Detection of the Plasmodium falciparum antigen histidine-rich protein 2 in blood of pregnant women : Implications for diagnosing placental malaria

• Published in: Journal of clinical microbiology Vol. 37; no. 9; pp. 2992 - 2996
• Main Authors: LEKE, R. F. G, DJOKAM, R. R, PARRA, M, TAYLOR, D. W, MBU, R, LEKE, R. J, FOGAKO, J, MEGNEKOU, R, METENOU, S, SAMA, G, YUAN ZHOU, CADIGAN, T
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society for Microbiology 01.09.1999
• Subjects: Animals; Antigens, Protozoan - blood; Biological and medical sciences; Enzyme-Linked Immunosorbent Assay; Female; Human protozoal diseases; Humans; Infectious diseases; Malaria; Malaria, Falciparum - diagnosis; Medical sciences; Microscopy; Parasitemia - diagnosis; Parasitic diseases; Parasitology; Placenta - parasitology; Plasmodium falciparum; Plasmodium falciparum - immunology; Plasmodium falciparum - isolation & purification; Pregnancy; Pregnancy Complications - diagnosis; Proteins - analysis; Protozoal diseases; Reagent Strips; Human; Protozoa; Apicomplexa; Protozoal disease; Pregnancy disorders; Malaria; Parasitosis; Enzyme immunoassay; Placenta diseases; Blood plasma; Infection; Antigen; Pregnancy; Plasmodium falciparum; Female; Diagnosis; Detection; ELISA assay
• ISSN: 0095-1137; 1098-660X
• DOI: 10.1128/JCM.37.9.2992-2996.1999

Pregnant women have an increased susceptibility to infection by Plasmodium falciparum. Parasites may be present in the placenta yet not detectable in peripheral blood smears by routine light microscopy. In order to determine how frequently misdiagnosis occurs, peripheral blood and placental samples were collected from 1,077 Cameroonian women at the time of giving birth and examined for the presence of malarial parasites by using light microscopy. Results showed that 20.1% of the women who had placental malaria were peripheral blood smear negative. Thus, malarial infection was not detected by microscopic examination of peripheral blood smears from approximately one out of five malaria-infected women. Since P. falciparum parasites secrete histidine-rich protein 2 (HRP-2), we sought to determine if detecting HRP-2 in either peripheral plasma or whole blood might be used to diagnose the presence of parasites "hidden" in the placenta. Samples of peripheral plasma from 127 women with different levels of placental malarial infection were assayed by HRP-2-specific enzyme-linked immunosorbent assay. HRP-2 was detected in 88% of the women with placental malaria who tested negative by blood smear. Additionally, whole blood was obtained from 181 women and tested for HRP-2 with a rapid, chromatographic strip test (ICT). The ICT test accurately detected malarial infection in 89.1% of P. falciparum-infected women. Furthermore, 94% of women with malaria were accurately diagnosed by using a combination of microscopy and the ICT test. Thus, detection of HRP-2 in conjunction with microscopy should improve diagnosis of malaria in pregnant women.