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Title: Operational performance of a plasmodium falciparum ultrasensitive rapid diagnostic test for detection of asymptomatic infections in eastern Myanmar
Authors: Jordi Landier
Warat Haohankhunnatham
Smita Das
Kamonchanok Konghahong
Peter Christensen
Jathee Raksuansak
Pase Phattharakokoedbun
Ladda Kajeechiwa
May Myo Thwin
Ihn Kyung Jang
Mallika Imwong
Jacher Wiladphaingern
Khin Maung Lwin
Clare Ling
Stephane Proux
Gonzalo J. Domingo
Gilles Delmas
François H. Nosten
Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale
PATH Seattle
Mahidol University
Nuffield Department of Clinical Medicine
Keywords: Medicine
Issue Date: 1-Aug-2018
Citation: Journal of Clinical Microbiology. Vol.56, No.8 (2018)
Abstract: © 2018 Landier et al. In the Greater Mekong Subregion in Southeast Asia, malaria elimination strategies need to target all Plasmodium falciparum parasites, including those carried asymptomatically. More than 70% of asymptomatic carriers are not detected by current rapid diagnostic tests (RDTs) or microscopy. An HRP2-based ultrasensitive RDT (uRDT) developed to improve the detection of low-density infections was evaluated during prevalence surveys within a malaria elimination program in a low-transmission area of eastern Myanmar. Surveys were conducted to identify high-prevalence villages. Two-milliliter venous blood samples were collected from asymptomatic adult volunteers and transported to the laboratory. Plasmodium parasites were detected by RDT, uRDT, microscopy, ultrasensitive qPCR (uPCR), and multiplex enzyme-linked immunosorbent assay (ELISA). The sensitivity, specificity, and predictive positive and negative values of RDT and uRDT were calculated compared to uPCR and ELISA. Parasite and antigen concentrations detected by each test were defined using uPCR and ELISA, respectively. A total of 1,509 samples, including 208 P. falciparum-positive samples were analyzed with all tests. The sensitivity of the uRDT was twofold higher than that of RDT, 51.4% versus 25.2%, with minor specificity loss, 99.5% versus 99.9%, against the combined reference (uPCR plus ELISA). The geometric mean parasitemia detected by uRDT in P. falciparum monospecific infections was 3,019 parasites per ml (95% confidence interval [95% CI], 1,790 to 5,094; n 79) compared to 11,352 parasites per ml (95% CI, 5,643 to 22,837; n 38) by RDT. The sensitivities of uRDT and RDT dropped to 34.6% and 15.1%, respectively, for the matched tests performed in the field. The uRDT performed consistently better than RDT and microscopy at low parasitemias. It shows promising characteristics for the identification of high-prevalence communities and warrants further evaluation in mass screening and treatment interventions.
ISSN: 1098660X
Appears in Collections:Scopus 2018

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