1. Antigen persistence of rapid diagnostic tests in pregnant women in Nanoro, Burkina Faso, and the implications for the diagnosis of malaria in pregnancy
- Author
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Johanna H, Kattenberg, Christian M, Tahita, Inge A J, Versteeg, Halidou, Tinto, Maminata, Traoré-Coulibaly, Henk D F H, Schallig, and Petra F, Mens
- Subjects
Adult ,Analysis of Variance ,L-Lactate Dehydrogenase ,Plasmodium falciparum ,Protozoan Proteins ,Antigens, Protozoan ,Enzyme-Linked Immunosorbent Assay ,Thymidylate Synthase ,Real-Time Polymerase Chain Reaction ,Artemisinins ,Tetrahydrofolate Dehydrogenase ,Treatment Outcome ,Anti-Infective Agents ,Multienzyme Complexes ,Pregnancy ,Pregnancy Complications, Parasitic ,Burkina Faso ,Humans ,Female ,Malaria, Falciparum ,Biomarkers ,Follow-Up Studies - Abstract
To evaluate persistence of several Plasmodium antigens in pregnant women after treatment and compare diagnostics during treatment follow-up.Thirty-two pregnant women (N = 32) with confirmed malaria infection by a histidine-rich protein 2 (HRP2)-based rapid diagnostic test (RDT) and microscopy were followed for 28 days after artemisinin-based combination therapy (ACT). A Plasmodium lactate dehydrogenase (pLDH)-based RDT and two ELISAs based on the detection of dihydrofolate reductase-thymidylate synthase (DHFR-TS) and haeme detoxification protein (HDP) were compared with each other and to RT-PCR at each visit.The mean visit number (95% confidence interval) on which the HRP2-based RDT was still positive after treatment was 3.4 (2.7-4.1) visits with some patients still positive at day 28. This is significantly later than the pLDH-based RDT [0.84 (0.55-1.1)], microscopy (median 1, range 1-3), DHFR-TS-ELISA [1.7 (1.1-2.3)] and RT-PCR (median 2, range 1-5) (P0.05), but not significantly later than HDP-ELISA [2.1 (1.6-2.7)]. Lower gravidity and higher parasite density at day 0 resulted in significantly longer positive results with most tests (P0.05).HRP2 can persist up to 28 days after ACT treatment; therefore, this test is not suitable for treatment follow-up in pregnant women and can generate problems when using this test during intermittent preventive treatment (IPTp). DHFR-TS is less persistent than HRP2, making it a potentially interesting target for diagnosis.
- Published
- 2012