Rapid diagnostic test negative Plasmodium falciparum malaria in a traveller returning from Ethiopia
Standard
Rapid diagnostic test negative Plasmodium falciparum malaria in a traveller returning from Ethiopia. / Schlabe, Stefan; Reiter-Owona, Ingrid; Nordmann, Tamara; Dolscheid-Pommerich, Ramona; Tannich, Egbert; Hoerauf, Achim; Rockstroh, Jürgen.
In: MALARIA J, Vol. 20, No. 1, 145, 12.03.2021.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Rapid diagnostic test negative Plasmodium falciparum malaria in a traveller returning from Ethiopia
AU - Schlabe, Stefan
AU - Reiter-Owona, Ingrid
AU - Nordmann, Tamara
AU - Dolscheid-Pommerich, Ramona
AU - Tannich, Egbert
AU - Hoerauf, Achim
AU - Rockstroh, Jürgen
PY - 2021/3/12
Y1 - 2021/3/12
N2 - BACKGROUND: Plasmodium falciparum strains with mutations/deletions of the genes encoding the histidine-rich proteins 2/3 (pfhrp2/3) have emerged during the last 10 years leading to false-negative results in HRP2-based rapid diagnostic tests (RDTs). This can lead to unrecognized infections in individuals and to setbacks in malaria control in endemic countries where RDTs are the backbone of malaria diagnostics and control.CASE DESCRIPTION: Here the detection of a pfhrp2/3-negative P. falciparum infection acquired in Ethiopia by a 63-year old female traveller is presented. After onset of symptoms during travel, she was first tested negative for malaria, most probably by RDT, at a local hospital in Harar, Ethiopia. Falciparum malaria was finally diagnosed microscopically upon her return to Germany, over 4 weeks after infection. At a parasite density of approximately 5387 parasites/µl, two different high-quality RDTs: Palutop + 4 OPTIMA, NADALRMalaria PF/pan Ag 4 Species, did not respond at their respective P. falciparum test lines. pfhrp2/3 deletion was confirmed by multiplex-PCR. The patient recovered after a complete course of atovaquone and proguanil. According to the travel route, malaria was acquired most likely in the Awash region, Central Ethiopia. This is the first case of imported P. falciparum with confirmed pfhrp2/3 deletion from Ethiopia.CONCLUSION: HRP2-negative P. falciparum strains may not be recognized by the presently available HRP2-based RDTs. When malaria is suspected, confirmation by microscopy and/or qPCR is necessary in order to detect falciparum malaria, which requires immediate treatment. This case of imported P. falciparum, non-reactive to HRP2-based RDT, possibly underlines the necessity for standardized, nationwide investigations in Ethiopia and should alert clinicians from non-endemic countries to the possibility of false-negative RDT results which may increase in returning travellers with potentially life-threatening infections.
AB - BACKGROUND: Plasmodium falciparum strains with mutations/deletions of the genes encoding the histidine-rich proteins 2/3 (pfhrp2/3) have emerged during the last 10 years leading to false-negative results in HRP2-based rapid diagnostic tests (RDTs). This can lead to unrecognized infections in individuals and to setbacks in malaria control in endemic countries where RDTs are the backbone of malaria diagnostics and control.CASE DESCRIPTION: Here the detection of a pfhrp2/3-negative P. falciparum infection acquired in Ethiopia by a 63-year old female traveller is presented. After onset of symptoms during travel, she was first tested negative for malaria, most probably by RDT, at a local hospital in Harar, Ethiopia. Falciparum malaria was finally diagnosed microscopically upon her return to Germany, over 4 weeks after infection. At a parasite density of approximately 5387 parasites/µl, two different high-quality RDTs: Palutop + 4 OPTIMA, NADALRMalaria PF/pan Ag 4 Species, did not respond at their respective P. falciparum test lines. pfhrp2/3 deletion was confirmed by multiplex-PCR. The patient recovered after a complete course of atovaquone and proguanil. According to the travel route, malaria was acquired most likely in the Awash region, Central Ethiopia. This is the first case of imported P. falciparum with confirmed pfhrp2/3 deletion from Ethiopia.CONCLUSION: HRP2-negative P. falciparum strains may not be recognized by the presently available HRP2-based RDTs. When malaria is suspected, confirmation by microscopy and/or qPCR is necessary in order to detect falciparum malaria, which requires immediate treatment. This case of imported P. falciparum, non-reactive to HRP2-based RDT, possibly underlines the necessity for standardized, nationwide investigations in Ethiopia and should alert clinicians from non-endemic countries to the possibility of false-negative RDT results which may increase in returning travellers with potentially life-threatening infections.
KW - Diagnostic Tests, Routine/statistics & numerical data
KW - Ethiopia
KW - Female
KW - Germany
KW - Humans
KW - Malaria, Falciparum/diagnosis
KW - Middle Aged
KW - Plasmodium falciparum/isolation & purification
KW - Travel
U2 - 10.1186/s12936-021-03678-2
DO - 10.1186/s12936-021-03678-2
M3 - SCORING: Journal article
C2 - 33712017
VL - 20
JO - MALARIA J
JF - MALARIA J
SN - 1475-2875
IS - 1
M1 - 145
ER -