Comparison of HRP2- and pLDH-based rapid diagnostic tests for malaria with longitudinal follow-up in Kampala, Uganda.
Presumptive treatment of malaria results in significant overuse of antimalarials. Malaria rapid diagnostic tests (RDTs) may offer a reliable alternative for case management, but the optimal RDT strategy is uncertain. We compared the diagnostic accuracy of histidine-rich protein 2 (HRP2)- and plasmodium lactate dehydrogenase (pLDH)-based RDTs, using expert microscopy as the gold standard, in a longitudinal study of 918 fever episodes over an 8-month period in a cohort of children in Kampala, Uganda. Sensitivity was 92% for HRP2 and 85% for pLDH, with differences primarily due to better detection with HRP2 at low parasite densities. Specificity was 93% for HRP2 and 100% for pLDH, with differences primarily due to rapid clearance of pLDH antigenemia after treatment of a previous malaria episode. RDTs may provide an effective strategy for improving rational delivery of antimalarial therapy; in Kampala, either test could dramatically decrease inappropriate presumptive treatments.
Hopkins
Heidi
H
University of California, San Francisco, San Francisco, California 94143, USA. hhopkins@medsfgh.ucsf.edu
Kambale
Wilson
W
Kamya
Moses R
MR
Staedke
Sarah G
SG
Dorsey
Grant
G
Rosenthal
Philip J
PJ
D000818:Animals; D000953:Antigens, Protozoan / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016054:DNA, Protozoan / Q000737:chemistry / Q000235:genetics; D006801:Humans; D007223:Infant; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008137:Longitudinal Studies; D016778:Malaria, Falciparum / Q000097:blood / Q000175:diagnosis* / Q000201:enzymology / Q000469:parasitology; D010963:Plasmodium falciparum / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D015800:Protozoan Proteins / Q000097:blood*; D011933:Reagent Kits, Diagnostic / Q000469:parasitology*; D012680:Sensitivity and Specificity; D014454:Uganda
D000953:Antigens, Protozoan; D016054:DNA, Protozoan; C514457:HRP-2 antigen, Plasmodium falciparum; D015800:Protozoan Proteins; D011933:Reagent Kits, Diagnostic; D007770:L-Lactate Dehydrogenase