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Background  In most sub-Saharan African countries malaria rapid diagnostic tests (RDTs) are now used for the diagnosis of malaria. Most RDTs used detect  Plasmodium falciparum  histidine-rich protein-2 ( Pf HRP2), though  P. falciparum -specific parasite lactate dehydrogenase ( Pf -pLDH)-detecting RDTs may have advantages over  Pf HRP2-detecting RDTs. Only few data are available on the use of RDTs in severe illness and the present study compared  Pf -pLDH to  Pf HRP2-detection.    Methods  Hospitalized children aged one month to 14 years presenting with fever or severe illness were included over one year. Venous blood samples were drawn for malaria diagnosis (microscopy and RDT), culture and complete blood count. Leftovers were stored at −80 °C and used for additional RDT analysis and PCR. An RDT targeting both  Pf HRP2 and  Pf -pLDH was performed on all samples for direct comparison of diagnostic accuracy with microscopy as reference method. PCR was performed to explore false-positive RDT results.    Results  In 376 of 694 (54.2%) included children, malaria was microscopically confirmed. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value were 100.0, 70.9, 69.4 and 100.0%, respectively for  Pf HRP2-detection and 98.7, 94.0, 91.6 and 99.1%, respectively for  Pf -pLDH-detection. Specificity and PPV were significantly lower for  Pf HRP2-detection ( p  <0.001). For both detection antigens, specificity was lowest for children one to five years and in the rainy season. PPV for both antigens was highest in the rainy season, because of higher malaria prevalence. False positive  Pf HRP2 results were associated with prior anti-malarial treatment and positive PCR results (98/114 (86.0%) samples tested).    Conclusion  Among children presenting with severe febrile illness in a seasonal hyperendemic malaria transmission area, the present study observed similar sensitivity but lower specificity and PPV of  Pf HRP2 compared to  Pf -pLDH-detection. Further studies should assess the diagnostic accuracy and safety of an appropriate  Pf -pLDH-detecting RDT in field settings and if satisfying, replacement of  Pf HRP2 by  Pf -pLDH-detecting RDTs should be considered.

malaria journal

Accuracy of Pf HRP2 versus Pf-pLDH antigen detection by malaria rapid diagnostic tests in hospitalized children in a seasonal hyperendemic malaria transmission area in Burkina Faso