Misdiagnosis of imported falciparum malaria from African areas due to an increased prevalence of pfhrp2/pfhrp3 gene deletion: the Djibouti case

Following the diagnosis of a falciparum malaria case imported from Djibouti and not detected by a pfHRP2-based rapid diagnostic test (RDT), we investigated the prevalence of the pfhrp2/pfhrp3-deleted parasites in Djibouti using 378 blood samples collected between January and May 2019, from Djiboutia...

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Bibliographic Details
Published in:Emerging microbes & infections 2020-01, Vol.9 (1), p.1984-1987
Main Authors: Iriart, Xavier, Menard, Sandie, Chauvin, Pamela, Mohamed, Hasna S., Charpentier, Elena, Mohamed, Mohamed A., Berry, Antoine, Aboubaker, Mohamed H.
Format: Article
Language:English
Subjects:
Antigens, Protozoan - genetics
deletion
Diagnostic Errors
Diagnostic Tests, Routine
Djibouti
Erythrocytes
Gene Deletion
histidine-rich protein 2
Human health and pathology
Humans
Infectious diseases
Letter
Life Sciences
Malaria
Malaria, Falciparum - diagnosis
Parasites
Plasmodium falciparum
Plasmodium falciparum - classification
Plasmodium falciparum - genetics
Population Surveillance
Prevalence
Protozoan Proteins - genetics
rapid diagnostic test
Sensitivity and Specificity
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Summary:Following the diagnosis of a falciparum malaria case imported from Djibouti and not detected by a pfHRP2-based rapid diagnostic test (RDT), we investigated the prevalence of the pfhrp2/pfhrp3-deleted parasites in Djibouti using 378 blood samples collected between January and May 2019, from Djiboutian patients with suspected malaria. Malaria diagnosis by quantitative PCR confirmed the presence of Plasmodium falciparum for 20.9% (79/378) samples while RDTs did not detect HRP2 antigen in 83.5% (66/79) of these samples. Quantitative PCRs targeting the pfhrp2/pfhrp3 genes confirmed the absence of both genes for 86.5% of P. falciparum strains. The very large number (86.5%) of falciparum parasites lacking the pfhrp2/pfhrp3 genes observed in this study, now justifies the use of non-HRP2 alternative RDTs in Djibouti. In this area and in most countries where HRP2-based RDTs constitute the main arsenal for falciparum malaria diagnosis, it is important to implement a systematic surveillance and to inform biologists and clinicians about the risk of malaria misdiagnosis. Further investigations are needed to better understand the mechanism of selection and diffusion of the pfhrp2/pfhrp3-deleted parasites.
ISSN:2222-1751
2222-1751
DOI:10.1080/22221751.2020.1815590