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. 2013 Apr 11:12:123.
doi: 10.1186/1475-2875-12-123.

Field evaluation of HRP2 and pan pLDH-based immunochromatographic assay in therapeutic monitoring of uncomplicated falciparum malaria in Myanmar

Myat H Nyunt, Myat P Kyaw, Kyu K Win, Khin M Myint, Khin M Nyunt

Field evaluation of HRP2 and pan pLDH-based immunochromatographic assay in therapeutic monitoring of uncomplicated falciparum malaria in Myanmar

Myat H Nyunt et al. Malar J. .

Abstract

Background: Malaria rapid diagnostic tests (RDT) are used for diagnostic purpose in malaria-endemic areas where reliable microscopy is not available. Persistence of the antigenaemia causes over-diagnosis and may limit the usefulness of the RDT in monitoring treatment. In this study, the usefulness of histidine-rich protein-2 (HRP2) and pan-specific or species-specific Plasmodium lactate dehydrogenase (pLDH) in treatment monitoring of uncomplicated falciparum malaria was carried out in an endemic setting in Myanmar.

Methods: A prospective longitudinal, single-arm, cohort study was done by microscopy to confirm Plasmodium falciparum mono-infected cases. After direct treatment with an artemether-lumefantrine combination, patients were followed up on day 3, 7, 14, 21, 28 and any other day of recurrent fever. Blood film examination and RDT were carried out on day 0 and all follow-up days.

Results: Out of 77 recruited falciparum cases, 63 became adequate clinical and parasitological response (ACPR) cases, and 60.3% of them were still positive for HRP2 up to day 28. Eleven out of 12 treatment failure cases (91.6%) were detected by pan pLDH. The mean duration required to become negative of HRP2 was 20 days (SD ± 6.03) and that of pan pLDH was six days with or without gametocytes and 3.7 days without gametocytes.

Conclusion: Although treatment monitoring cannot be performed by HRP2, it can be assessed by pan pLDH-based assay after day 3 if a gametocidal drug has been administered and after day 7 if the presence of gametocytes was not excluded. The pan pLDH-based assay was a suitable test to monitor the treatment response of uncomplicated falciparum malaria patients.

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Figures

Figure 1
Figure 1
Screening algorithm of the study cases. MP = malaria parasite, Pv = Plasmodium vivax, Pf = Plasmodium falciparum, LPF = late parasitological failure, ACPR = adequate clinical and parasitological response.
Figure 2
Figure 2
Comparison of HRP2 and pLDH result with microscopy in each of the follow-up days in all ACPR cases.
Figure 3
Figure 3
Correlation of persistence of band intensity of HRP2 and pLDH with initial parasite count. Higher initial parasite counts were correlated with the higher persistence of the band intensity in HRP2-based RDTs.
See this image and copyright information in PMC

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