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More than 80% of available malaria rapid diagnostic tests (RDTs) are based on the detection of histidine-rich protein-2 (PfHRP2) for diagnosis of  Plasmodium falciparum  malaria. Recent studies have shown the genes that code for this protein and its paralog, histidine-rich protein-3 (PfHRP3), are absent in parasites from the Peruvian Amazon Basin. Lack of PfHRP2 protein through deletion of the  pfhrp2  gene leads to false-negative RDT results for  P .  falciparum . We have evaluated the extent of  pfhrp2  and  pfhrp3  gene deletions in a convenience sample of 198 isolates from six sites in three states across the Brazilian Amazon Basin (Acre, Rondonia and Para) and 25 isolates from two sites in Bolivia collected at different times between 2010 and 2012.  Pfhrp2  and  pfhrp3  gene and their flanking genes on chromosomes 7 and 13, respectively, were amplified from 198 blood specimens collected in Brazil. In Brazil, the isolates collected in Acre state, located in the western part of the Brazilian Amazon, had the highest percentage of deletions for  pfhrp2  25 (31.2%) of 79, while among those collected in Rondonia, the prevalence of  pfhrp2  gene deletion was only 3.3% (2 out of 60 patients). In isolates from Para state, all parasites were  pfhrp2 -positive. In contrast, we detected high proportions of isolates from all 3 states that were  pfhrp3 -negative ranging from 18.3% (11 out of 60 samples) to 50.9% (30 out of 59 samples). In Bolivia, only one of 25 samples (4%) tested had deleted  pfhrp2  gene, while 68% (17 out of 25 samples) were  pfhrp3 -negative. Among the isolates tested,  P .  falciparum pfhrp2  gene deletions were present mainly in those from Acre State in the Brazilian Amazon. These results indicate it is important to reconsider the use of PfHRP2-based RDTs in the western region of the Brazilian Amazon and to implement appropriate surveillance systems to monitor  pfhrp2  gene deletions in this and other parts of the Amazon region.

Histidine-rich protein 2 (pfhrp2) and pfhrp3 gene deletions in Plasmodium falciparum isolates from select sites in Brazil and Bolivia