Evaluation of a PfHRP2 and a pLDH-based diagnostic test for the diagnosis of severe malaria in 2 populations of African children.

Ilse C E Hendriksen, George Mtove, Alínia José Pedro, Ermelinda Gomes, Kamolrat Silamut, Sue J. Lee, Abraham Mwambuli, Samwel Gesase, Hugh Reyburn, Nicholas P J Day, Nicholas J. White, Lorenz Von Seidlein, Arjen M. Dondorp

    Research output: Contribution to journalArticlepeer-review


    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. 

    Conclusion: 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.

    Original languageEnglish
    Pages (from-to)1100-1107
    Number of pages8
    JournalClinical Infectious Diseases
    Issue number9
    Publication statusPublished - 2011


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