Streamlined, PCR-based testing for pfhrp2- and pfhrp3-negative Plasmodium falciparum

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  • Parr, Jonathan B
    • Affiliation: School of Medicine, Division of Infectious Diseases
  • Anderson, Olivia G
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Juliano, Jonathan
    • Affiliation: School of Medicine, Division of Infectious Diseases
  • Meshnick, Steven R.
    • Affiliation: School of Medicine, Division of Infectious Diseases
Abstract
  • Background Rapid diagnostic tests (RDTs) that detect histidine-rich protein 2 (PfHRP2) are used throughout Africa for the diagnosis of Plasmodium falciparum malaria. However, recent reports indicate that parasites lacking the pfhrp2 and/or histidine-rich protein 3 (pfhrp3) genes, which produce antigens detected by these RDTs, are common in select regions of South America, Asia, and Africa. Proving the absence of a gene is challenging, and multiple PCR assays targeting these genes have been described. A detailed characterization and comparison of published assays is needed to facilitate robust and streamlined testing approaches. Results Among six pfhrp2 and pfhrp3 PCR assays tested, the lower limit of detection ranged from 0.01 pg/µL to 0.1 ng/µL of P. falciparum 3D7 strain DNA, or approximately 0.4–4000 parasite genomes/µL. By lowering the elongation temperature to 60 °C, a tenfold improvement in the limit of detection and/or darker bands for all exon 1 targets and for the first-round reaction of a single exon 2 target was achieved. Additionally, assays targeting exon 1 of either gene yielded spurious amplification of the paralogous gene. Using these data, an optimized testing algorithm for the detection of pfhrp2- and pfhrp3-negative P. falciparum is proposed. Conclusions Surveillance of pfhrp2- and pfhrp3-negative P. falciparum requires careful laboratory workflows. PCR-based testing methods coupled with microscopy and/or antigen testing serve as useful tools to support policy development. Standardized approaches to the detection of pfhrp2- and pfhrp3-negative P. falciparum should inform efforts to define the impact of these parasites.
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  • Article
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  • In Copyright
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  • The Author(s)
Journal title
  • Malaria Journal
Journal volume
  • 17
Journal issue
  • 1
Page start
  • 137
Language
  • English
Bibliographic citation
  • Malaria Journal. 2018 Apr 02;17(1):137
Publisher
  • BioMed Central

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