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. 2023 May 24;22(1):163.
doi: 10.1186/s12936-023-04596-1.

Poor performance of malaria rapid diagnostic tests for the detection of Plasmodium malariae among returned international travellers in China

Jingyao Wu #  1 , Jianxia Tang #  1   2 , Weiming Wang #  1 , Gangcheng Chen  1 , Xiaoqin He  1   2 , Sui Xu  1 , Yuanyuan Cao  1 , Yaping Gu  1 , Guoding Zhu  3   4 , Jun Cao  5   6
Affiliations

Poor performance of malaria rapid diagnostic tests for the detection of Plasmodium malariae among returned international travellers in China

Jingyao Wu et al. Malar J. .

Abstract

Background: Malaria is a worldwide infectious disease. For countries that have achieved malaria elimination, the prevention of re-establishment due to infections in returned travellers has become important. The accurate and timely diagnosis of malaria is the key in preventing re-establishment, and malaria rapid diagnostic tests (RDTs) are frequently used due to their convenience. However, the RDT performance in Plasmodium malariae (P. malariae) infection diagnosis remains unknown.

Methods: This study analysed epidemiological features and diagnosis patterns of imported P. malariae cases from 2013 to 2020 in Jiangsu Province and evaluated the sensitivity of four parasite enzyme lactate dehydrogenase (pLDH)-targeting RDTs (Wondfo, SD BIONLINE, CareStart and BioPerfectus) and one aldolase-targeting RDT(BinaxNOW) for P. malariae detection. Furthermore, influential factors were investigated, including parasitaemia load, pLDH concentration and target gene polymorphisms.

Results: The median duration from symptom onset to diagnosis among patients with P. malariae infection was 3 days, which was longer than that with Plasmodium falciparum (P. falciparum) infection. The RDTs had a low detection rate (39/69, 56.5%) among P. malariae cases. All tested RDT brands had poor performance in P. malariae detection. All the brands except the worst-performing SD BIOLINE, achieved 75% sensitivity only when the parasite density was higher than 5000 parasites/μL. Both pLDH and aldolase showed relatively conserved and low gene polymorphism rates.

Conclusions: The diagnosis of imported P. malariae cases was delayed. The RDTs had poor performance in P. malariae diagnosis and may threaten the prevention of malaria re-establishment from returned travellers. The improved RDTs or nucleic acid tests for P. malariae cases are urgently needed for the detection of imported cases in the future.

Keywords: Malaria; Plasmodium malariae; Prevention of re-establishment; Rapid diagnostic tests (RDTs).

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Conflict of interest statement

All the authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Number of imported malaria cases in China. a Number of imported malaria cases in China, 2013–2020, b Number of imported P. malariae cases in China, 2013–2020
Fig. 2
Fig. 2
Comparison of the time from symptom onset to diagnosis in Jiangsu Province, 2013–2020. The middle line of each violin plot represents the median, while the dotted line represents the interquartile range. The black dots represent individual cases
Fig. 3
Fig. 3
Correlation between parasite density and pLDH concentration among samples
See this image and copyright information in PMC

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