Rapid diagnostic test negative Plasmodium falciparum malaria in a traveller returning from Ethiopia

Malaria Journal

Stefan Schlabe¹  Tamara Nordmann¹  Jürgen Rockstroh¹  Achim Hoerauf²  Ingrid Reiter-Owona²  Ramona Dolscheid-Pommerich³  Egbert Tannich⁴ 

[1] Department of Internal Medicine I, University Hospital of Bonn;Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital of Bonn;Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn;National Reference Centre for Tropical Pathogens, Bernhard Nocht-Institute for Tropical Medicine (BNITM);

关键词: Malaria;    RDT;    HRP2;    Ethiopia;   

DOI  :  10.1186/s12936-021-03678-2

来源: DOAJ

【 摘 要 】

Abstract 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.

【 授权许可】

Unknown