title: Evaluation of a PfHRP2 and a pLDH-based rapid diagnostic test for the diagnosis of severe malaria in 2 populations of African children.
abstract: BACKGROUND
  Rapid diagnostic tests (RDTs) now play an important role in the diagnosis of falciparum malaria in many countries where the disease is endemic. Although these tests have been extensively evaluated in uncomplicated falciparum malaria, reliable data on their performance for diagnosing potentially lethal severe malaria is lacking.
  
  
  METHODS
  We compared a Plasmodium falciparum histidine-rich-protein2 (PfHRP₂)-based RDT and a Plasmodium lactate dehydrogenase (pLDH)-based RDT with routine microscopy of a peripheral blood slide and expert microscopy as a reference standard for the diagnosis of severe malaria in 1898 children who presented with severe febrile illness at 2 centers in Mozambique and Tanzania.
  
  
  RESULTS
  The overall sensitivity, specificity, positive predictive value, and negative predictive values of the PfHRP₂-based test were 94.0%, 70.9%, 85.4%, and 86.8%, respectively, and for the pLDH-based test, the values were 88.0%, 88.3%, 93.2%, and 80.3%, respectively. At parasite counts < 1000 parasites/μL (n = 173), sensitivity of the pLDH-based test was low (45.7%), compared with that of the PfHRP₂-based test (69.9%). Both RDTs performed better than did the routine slide reading in a clinical laboratory as assessed in 1 of the centers.
  
  
  CONCLUSIONS
  The evaluated PfHRP2-based RDT is an acceptable alternative to routine microscopy for diagnosing severe malaria in African children and performed better than did the evaluated pLDH-based RDT.
authors.affiliation: Mahidol-Oxford Research Unit, Bangkok, Thailand.
authors.forename: Ilse C E
authors.initials: IC
authors.lastname: Hendriksen
authors.forename: George
authors.initials: G
authors.lastname: Mtove
authors.forename: Alínia José
authors.initials: AJ
authors.lastname: Pedro
authors.forename: Ermelinda
authors.initials: E
authors.lastname: Gomes
authors.forename: Kamolrat
authors.initials: K
authors.lastname: Silamut
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Abraham
authors.initials: A
authors.lastname: Mwambuli
authors.forename: Samwel
authors.initials: S
authors.lastname: Gesase
authors.forename: Hugh
authors.initials: H
authors.lastname: Reyburn
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Lorenz
authors.initials: L
authors.lastname: von Seidlein
authors.forename: Arjen M
authors.initials: AM
authors.lastname: Dondorp
mesh_terms: D000953:Antigens, Protozoan; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007223:Infant; D007770:L-Lactate Dehydrogenase; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000276:immunology / Q000469:parasitology / Q000503:physiopathology; D008297:Male; D008853:Microscopy / Q000379:methods; D009073:Mozambique; D010963:Plasmodium falciparum / Q000378:metabolism*; D011237:Predictive Value of Tests; D015800:Protozoan Proteins; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013636:Tanzania; D013997:Time Factors
chemical_list: D000953:Antigens, Protozoan; C514457:HRP-2 antigen, Plasmodium falciparum; D015800:Protozoan Proteins; D011933:Reagent Kits, Diagnostic; D007770:L-Lactate Dehydrogenase