Prevalence and clinical impact of malaria infections detected with a highly sensitive HRP2 rapid diagnostic test in Beni
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Malaria Journal Open Access
RESEARCH
Prevalence and clinical impact of malaria infections detected with a highly sensitive HRP2 rapid diagnostic test in Beninese pregnant women Valérie Briand1,2* , Gilles Cottrell2, Nicaise Tuike Ndam2, Xavier Martiáñez‑Vendrell3, Bertin Vianou4, Atika Mama4, Bienvenue Kouwaye4, Sandrine Houzé2,5, Justine Bailly5, Erasme Gbaguidi4, Darius Sossou4, Achille Massougbodji4, Manfred Accrombessi4,6, Alfredo Mayor3, Xavier C. Ding7 and Nadine Fievet2
Abstract Background: While sub-microscopic malarial infections are frequent and potentially deleterious during pregnancy, routine molecular detection is still not feasible. This study aimed to assess the performance of a Histidine Rich Protein 2 (HRP2)-based ultrasensitive rapid diagnostic test (uRDT, Alere Malaria Ag Pf ) for the detection of infections of low parasite density in pregnant women. Methods: This was a retrospective study based on samples collected in Benin from 2014 to 2017. A total of 942 whole blood samples collected in 327 women in the 1st and 3rd trimesters and at delivery were tested by uRDT, conventional RDT (cRDT, SD BIOLINE Malaria Ag Pf ), microscopy, quantitative polymerase chain-reaction (qPCR) and Luminex-based suspension array technology targeting P. falciparum HRP2. The performance of each RDT was evalu‑ ated using qPCR as reference standard. The association between infections detected by uRDT, but not by cRDT, with poor maternal and birth outcomes was assessed using multivariate regression models. Results: The overall positivity rate detected by cRDT, uRDT, and qPCR was 11.6% (109/942), 16.2% (153/942) and 18.3% (172/942), respectively. Out of 172 qPCR-positive samples, 68 were uRDT-negative. uRDT had a significantly better sensitivity (60.5% [52.7–67.8]) than cRDT (44.2% [36.6–51.9]) and a marginally decreased specificity (93.6% [91.7–95.3] versus 95.7% [94.0–97.0]). The gain in sensitivity was particularly high (33%) and statistically significant in the 1st trimester. Only 28 (41%) out of the 68 samples which were qPCR-positive, but uRDT-negative had detectable but very low levels of HRP2 (191 ng/mL). Infections that were detected by uRDT but not by cRDT were associated with a 3.4-times (95%CI 1.29–9.19) increased risk of anaemia during pregnancy. Conclusions: This study demonstrates the higher performance of uRDT, as compared to cRDTs, to detect low para‑ site density P. falciparum infections during pregnancy, particularly in the 1st trimester. uRDT allowed the detection of infections associated with maternal anaemia. Keywords: Malaria, Pregnancy, Africa, Diagnostic tests, HRP-2 antigen
*Correspondence: [email protected] 2 Université de Paris, MERIT, IRD, 75006 Paris, France Full list of author information is available at the end of the article
Background In sub-Saharan Africa (SSA), around 39 million pregnant women are exposed to malaria every year [1]. Malaria in pregnancy (MiP) due to Plasmodium falciparum is one of
© The Author(s) 2020. This article is licensed under a Creative Commons Attri
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