Contribution of P. falciparum parasites with Pfhrp 2 gene deletions to false negative PfHRP 2 based malaria RDT results in Ghana: A nationwide study of symptomatic malaria patients

Abstract

Introduction False-negative malaria rapid diagnostic test (RDT) results amongst symptomatic malaria patients are detrimental as they could lead to ineffective malaria case management. This study determined the nationwide contribution of parasites with Pfhrp2 and Pfhrp 3 gene deletions to false negative malaria RDT results in Ghana. Methods This was a cross sectional study where whole blood (~2 ml) was collected from patients presenting with malaria symptoms at 100 health facilities in all the regions in Ghana from May to August 2018. An aliquot of the blood was used to prepare thin and thick blood smears, filter paper blood spots (DBS) and spot a PfHRP 2 RDT kit. The remaining blood was separated into plasma and blood cells and stored at-20˚C. Plasmodium parasite density and species identity was estimated from the blood smears. Plasmodium falciparum specific 18S rRNA PCR, merozoite surface protein (msp 1) and glutamate rich protein (glurp) gene PCR were used to identify P. falciparum positive samples, which were subjected to Pfhrp 2/3 exon1-2 and exon2 genotyping. Results Of the 2,860 microscopically P. falciparum positive patients analyzed, 134 (4.69%) had false negative P. falciparum specific RDT results. Samples for PCR analysis was available for 127 of the false negative patients, and the analysis identified 116 (91.3%) as positive for

Nationwide molecular surveillance of three Plasmodium species harboured by symptomatic malaria patients living in Ghana

“…Study participants ranged in age from 1 to 94 years. The demographics of the larger study population have been reported previously [ 16 , 17 ].…”

“…This cross-sectional study was conducted in the 10 regions of Ghana as of 2018: Greater Accra Region (GAR), Central Region (CR), Ashanti Region (AR), Western Region (WR), Eastern Region (ER), Brong-Ahafo Region (BAR), Volta Region (VR), Northern Region (NR), Upper East Region (UER) and Upper West Region (UWR). Ten healthare facilities were randomly selected in each of the 10 regions of Ghana [ 16 , 17 ].…”

Genotypic glucose-6-phosphate dehydrogenase (G6PD) deficiency protects against Plasmodium falciparum infection in individuals living in Ghana

“…Samples used for this study were collected in 2018, from 10 health facilities scattered across each of the 10 regions of Ghana, making a total of 100 facilities ( S1 File ) as part of a cross-sectional study that recruited 19896 suspected malaria patients [ 36 , 37 ]. The study was performed in accordance with the Declaration of Helsinki.…”

“…A total sample of 6108 participants were randomly selected from all the regions and for use in this study. The demographic details (age and sex) and the infecting malaria parasite species of the participants whose samples were used in this study were obtained from the larger study [ 36 , 37 ].…”

Progress in Parasite Genomics and Its Application to Current Challenges in Malaria Control

“…The highest prevalence (50% pfhrp2 deletions among all positive cases) were reported in Cambodia, Peru, and Eritrea [46]. Such a high prevalence could be explained by technical errors, mutations, selection and spread of the pfhrp2 and 3 variants [47] from South America to Africa and Asia [41]. Recently, a novel HRP2based Alere™ Malaria Ag P.f RDT (uRDT) was developed specifically for the detection of asymptomatic infections.…”