 and 2015, then increased until 2019. During 2012-2019, the incidence in travellers ranged from 1.34 to 7.71 per 100 000 trips. Cases were primarily acquired in Sub-Saharan Africa (n = 1433; 45%), Oceania (n = 569; 18%) and Southern and Central Asia (n = 367; 12%). The most common countries of acquisition were Papua New Guinea (n = 474) and India (n = 277). Plasmodium falciparum accounted for 58% (1871/3204) of cases and was predominantly acquired in Sub-Saharan Africa, and Plasmodium vivax accounted for 32% (1016/3204), predominantly from Oceania and Asia. Molecular studies of imported malaria cases to Australia identified genetic mutations and deletions associated with drug resistance and false-negative rapid diagnostic test results, and led to the establishment of reference genomes for P. vivax and Plasmodium malariae. CONCLUSIONS Our analysis highlights the continuing burden of imported malaria into Australia. Molecular studies have offered valuable insights into drug resistance and diagnostic limitations, and established reference genomes. Integrating molecular data into national surveillance systems could provide important infectious disease intelligence to optimize treatment guidelines for returning travellers and support endemic country surveillance programmes.
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Affiliation(s)
- Asma Sohail
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Infectious Diseases, Grampians Health, Ballarat 3350, Australia
| | - Alyssa Barry
- Institute for Physical and Mental Health and Clinical Translation (IMPACT) and School of Medicine, Deakin University, Geelong 3220, Australia
- Disease Elimination Program, Burnet Institute, Melbourne 3004, Australia
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0800, Australia
| | - Qin Cheng
- Drug Resistance and Diagnostics, Australian Defence Force Malaria and Infectious Disease Institute, Brisbane 4051, Australia
| | - Colleen L Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | - Rogan Lee
- Parasitology Unit, Institute of Clinical Pathology and Medical Research, Sydney 2145, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0800, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Luis Furuya-Kanamori
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Australia
| | - Paolo Bareng
- Institute for Physical and Mental Health and Clinical Translation (IMPACT) and School of Medicine, Deakin University, Geelong 3220, Australia
| | - Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne 3004, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Victorian Infectious Diseases Service, Melbourne Health, Melbourne 3052, Australia
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Srivastava B, Sharma S, Swarnkar D, Ahmed N, Valecha N, Anvikar AR. Benefits of Lot Testing to Improve the Quality of Malaria Rapid Diagnostic Tests in India. Am J Trop Med Hyg 2024; 110:431-435. [PMID: 38350136 PMCID: PMC10919188 DOI: 10.4269/ajtmh.23-0339] [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: 05/25/2023] [Accepted: 11/02/2023] [Indexed: 02/15/2024] Open
Abstract
Since 2010, malaria rapid diagnostic tests (RDTs) are widely used to detect malaria. The Indian Council of Medical Research-National Institute of Malaria Research performed lot testing (LT) according to WHO procedures since 2016. Lot testing is performed to evaluate the lot-to-lot variation in performance of malaria RDTs. Four sets of positive quality control (QC) panels for P. falciparum (Pf) and P. vivax (Pv) and 10 negative panels tested RDTs. RDTs were reported as pass, failed, or deferred on the basis of WHO criteria. In the past 5 years, 275 lots containing 15,488 RDT kits for malaria diagnosis were subjected to LT. The monovalent RDTs (n = 1,216), based on either Pf histidine rich protein 2 (HRP2) or Pan-Plasmodium lactate dehydrogenase (Pan-pLDH) antigens, showed 90.4% sensitivity and 100% specificity, whereas RDTs based on HRP2 + Pan-pLDH or HRP2 + pLDH (n = 13,924) had sensitivity 95.6% and specificity 99.5%, respectively. RDTs based on PfHRP2 + Pv-pLDH + Pan-pLDH (n = 348) had 100% sensitivity and specificity. In a comparison between HRP2 + pLDH or HRP2 + Pan-pLDH to HRP2 + pLDH + Pan-pLDH RDTs, it was found that the sensitivity of PfHRP2 with Pan-pLDH RDTs (n = 2,382) was only 83%. Of the 275 lots analyzed, 15 lots of PfHRP2 with Pan-pLDH were deferred. The QC panel for Pf revealed a faint Pan band in the tested lots, which is a cause for concern. The results of deferred lots were reported to concerned government agencies. Quality-compromised RDTs may lead to an incorrect diagnosis. It is critical to have a QC system in place for effective malaria management.
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Affiliation(s)
- Bina Srivastava
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Supriya Sharma
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Deendayal Swarnkar
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Naseem Ahmed
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Neena Valecha
- Independent Malaria Technical Expert, New Delhi, India
| | - Anupkumar R. Anvikar
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka, New Delhi, India
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Watson OJ, Tran TNA, Zupko RJ, Symons T, Thomson R, Visser T, Rumisha S, Dzianach PA, Hathaway N, Kim I, Juliano JJ, Bailey JA, Slater H, Okell L, Gething P, Ghani A, Boni MF, Parr JB, Cunningham J. Global risk of selection and spread of Plasmodium falciparum histidine-rich protein 2 and 3 gene deletions. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.10.21.23297352. [PMID: 37905102 PMCID: PMC10615018 DOI: 10.1101/2023.10.21.23297352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
In the thirteen years since the first report of pfhrp2-deleted parasites in 2010, the World Health Organization (WHO) has found that 40 of 47 countries surveyed worldwide have reported pfhrp2/3 gene deletions. Due to a high prevalence of pfhrp2/3 deletions causing false-negative HRP2 RDTs, in the last five years, Eritrea, Djibouti and Ethiopia have switched or started switching to using alternative RDTs, that target pan-specific-pLDH or P. falciparum specific-pLDH alone of in combination with HRP2. However, manufacturing of alternative RDTs has not been brought to scale and there are no WHO prequalified combination tests that use Pf-pLDH instead of HRP2 for P. falciparum detection. For these reasons, the continued spread of pfhrp2/3 deletions represents a growing public health crisis that threatens efforts to control and eliminate P. falciparum malaria. National malaria control programmes, their implementing partners and test developers desperately seek pfhrp2/3 deletion data that can inform their immediate and future resource allocation. In response, we use a mathematical modelling approach to evaluate the global risk posed by pfhrp2/3 deletions and explore scenarios for how deletions will continue to spread in Africa. We incorporate current best estimates of the prevalence of pfhrp2/3 deletions and conduct a literature review to estimate model parameters known to impact the selection of pfhrp2/3 deletions for each malaria endemic country. We identify 20 countries worldwide to prioritise for surveillance and future deployment of alternative RDT, based on quickly selecting for pfhrp2/3 deletions once established. In scenarios designed to explore the continued spread of deletions in Africa, we identify 10 high threat countries that are most at risk of deletions both spreading to and subsequently being rapidly selected for. If HRP2-based RDTs continue to be relied on for malaria case management, we predict that the major route for pfhrp2 deletions to spread is south out from the current hotspot in the Horn of Africa, moving through East Africa over the next 20 years. We explore the variation in modelled timelines through an extensive parameter sensitivity analysis and despite wide uncertainties, we identify three countries that have not yet switched RDTs (Senegal, Zambia and Kenya) that are robustly identified as high risk for pfhrp2/3 deletions. These results provide a refined and updated prediction model for the emergence of pfhrp2/3 deletions in an effort to help guide pfhrp2/3 policy and prioritise future surveillance efforts and innovation.
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Affiliation(s)
- Oliver J Watson
- Medical Research Council Centre for Global Infectious Disease Analysis, Faculty of Medicine, Imperial College London, London, UK
| | - Thu Nguyen-Anh Tran
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA
| | - Robert J Zupko
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA
| | - Tasmin Symons
- Malaria Atlas Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia
| | | | | | - Susan Rumisha
- Malaria Atlas Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia
| | - Paulina A Dzianach
- Malaria Atlas Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia
| | - Nicholas Hathaway
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Isaac Kim
- Center for Computational Molecular Biology, Brown University, Providence, RI, USA
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jonathan J Juliano
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey A Bailey
- Center for Computational Molecular Biology, Brown University, Providence, RI, USA
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | | | - Lucy Okell
- Medical Research Council Centre for Global Infectious Disease Analysis, Faculty of Medicine, Imperial College London, London, UK
| | - Peter Gething
- Malaria Atlas Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Azra Ghani
- Medical Research Council Centre for Global Infectious Disease Analysis, Faculty of Medicine, Imperial College London, London, UK
| | - Maciej F Boni
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jonathan B Parr
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jane Cunningham
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
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Walker IS, Rogerson SJ. Pathogenicity and virulence of malaria: Sticky problems and tricky solutions. Virulence 2023; 14:2150456. [PMID: 36419237 PMCID: PMC9815252 DOI: 10.1080/21505594.2022.2150456] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
Infections with Plasmodium falciparum and Plasmodium vivax cause over 600,000 deaths each year, concentrated in Africa and in young children, but much of the world's population remain at risk of infection. In this article, we review the latest developments in the immunogenicity and pathogenesis of malaria, with a particular focus on P. falciparum, the leading malaria killer. Pathogenic factors include parasite-derived toxins and variant surface antigens on infected erythrocytes that mediate sequestration in the deep vasculature. Host response to parasite toxins and to variant antigens is an important determinant of disease severity. Understanding how parasites sequester, and how antibody to variant antigens could prevent sequestration, may lead to new approaches to treat and prevent disease. Difficulties in malaria diagnosis, drug resistance, and specific challenges of treating P. vivax pose challenges to malaria elimination, but vaccines and other preventive strategies may offer improved disease control.
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Affiliation(s)
- Isobel S Walker
- Department of Infectious Diseases, The University of Melbourne, The Doherty Institute, Melbourne, Australia
| | - Stephen J Rogerson
- Department of Infectious Diseases, The University of Melbourne, The Doherty Institute, Melbourne, Australia
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Diaz J, Gusto C, McCoy K, Silvert C, Bala JA, Atibu J, Tshefu A, Mwandagalirwa M, Dinglasan RR. A mixed methods study assessing the adoption potential of a saliva-based malaria rapid test in the Democratic Republic of Congo. Malar J 2023; 22:180. [PMID: 37291561 DOI: 10.1186/s12936-023-04599-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 05/20/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The reliance on blood for thin and thick blood smear microscopy-using a relatively invasive procedure has presented challenges to the use of reliable diagnostic tests in non-clinical settings at the point-of-need (PON). To improve the capacity of non-blood-based rapid diagnostic tests to confirm subclinical infections, and thereby identify and quantify the human reservoir at the PON, a cross-sectoral collaboration between university researchers and commercial partners produced an innovative, non-invasive saliva-based RDT capable of identifying novel, non-hrp2/3 parasite biomarkers. While this new saliva-based malaria asymptomatic and asexual rapid test (SMAART-1) shows increased detection sensitivity and precision potential by identifying a new P. falciparum protein marker (PSSP17), appraising its utility in the field-particularly with respect to its adoption potential with children and adults in high risk, endemic regions-is necessary to warrant its continued development. METHODS The purpose of this study was to assess the acceptability and adoption potential of the SMAART-1 at select PON sites in the Kinshasa Province. Teachers, community health workers, nurses, and laboratory technicians participated in data collection at three distinct community sites in Kinshasa Province, Democratic Republic of the Congo. Three data collection methods were utilized in this mixed methods study to provide an overarching acceptability evaluation of the SMAART-1 at PON field sites: observation checklists of SMAART-1 implementation, focus group discussions, and surveys with local health care practitioners-particularly teachers and community health workers. RESULTS Findings indicate participants were interested in and supportive of the SMAART-1 protocol, with approximately 99% of the participants surveyed indicating that they either "agreed" or "strongly agreed" with the statement that they "would use the saliva-based malaria asymptomatic rapid test as part of a community malaria detection and treatment programme." Data also suggest that the protocol was broadly appealing for its testing sensitivity and ease of use. CONCLUSIONS The SMAART-1 protocol's clinically reliable results demonstrate a promising new level of sensitivity and precision for detecting parasite biomarkers. This study's mixed-methods assessment of the protocol's utility and adoption potential in the field, with a target user audience, advances its development and points to opportunities to formalize and expand evaluation efforts.
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Affiliation(s)
- John Diaz
- Gulf Coast Research and Education Center, University of Florida, 1200 N. Park Road, Plant City, FL, 33563, USA.
| | - Cody Gusto
- Department of Agricultural Education and Communication, University of Florida, Rolfs Hall, Gainesville, FL, 32611, USA
| | - Kaci McCoy
- Department of Infectious Diseases and Immunology, Emerging Pathogens Institute, College of Veterinary Medicine, University of Florida, 2055 Mowry Road, Rm 375, Gainesville, FL, 32611, USA
| | - Colby Silvert
- Department of Agricultural Education and Communication, University of Florida, Rolfs Hall, Gainesville, FL, 32611, USA
| | - Joseph A Bala
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Joseph Atibu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Rhoel R Dinglasan
- Department of Infectious Diseases and Immunology, Emerging Pathogens Institute, College of Veterinary Medicine, University of Florida, 2055 Mowry Road, Rm 375, Gainesville, FL, 32611, USA
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9
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Natama HM, Traoré TE, Rouamba T, Somé MA, Zango SH, Rovira-Vallbona E, Sorgho H, Guetens P, Coulibaly-Traoré M, Valéa I, Tinto H, Rosanas-Urgell A. Performance of PfHRP2-RDT for malaria diagnosis during the first year of life in a high malaria transmission area in Burkina Faso. J Parasit Dis 2023; 47:280-289. [PMID: 37193494 PMCID: PMC10182193 DOI: 10.1007/s12639-023-01566-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/07/2023] [Indexed: 01/20/2023] Open
Abstract
In this study, we evaluated the performance of a P. falciparum Histidine Rich Protein 2 (PfHRP2)-based rapid diagnostic test (RDT) used for malaria case detection (SD-Bioline malaria RDT P.f®) along with light microscopy (LM) against qPCR among children during the first year of life in a high and seasonal malaria transmission area in Burkina Faso. A total of 723 suspected malaria cases (including multiple episodes) that occurred among 414 children participating in a birth-cohort study were included in the present analysis. Factors including age at the time of malaria screening, transmission season and parasite densities were investigated for their potential influence in the performance of the RDT. Clinical malaria cases as detected by RDT, LM and qPCR were 63.8%, 41.5% and 49.8%, respectively. Compared with qPCR, RDT had a false-positive results rate of 26.7%, resulting in an overall accuracy of 79.9% with a sensitivity of 93%, a specificity of 66.1%, a Positive Predictive Value of 73.3% and a Negative Predictive Value of 91.6%. Its specificity differed significantly between high and low transmission seasons (53.7% vs 79.8%; P < 0.001) and decreased with increasing age (80.6-62%; P for trend = 0.024). The overall accuracy of LM was 91.1% and its performance was not significantly influenced by transmission season or age. These findings highlight the need to adapt malaria diagnostic tools recommendations to face the challenge of adequate malaria detection in this population group living in high burden and seasonal malaria transmission settings.
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Affiliation(s)
- Hamtandi Magloire Natama
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Tiampan Edwig Traoré
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - M. Athanase Somé
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Serge Henri Zango
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Eduard Rovira-Vallbona
- Universitat de Barcelona, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Hermann Sorgho
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Pieter Guetens
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maminata Coulibaly-Traoré
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Innocent Valéa
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Halidou Tinto
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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10
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Kshirsagar A, Choi G, Santosh V, Harvey T, Bernhards RC, Guan W. Handheld Purification-Free Nucleic Acid Testing Device for Point-of-Need Detection of Malaria from Whole Blood. ACS Sens 2023; 8:673-683. [PMID: 36696460 PMCID: PMC11214673 DOI: 10.1021/acssensors.2c02169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
World Health Organization's aim to eliminate malaria from developing/resource-limited economies requires easy access to low-cost, highly sensitive, and specific screening. We present a handheld nucleic acid testing device with on-chip automated sample preparation to detect malaria (Plasmodium falciparum) infection from a whole blood sample as a feasibility study. We used a simple two-reagent-based purification-free protocol to prepare the whole blood sample on a piezo pump pressure-driven microfluidic cartridge. The cartridge includes a unique mixing chamber for sample preparation and metering structures to dispense a predetermined volume of the sample lysate mixture into four chambers containing a reaction mix. The parasite genomic DNA concentration can be estimated by monitoring the fluorescence generated from the loop-mediated isothermal amplification reaction in real time. We achieved a sensitivity of ∼0.42 parasite/μL of whole blood, sufficient for detecting asymptomatic malaria parasite carriers.
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Affiliation(s)
- Aneesh Kshirsagar
- School of Electrical Engineering and Computer Science, Pennsylvania State University, University Park 16802, USA
| | - Gihoon Choi
- School of Electrical Engineering and Computer Science, Pennsylvania State University, University Park 16802, USA
| | - Vishaka Santosh
- U.S. Army, DEVCOM Chemical Biological Center, Aberdeen Proving Ground, MD, 21010, USA
| | - Tara Harvey
- U.S. Army, DEVCOM Chemical Biological Center, Aberdeen Proving Ground, MD, 21010, USA
| | - Robert Cory Bernhards
- U.S. Army, DEVCOM Chemical Biological Center, Aberdeen Proving Ground, MD, 21010, USA
| | - Weihua Guan
- School of Electrical Engineering and Computer Science, Pennsylvania State University, University Park 16802, USA
- Department of Biomedical Engineering, Pennsylvania State University, University Park 16802, USA
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11
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Thang ND, Rovira-Vallbona E, Binh NTH, Dung DV, Ngoc NTH, Long TK, Duong TT, Martin NJ, Edgel KA. Surveillance of pfhrp2 and pfhrp3 gene deletions among symptomatic Plasmodium falciparum malaria patients in Central Vietnam. Malar J 2022; 21:371. [PMID: 36471315 PMCID: PMC9724378 DOI: 10.1186/s12936-022-04399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malaria rapid diagnostic tests (RDTs) remain the main point-of-care tests for diagnosis of symptomatic Plasmodium falciparum malaria in endemic areas. However, parasites with gene deletions in the most common RDT target, histidine rich protein 2 (pfhrp2/HRP2), can produce false-negative RDT results leading to inadequate case management. The objective of this study was to determine the prevalence of hrp2/3 deletions causing false-negative RDT results in Vietnam (Gia Lai and Dak Lak provinces). METHODS Individuals presenting with malaria symptoms at health facilities were screened for P. falciparum infection using light microscopy and HRP2-RDT (SD Bioline Malaria Antigen Pf/Pv RDT, Abbott). Microscopically confirmed P. falciparum infections were analysed for parasite species by 18S rRNA qPCR, and pfhrp2 and pfhrp3 exon2 deletions were investigated by nested PCR. pfhrp2 amplicons were sequenced by the Sanger method and HRP2 plasma levels were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS The prevalence of false-negative RDT results among symptomatic cases was 5.6% (15/270). No pfhrp2 and pfhrp3 deletions were identified. False-negative RDT results were associated with lower parasite density (p = 0.005) and lower HRP2 plasma concentrations (p < 0.001), as compared to positive RDT. CONCLUSIONS The absence of hrp2/3 deletions detected in this survey suggests that HRP2-based malaria RDTs remain effective for the diagnosis of symptomatic P. falciparum malaria in Central Vietnam.
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Affiliation(s)
- Ngo Duc Thang
- grid.452658.8National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | | | - Nguyen Thi Huong Binh
- grid.452658.8National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Dang Viet Dung
- grid.452658.8National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Nguyen Thi Hong Ngoc
- grid.452658.8National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | | | - Tran Thanh Duong
- grid.452658.8National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
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12
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Srinamon K, Watson JA, Silamut K, Intharabut B, Phu NH, Diep PT, Lyke KE, Fanello C, von Seidlein L, Chotivanich K, Dondorp AM, Day NPJ, White NJ. The prognostic and diagnostic value of intraleukocytic malaria pigment in patients with severe falciparum malaria. Nat Commun 2022; 13:6882. [PMID: 36371433 PMCID: PMC9653500 DOI: 10.1038/s41467-022-34678-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 11/02/2022] [Indexed: 11/13/2022] Open
Abstract
Severe falciparum malaria is a major cause of death in tropical countries, particularly in African children. Rapid and accurate diagnosis and prognostic assessment are critical to clinical management. In 6027 prospectively studied patients diagnosed with severe malaria we assess the prognostic value of peripheral blood film counts of malaria pigment containing polymorphonuclear leukocytes (PMNs) and monocytes. We combine these results with previously published data and show, in an individual patient data meta-analysis (n = 32,035), that the proportion of pigment containing PMNs is predictive of in-hospital mortality. In African children the proportion of pigment containing PMNs helps distinguish severe malaria from other life-threatening febrile illnesses, and it adds to the prognostic assessment from simple bedside examination, and to the conventional malaria parasite count. Microscopy assessment of pigment containing PMNs is simple and rapid, and should be performed in all patients hospitalised with suspected severe malaria.
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Affiliation(s)
- Ketsanee Srinamon
- grid.10223.320000 0004 1937 0490Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand
| | - James A. Watson
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG UK ,grid.499581.8WorldWide Antimalarial Resistance Network, Oxford, UK
| | - Kamolrat Silamut
- grid.10223.320000 0004 1937 0490Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand
| | - Benjamas Intharabut
- grid.10223.320000 0004 1937 0490Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand
| | - Nguyen Hoan Phu
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Pham Thi Diep
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Kirsten E. Lyke
- grid.411024.20000 0001 2175 4264Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD USA
| | - Caterina Fanello
- grid.10223.320000 0004 1937 0490Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG UK
| | - Lorenz von Seidlein
- grid.10223.320000 0004 1937 0490Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG UK
| | - Kesinee Chotivanich
- grid.10223.320000 0004 1937 0490Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand
| | - Arjen M. Dondorp
- grid.10223.320000 0004 1937 0490Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG UK
| | - Nicholas P. J. Day
- grid.10223.320000 0004 1937 0490Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG UK
| | - Nicholas J. White
- grid.10223.320000 0004 1937 0490Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG UK
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13
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Kim YJ, Choi JW. Enzyme-linked aptamer-based sandwich assay (ELASA) for detecting Plasmodium falciparum lactate dehydrogenase, a malarial biomarker. RSC Adv 2022; 12:29535-29542. [PMID: 36320752 PMCID: PMC9562052 DOI: 10.1039/d2ra03796c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/08/2022] [Indexed: 01/24/2023] Open
Abstract
Herein, we report a sensitive and selective enzyme-linked aptamer-based sandwich assay (ELASA) to detect Plasmodium falciparum lactate dehydrogenase (PfLDH), which is an attractive biomarker for malaria diagnosis and antimalarial medication. We performed the sandwich assay with a single aptamer sequence, called 2008s, owing to the structural properties of the PfLDH tetramer instead of using a conventional sandwich assay with two different aptamers (or antibodies) for capturing and probing a target molecule. First, the biotinylated PfLDH aptamer was linked with immobilized streptavidin on a microwell plate for binding flexibility, and then PfLDH was bound to the aptamer. Next, a horseradish peroxidase-conjugated aptamer of the same sequence was used to analyze PfLDH quantitatively. Using this approach, the limit of detection (LOD) of PfLDH with the naked eye was 100 ng mL-1, and the LOD and limit of quantification from the absorbance measurements were 34.9 ng mL-1 and 95.5 ng mL-1, respectively, based on PfLDH spiked blood samples. Our proposed method selectively binds PfLDH, not human lactate dehydrogenase. Therefore, this method may be a valuable tool for diagnosing, monitoring, and quarantining malaria cases easily and rapidly.
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Affiliation(s)
- Yeon-Jun Kim
- Department of Biomedical Science, Cheongju UniversityCheongju 28160Republic of Korea
| | - Jae-Won Choi
- Department of Biomedical Science, Cheongju UniversityCheongju 28160Republic of Korea,Department of Bioindustrial EngineeringCheongju 28503Republic of Korea
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14
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Feleke SM, Gidey B, Mohammed H, Nega D, Dillu D, Haile M, Solomon H, Parr JB, Tollera G, Tasew G, Mamo H, Petros B. Field performance of Plasmodium falciparum lactate dehydrogenase rapid diagnostic tests during a large histidine-rich protein 2 deletion survey in Ethiopia. Malar J 2022; 21:236. [PMID: 35971118 PMCID: PMC9377056 DOI: 10.1186/s12936-022-04257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Malaria rapid diagnostic tests (RDTs) have expanded diagnostic service to remote endemic communities in Ethiopia, where 70% of malaria services per annum are reliant on them. However, diagnostic strategies are threatened by Plasmodium falciparum parasites with deletions of the histidine-rich protein 2 and/or 3 (pfhrp2/3) genes. Studies have reported pfhrp2/3 gene deletion prevalence in Ethiopia that exceeds the WHO recommended threshold to switch to non-HRP2 targeted RDTs for detection of P. falciparum. Therefore, RDTs that target alternative antigens, such as P. falciparum lactate dehydrogenase (PfLDH) are increasingly in programmatic use. Methods Malaria suspected patients visiting health facilities of Amhara, Tigray, Gambella, and Oromia regions of Ethiopia were screened by community health workers using Carestart Pf/Pv (HRP2/Pv-LDH) and SD-Bioline Pf (HRP2 for Pf/LDH for Pf) RDTs. Dried blood spot (DBS) samples were collected from selected patients for molecular and serological analysis. The clinical data and RDT results were recorded on standard forms, entered into EpiInfo, and analysed using STATA. The Pf-LDH detecting RDT results were compared with real-time PCR and bead-based immunoassay to determine their diagnostic performance. Results The 13,172 (56% male and 44% female, median age of 19 years ranging from 1 to 99 year) study participants were enrolled and tested with PfHRP2 and PfLDH detection RDTs; 20.6% (95% CI: 19.6 to 21.6) were P. falciparum RDT positive. A subset of samples (n = 820) were previously tested using P. falciparum lactate dehydrogenase (pfldh) quantitative real-time PCR, and 456 of these further characterized using bead-based immunoassay. The proportion of samples positive for P. falciparum by the PfHRP2 Carestart and SD-Bioline RDTs were 66% (539/820) and 59% (481/820), respectively; 68% (561/820) were positive for the PfLDH band on the SD-Bioline RDT. The sensitivity and specificity of the PfLDH RDT band were 69% and 38%, respectively, versus pfldh qPCR; and 72% and 36%, respectively, versus PfLDH detection by immunoassay. Among samples with results for RDT, qPCR, and immunoassay, higher proportions of P. falciparum were recorded by pfldh qPCR (90%, 411/456) and PfLDH immunoassay (88%, 363/413) compared to the PfLDH band on the SD-Bioline RDT (74.6%, 340/456). Conclusion and recommendation Both PfHRP2 RDTs detected fewer P. falciparum cases than PfLDH, and fewer cases than qPCR or immunoassay. The poor sensitivity and specificity of the PfLDH RDT compared to qPCR and to immunoassay in this study raises concern. Continuous operator training and RDTs quality assurance programme to ensure quality diagnostic services are recommended.
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Affiliation(s)
| | | | | | - Desalegn Nega
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Jonathan B Parr
- Institute for Global Health and Infectious Diseases and Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Beyene Petros
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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15
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Marquart L, Webb L, O'Rourke P, Gatton ML, Hsiang MS, Kalnoky M, Jang IK, Ntuku H, Mumbengegwi DR, Domingo GJ, McCarthy JS, Britton S. The in-vivo dynamics of Plasmodium falciparum HRP2: implications for the use of rapid diagnostic tests in malaria elimination. Malar J 2022; 21:233. [PMID: 35922803 PMCID: PMC9351188 DOI: 10.1186/s12936-022-04245-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Rapid diagnostic tests (RDTs) that rely on the detection of Plasmodium falciparum histidine-rich protein 2 (PfHRP2) have become key tools for diagnosing P. falciparum infection. The utility of RDTs can be limited by PfHRP2 persistence, however it can be a potential benefit in low transmission settings where detection of persistent PfHRP2 using newer ultra-sensitive PfHRP2 based RDTs can serve as a surveillance tool to identify recent exposure. Better understanding of the dynamics of PfHRP2 over the course of a malaria infection can inform optimal use of RDTs. Methods A previously published mathematical model was refined to mimic the production and decay of PfHRP2 during a malaria infection. Data from 15 individuals from volunteer infection studies were used to update the original model and estimate key model parameters. The refined model was applied to a cohort of patients from Namibia who received treatment for clinical malaria infection for whom longitudinal PfHRP2 concentrations were measured. Results The refinement of the PfHRP2 dynamic model indicated that in malaria naïve hosts, P. falciparum parasites of the 3D7 strain produce 33.6 × 10−15 g (95% CI 25.0–42.1 × 10−15 g) of PfHRP2 in vivo per parasite replication cycle, with an elimination half-life of 1.67 days (95% CI 1.11–3.40 days). The refined model included these updated parameters and incorporated individualized body fluid volume calculations, which improved predictive accuracy when compared to the original model. The performance of the model in predicting clearance of PfHRP2 post treatment in clinical samples from six adults with P. falciparum infection in Namibia improved when using a longer elimination half-life of 4.5 days, with 14% to 67% of observations for each individual within the predicted range. Conclusions The updated mathematical model can predict the growth and clearance of PfHRP2 during the production and decay of a mono-infection with P. falciparum, increasing the understanding of PfHRP2 antigen dynamics. This model can guide the optimal use of PfHRP2-based RDTs for reliable diagnosis of P. falciparum infection and re-infection in endemic settings, but also for malaria surveillance and elimination programmes in low transmission areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04245-z.
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Affiliation(s)
- Louise Marquart
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. .,University of Queensland, Brisbane, QLD, Australia.
| | - Lachlan Webb
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Peter O'Rourke
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | | | - Michelle S Hsiang
- Department of Pediatrics, University of Texas, Southwestern, Dallas, TX, USA.,Malaria Elimination Initiative, Institute for Global Health Services, University of California, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
| | | | | | - Henry Ntuku
- Malaria Elimination Initiative, Institute for Global Health Services, University of California, San Francisco, CA, USA
| | | | | | - James S McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Sumudu Britton
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
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16
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Shah HA, Carrasco LR, Hamlet A, Murray KA. Exploring agricultural land-use and childhood malaria associations in sub-Saharan Africa. Sci Rep 2022; 12:4124. [PMID: 35260722 PMCID: PMC8904834 DOI: 10.1038/s41598-022-07837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/24/2022] [Indexed: 11/09/2022] Open
Abstract
Agriculture in Africa is rapidly expanding but with this comes potential disbenefits for the environment and human health. Here, we retrospectively assess whether childhood malaria in sub-Saharan Africa varies across differing agricultural land uses after controlling for socio-economic and environmental confounders. Using a multi-model inference hierarchical modelling framework, we found that rainfed cropland was associated with increased malaria in rural (OR 1.10, CI 1.03-1.18) but not urban areas, while irrigated or post flooding cropland was associated with malaria in urban (OR 1.09, CI 1.00-1.18) but not rural areas. In contrast, although malaria was associated with complete forest cover (OR 1.35, CI 1.24-1.47), the presence of natural vegetation in agricultural lands potentially reduces the odds of malaria depending on rural-urban context. In contrast, no associations with malaria were observed for natural vegetation interspersed with cropland (veg-dominant mosaic). Agricultural expansion through rainfed or irrigated cropland may increase childhood malaria in rural or urban contexts in sub-Saharan Africa but retaining some natural vegetation within croplands could help mitigate this risk and provide environmental co-benefits.
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Affiliation(s)
- Hiral Anil Shah
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK. .,Grantham Institute - Climate Change and the Environment - Imperial College London, London, UK.
| | - Luis Roman Carrasco
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Arran Hamlet
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Kris A Murray
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.,MRC Unit The Gambia at London, School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia.,Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
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17
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Leonard CM, Assefa A, McCaffery JN, Herman C, Plucinski M, Sime H, Mohammed H, Kebede A, Solomon H, Haile M, Murphy M, Hwang J, Rogier E. Investigation of Plasmodium falciparum pfhrp2 and pfhrp3 gene deletions and performance of a rapid diagnostic test for identifying asymptomatic malaria infection in northern Ethiopia, 2015. Malar J 2022; 21:70. [PMID: 35246151 PMCID: PMC8895513 DOI: 10.1186/s12936-022-04097-7] [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: 10/14/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDTs) are widely used for malaria diagnosis of both symptomatic and asymptomatic infections. Although RDTs are a reliable and practical diagnostic tool, the sensitivity of histidine-rich protein 2 (HRP2)-based RDTs can be reduced if pfhrp2 or pfhrp3 (pfhrp2/3) gene deletions exist in the Plasmodium falciparum parasite population. This study evaluated dried blood spot (DBS) samples collected from a national household survey to investigate the presence of pfhrp2/3 deletions and the performance of the RDT used in the cross-sectional survey in a low transmission setting. METHODS The 2015 Ethiopia Malaria Indicator Survey tested household members by RDT and collected DBS samples. DBS (n = 2648) from three regions in northern Ethiopia were tested by multiplex bead-based antigen detection assay after completion of the survey. The multiplex assay detected pan-Plasmodium lactate dehydrogenase (LDH), pAldolase, and HRP2 antigens in samples. Samples suspected for pfhrp2/3 gene deletions (pLDH and/or pAldolase positive but low or absent HRP2) were further investigated by molecular assays for gene deletions. Antigen results were also compared to each individual's RDT results. Dose-response logistic regression models were fit to estimate RDT level of detection (LOD) antigen concentrations at which 50, 75, 90, and 95% of the RDTs returned a positive result during this survey. RESULTS Out of 2,648 samples assayed, 29 were positive for pLDH or pAldolase antigens but low or absent for HRP2 signal, and 15 of these samples (51.7%) were successfully genotyped for pfhrp2/3. Of these 15 P. falciparum infections, eight showed single deletions in pfhrp3, one showed a single pfhrp2 deletion, and six were pfhrp2/3 double-deletions. Six pfhrp2 deletions were observed in Tigray and one in Amhara. Twenty-five were positive for HRP2 by the survey RDT while the more sensitive bead assay detected 30 HRP2-positive samples. A lower concentration of HRP2 antigen generated a positive test result by RDT compared to pLDH (95% LOD: 16.9 ng/mL vs. 319.2 ng/mL, respectively). CONCLUSIONS There is evidence of dual pfhrp2/3 gene deletions in the Tigray and Amhara regions of Ethiopia in 2015. As the prevalence of malaria was very low (< 2%), it is difficult to make strong conclusions on RDT performance, but these results challenge the utility of biomarkers in household surveys in very low transmission settings.
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Affiliation(s)
- Colleen M Leonard
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Oak Ridge Institute for Science and Education, US. Department of Energy, Oak Ridge, TN, 37831, USA
| | - Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.,Infectious Disease Ecology and Epidemiology Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jessica N McCaffery
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,Oak Ridge Institute for Science and Education, US. Department of Energy, Oak Ridge, TN, 37831, USA
| | - Camelia Herman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Mateusz Plucinski
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,U.S. President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Heven Sime
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Amha Kebede
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | - Hiwot Solomon
- Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Matt Murphy
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,U.S. President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Jimee Hwang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.,U.S. President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
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18
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Chaudhry A, Cunningham J, Cheng Q, Gatton ML. Modelling the epidemiology of malaria and spread of HRP2-negative Plasmodium falciparum following the replacement of HRP2-detecting rapid diagnostic tests. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000106. [PMID: 36962137 PMCID: PMC10021339 DOI: 10.1371/journal.pgph.0000106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022]
Abstract
Malaria rapid diagnostic tests (RDTs) are dominated by products which use histidine-rich protein 2 (HRP2) to detect Plasmodium falciparum. The emergence of parasites lacking the pfhrp2 gene can lead to high rates of false-negative results amongst these RDTs. One solution to restore the ability to correctly diagnose falciparum malaria is to switch to an RDT which is not solely reliant on HRP2. This study used an agent-based stochastic simulation model to investigate the impact on prevalence and transmission caused by switching the type of RDT used once false-negative rates reached pre-defined thresholds within the treatment-seeking symptomatic population. The results show that low transmission settings were the first to reach the false-negative switch threshold, and that lower thresholds were typically associated with better long-term outcomes. Changing the diagnostic RDT away from a HRP2-only RDT is predicted to restore the ability to correctly diagnose symptomatic malaria infections, but often did not lead to the extinction of HRP2-negative parasites from the population which continued to circulate in low density infections, or return to the parasite prevalence and transmission levels seen prior to the introduction of the HRP2-negative parasite. In contrast, failure to move away from HRP2-only RDTs leads to near fixation of these parasites in the population, and the inability to correctly diagnose symptomatic cases. Overall, these results suggest pfhrp2-deleted parasites are likely to become a significant component of P. falciparum parasite populations, and that long-term strategies are needed for diagnosis and surveillance which do not rely solely on HRP2.
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Affiliation(s)
- Alisha Chaudhry
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Jane Cunningham
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Qin Cheng
- Department of Drug Resistance and Diagnostics, Australian Defence Force Malaria and Infectious Diseases Institute, Brisbane, Australia
- ADFMIDI Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Michelle L Gatton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Centre for Immunology and Infection Control, Queensland University of Technology, Brisbane, Australia
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19
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Prah JK, Amoah S, Yartey AN, Ampofo-Asiama A, Ameyaw EO. Assessment of malaria diagnostic methods and treatments at a Ghanaian health facility. Pan Afr Med J 2021; 39:251. [PMID: 34707752 PMCID: PMC8520419 DOI: 10.11604/pamj.2021.39.251.28996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/08/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION it has been more than a decade since the World Health Organization (WHO) recommended parasitological confirmation of malaria before treatment begins. Light microscopy and rapid diagnostic tests are currently being used for diagnosing malaria in routine clinical care settings. Many clinicians have however raised questions about the competencies of laboratory staff who perform these tests and the performance of these diagnostic methods. This study aimed at assessing the performance of microscopy and two rapid diagnostic test kits in the hands of routine laboratory staff compared to expert microscopy as well as assess the performance of clinical diagnosis. METHODS this was a cross sectional study involving 799 participants of all ages who visited the out patient department of the University of Cape Coast Hospital with symptoms suggestive of malaria. RESULTS when the different methods were compared to expert microscopy, the rapid diagnostic test kits had the highest sensitivities, Wondfo 94.83% (95% CI: 85.62-98.20) and CareStart 91.38 (95% CI: 81.02-97.14). Microscopy by laboratory staff had a sensitivity of 68.79 (95% CI: 55.46-80.46) whilst clinical diagnosis had the lowest sensitivity of 17.24 (95% CI: 8.59-29.43). Cohen´s kappa coefficient was used to measure the level of agreement of the methods with expert microscopy. Microscopy by laboratory staff, CareStart and Wondfo showed substantial measures of agreement (k = 0.737, 0.683, and 0.691 respectively). CONCLUSION these findings suggest that clinical diagnosis is highly unreliable whilst rapid diagnostic tests and microscopy performed by routine laboratory staff could be trusted by clinicians as reliable diagnostic methods.
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Affiliation(s)
| | - Samuel Amoah
- University of Cape Coast Hospital, Cape Coast, Ghana
| | | | | | - Elvis Ofori Ameyaw
- School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Cape Coast, Ghana
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20
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Giacometti M, Milesi F, Coppadoro PL, Rizzo A, Fagiani F, Rinaldi C, Cantoni M, Petti D, Albisetti E, Sampietro M, Ciardo M, Siciliano G, Alano P, Lemen B, Bombe J, Nwaha Toukam MT, Tina PF, Gismondo MR, Corbellino M, Grande R, Fiore GB, Ferrari G, Antinori S, Bertacco R. A Lab-On-chip Tool for Rapid, Quantitative, and Stage-selective Diagnosis of Malaria. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2004101. [PMID: 34306971 PMCID: PMC8292881 DOI: 10.1002/advs.202004101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/22/2021] [Indexed: 05/21/2023]
Abstract
Malaria remains the most important mosquito-borne infectious disease worldwide, with 229 million new cases and 409.000 deaths in 2019. The infection is caused by a protozoan parasite which attacks red blood cells by feeding on hemoglobin and transforming it into hemozoin. Despite the WHO recommendation of prompt malaria diagnosis, the quality of microscopy-based diagnosis is frequently inadequate while rapid diagnostic tests based on antigens are not quantitative and still affected by non-negligible false negative/positive results. PCR-based methods are highly performant but still not widely used in endemic areas. Here, a diagnostic tool (TMek), based on the paramagnetic properties of hemozoin nanocrystals in infected red blood cells (i-RBCs), is reported on. Exploiting the competition between gravity and magnetic forces, i-RBCs in a whole blood specimen are sorted and electrically detected in a microchip. The amplitude and time evolution of the electrical signal allow for the quantification of i-RBCs (in the range 10-105 i-RBC µL-1) and the distinction of the infection stage. A preliminary validation study on 75 patients with clinical suspect of malaria shows on-field operability, without false negative and a few false positive results. These findings indicate the potential of TMek as a quantitative, stage-selective, rapid test for malaria.
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Affiliation(s)
- Marco Giacometti
- Department of Electronics Information and BioengineeringPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Francesca Milesi
- Department of PhysicsPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Pietro Lorenzo Coppadoro
- Department of Electronics Information and BioengineeringPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Alberto Rizzo
- Specialità di Microbiologia e Virologia Università degli Studi di MilanoMilanoItaly
| | - Federico Fagiani
- Department of PhysicsPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Christian Rinaldi
- Department of PhysicsPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Matteo Cantoni
- Department of PhysicsPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Daniela Petti
- Department of PhysicsPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Edoardo Albisetti
- Department of PhysicsPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Marco Sampietro
- Department of Electronics Information and BioengineeringPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Mariagrazia Ciardo
- Dipartimento di Malattie InfettiveIstituto Superiore di SanitàViale Regina Elena n.299Roma00161Italy
| | - Giulia Siciliano
- Dipartimento di Malattie InfettiveIstituto Superiore di SanitàViale Regina Elena n.299Roma00161Italy
| | - Pietro Alano
- Dipartimento di Malattie InfettiveIstituto Superiore di SanitàViale Regina Elena n.299Roma00161Italy
| | | | | | | | | | - Maria Rita Gismondo
- UOC Microbiologia ClinicaVirologia e Diagnostica Bioemergenza – Sacco teaching Hospital ASST FBF Saccovia GB GrassiMilano74‐20157Italy
| | - Mario Corbellino
- Department of Biomedical and Clinical Sciences “Luigi Sacco”University of Milanovia GB GrassiMilano74‐20157Italy
| | - Romualdo Grande
- UOC Microbiologia ClinicaVirologia e Diagnostica Bioemergenza – Sacco teaching Hospital ASST FBF Saccovia GB GrassiMilano74‐20157Italy
| | - Gianfranco Beniamino Fiore
- Department of Electronics Information and BioengineeringPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Giorgio Ferrari
- Department of Electronics Information and BioengineeringPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences “Luigi Sacco”University of Milanovia GB GrassiMilano74‐20157Italy
| | - Riccardo Bertacco
- Department of PhysicsPolitecnico di MilanoPiazza Leonardo da Vinci 32Milano20133Italy
- CNR‐IFNInstitute for Photonics and NanotechnologiesPiazza Leonardo da Vinci 32Milano20133Italy
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21
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Gimenez AM, Marques RF, Regiart M, Bargieri DY. Diagnostic Methods for Non-Falciparum Malaria. Front Cell Infect Microbiol 2021; 11:681063. [PMID: 34222049 PMCID: PMC8248680 DOI: 10.3389/fcimb.2021.681063] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Malaria is a serious public health problem that affects mostly the poorest countries in the world, killing more than 400,000 people per year, mainly children under 5 years old. Among the control and prevention strategies, the differential diagnosis of the Plasmodium-infecting species is an important factor for selecting a treatment and, consequently, for preventing the spread of the disease. One of the main difficulties for the detection of a specific Plasmodium sp is that most of the existing methods for malaria diagnosis focus on detecting P. falciparum. Thus, in many cases, the diagnostic methods neglect the other non-falciparum species and underestimate their prevalence and severity. Traditional methods for diagnosing malaria may present low specificity or sensitivity to non-falciparum spp. Therefore, there is high demand for new alternative methods able to differentiate Plasmodium species in a faster, cheaper and easier manner to execute. This review details the classical procedures and new perspectives of diagnostic methods for malaria non-falciparum differential detection and the possibilities of their application in different circumstances.
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Affiliation(s)
- Alba Marina Gimenez
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rodolfo F. Marques
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Matías Regiart
- Department of Fundamental Chemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | - Daniel Youssef Bargieri
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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22
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Kong A, Wilson SA, Ah Y, Nace D, Rogier E, Aidoo M. HRP2 and HRP3 cross-reactivity and implications for HRP2-based RDT use in regions with Plasmodium falciparum hrp2 gene deletions. Malar J 2021; 20:207. [PMID: 33926477 PMCID: PMC8086288 DOI: 10.1186/s12936-021-03739-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/19/2021] [Indexed: 01/29/2023] Open
Abstract
Background The Plasmodium falciparum antigen histidine rich protein 2 (HRP2) is a preferred target for malaria rapid diagnostic tests (RDTs) because of its abundant production by the parasite and thermal stability. As a result, a majority of RDTs procured globally target this antigen. However, previous reports from South America and recent reports from sub-Saharan Africa and Asia indicate that certain P. falciparum parasites have deletions of the gene coding for HRP2. The HRP2 antigen is paralogous to another P. falciparum antigen HRP3 and some antibodies to HRP2 cross-react with HRP3. Multiple parasites have been described with deletions of one or both hrp2 and hrp3 genes. It is unclear how the various combinations of hrp2 and hrp3 deletion genotypes affect clinical sensitivity of HRP2-based RDTs. Methods Cross-reactivity between HRP2 and HRP3 was tested on malaria RDTs using culture-adapted P. falciparum parasites with both hrp2 and hrp3 intact or with one or both genes deleted. Ten-fold serial dilutions of four culture-adapted P. falciparum parasites [3D7 (hrp2+/hrp3+), Dd2 (hrp2−/hrp3+), HB3 (hrp2+/hrp3−) and 3BD5 (hrp2−/hrp3−)] ranging from 100,000 to 0.01 parasites/µL were prepared. HRP2, Plasmodium lactate dehydrogenase (pLDH) and aldolase concentrations were determined for the diluted samples using a multiplex bead assay. The samples were subsequently tested on three RDT products designed to detect P. falciparum by HRP2 alone or in combination with pLDH. Results At parasite densities of approximately 1000 parasites/µL, parasites that expressed either hrp2 or hrp3 were detected by all three RDTs. Multiplex based antigen measurement using HRP2- conjugated beads demonstrated higher antigen concentration when both hrp2 and hrp3 genes were intact (3D7 parasites, 47.9 ng/ml) compared to HB3 (3.02 ng/mL) and Dd2 (0.20 ng/mL) strains that had one gene deleted. 3D7 at 10 parasites/µL (0.45 ng/mL) was reactive on all three RDT products whereas none of the other parasites were reactive at that density. Conclusions Above a certain antigen threshold, HRP3 cross-reactivity on HRP2-based RDTs is sufficient to mask the effects of deletions of hrp2 only. Studies of hrp2 deletion and its effects on HRP2-based RDTs must be studied alongside hrp3 deletions and include clinical sample reactivity on HRP2-based tests.
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Affiliation(s)
- Amy Kong
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Scott A Wilson
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.,The CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, GA, 30308, USA
| | - Yong Ah
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.,The CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, GA, 30308, USA
| | - Douglas Nace
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Eric Rogier
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Michael Aidoo
- Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.
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23
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Góes L, Chamma-Siqueira N, Peres JM, Nascimento JM, Valle S, Arcanjo AR, Lacerda M, Blume L, Póvoa M, Viana G. Evaluation of Histidine-Rich Proteins 2 and 3 Gene Deletions in Plasmodium falciparum in Endemic Areas of the Brazilian Amazon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010123. [PMID: 33375379 PMCID: PMC7795390 DOI: 10.3390/ijerph18010123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/30/2022]
Abstract
Histidine-rich proteins 2 and 3 gene (pfhrp2 and pfhrp3) deletions affect the efficacy of rapid diagnostic tests (RDTs) based on the histidine-rich protein 2 (HRP2), compromising the correct identification of the Plasmodium falciparum species. Therefore, molecular surveillance is necessary for the investigation of the actual prevalence of this phenomenon and the extent of the disappearance of these genes in these areas and other South American countries, thus guiding national malaria control programs on the appropriate use of RDTs. This study aimed to evaluate the pfhrp2 and pfhrp3 gene deletion in P. falciparum in endemic areas of the Brazilian Amazon. Aliquots of DNA from the biorepository of the Laboratory of Basic Research in Malaria, Evandro Chagas Institute, with a positive diagnosis for P. falciparum infection as determined by microscopy and molecular assays, were included. Monoinfection was confirmed by nested-polymerase chain reaction assay, and DNA quality was assessed by amplification of the merozoite surface protein-2 gene (msp2). The pfhrp2 and pfhrp3 genes were amplified using primers for the region between exons 1 and 2 and for all extension of exon 2. Aliquots of DNA from 192 P. falciparum isolates were included in the study, with 68.7% (132/192) from the municipality of Cruzeiro do Sul (Acre) and 31.3% (60/192) from Manaus (Amazonas). Of this total, 82.8% (159/192) of the samples were considered of good quality. In the state of Acre, 71.7% (71/99) showed pfhrp2 gene deletion and 94.9% (94/99) showed pfhrp3 gene deletion, while in the state of Amazonas, 100.0% (60/60) of the samples showed pfhrp2 gene deletion and 98.3% (59/60) showed pfhrp3 gene deletion. Moreover, 79.8% (127/159) of isolates displayed gene deletion. Our findings confirm the presence of a parasite population with high frequencies of pfhrp2 and pfhrp3 gene deletions in the Brazilian Amazon region. This suggests reconsidering the use of HRP2-based RDTs in the Acre and Amazonas states and calls attention to the importance of molecular surveillance and mapping of pfhrp2/pfhrp3 deletions in this area and in other locations in the Amazon region to guarantee appropriate patient care, control and ultimately contribute to achieving P. falciparum malaria elimination.
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Affiliation(s)
- Leandro Góes
- Graduate Program in Epidemiology and Health Surveillance (PPGEVS), Centre for Education and Graduate Programs (NEP), Evandro Chagas Institute (IEC/SVS/MS), 67.030-000 Ananindeua, Pará, Brazil;
| | - Nathália Chamma-Siqueira
- Parasitology Section, Evandro Chagas Institute-IEC/SVS/MS, 67.030-000 Ananindeua, Pará, Brazil; (J.M.P.); (J.M.N.); (M.P.)
- Correspondence: (N.C.-S.); (G.V.)
| | - José Mário Peres
- Parasitology Section, Evandro Chagas Institute-IEC/SVS/MS, 67.030-000 Ananindeua, Pará, Brazil; (J.M.P.); (J.M.N.); (M.P.)
| | - José Maria Nascimento
- Parasitology Section, Evandro Chagas Institute-IEC/SVS/MS, 67.030-000 Ananindeua, Pará, Brazil; (J.M.P.); (J.M.N.); (M.P.)
| | - Suiane Valle
- Hemonúcleo Cruzeiro do Sul, State Health Department of Acre, 69.980-000 Cruzeiro do Sul, Acre, Brazil;
| | - Ana Ruth Arcanjo
- Central Public Health Laboratory of Amazonas (LACEN/Amazonas), 69.020-245 Manaus, Amazonas, Brazil;
| | - Marcus Lacerda
- Heitor Vieira Dourado Tropical Medicine Foundation, 69.040-000 Manaus, Brazil;
- Leônidas and Maria Deane Institute-Fiocruz Amazônia, 69.027-070 Manaus, Amazonas, Brazil
| | - Liana Blume
- Malaria Technical Group, General Coordination for the Monitoring of Zoonoses and Malaria Vector Transmission Diseases, CGZV Department of Immunization and Communicable Diseases, DEIDT, Health Surveillance Secretariat, SVS, Ministry of Health, 70.070-942 Brasília, Brazil;
| | - Marinete Póvoa
- Parasitology Section, Evandro Chagas Institute-IEC/SVS/MS, 67.030-000 Ananindeua, Pará, Brazil; (J.M.P.); (J.M.N.); (M.P.)
- National Council for Scientific and Technological Development, CNPq, 71.605-001 Brasília, Brazil
| | - Giselle Viana
- Parasitology Section, Evandro Chagas Institute-IEC/SVS/MS, 67.030-000 Ananindeua, Pará, Brazil; (J.M.P.); (J.M.N.); (M.P.)
- Correspondence: (N.C.-S.); (G.V.)
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