Antigen persistence of rapid diagnostic tests in pregnant women in Nanoro, Burkina Faso, and the implications for the diagnosis of malaria in pregnancy; Persistance d'antigènes dans les tests de diagnostic rapide du paludisme chez les femmes enceintes à Nanoro, au Burkina-Faso et implications pour le diagnostic pendant la grossesse; Persistencia de antígenos de pruebas diagnósticas rápidas en mujeres embarazadas en Nanoro, Burkina Faso, e implicaciones para el diagnóstico de la malaria durante e

• Published in: Tropical medicine & international health Vol. 17; no. 5; p. 550
• Main Authors: Kattenberg, Johanna H, Tahita, Christian M, Versteeg, Inge A. J, Tinto, Halidou, Traoré-Coulibaly, Maminata, Schallig, Henk D. F. H, Mens, Petra F
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.05.2012
• Subjects: Antigens; Diagnostic tests; Drug therapy; Malaria; Pregnancy; Burkina Faso
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2012.02975.x

Objectives: To evaluate persistence of several Plasmodium antigens in pregnant women after treatment and compare diagnostics during treatment follow-up. Methods: Thirty-two pregnant women (N=32) with confirmed malaria infection by a histidine-rich protein 2 (HRP2)-based rapid diagnostic test (RDT) and microscopy were followed for 28days after artemisinin-based combination therapy (ACT). A Plasmodium lactate dehydrogenase (pLDH)-based RDT and two ELISAs based on the detection of dihydrofolate reductase-thymidylate synthase (DHFR-TS) and heme detoxification protein (HDP) were compared with each other and to RT-PCR at each visit. Results: The mean visit number (95% confidence interval) on which the HRP2-based RDT was still positive after treatment was 3.4 (2.7-4.1) visits with some patients still positive at day 28. This is significantly later than the pLDH-based RDT [0.84 (0.55-1.1)], microscopy (median 1, range 1-3), DHFR-TS-ELISA [1.7 (1.1-2.3)] and RT-PCR (median 2, range 1-5) (P<0.05), but not significantly later than HDP-ELISA [2.1 (1.6-2.7)]. Lower gravidity and higher parasite density at day 0 resulted in significantly longer positive results with most tests (P<0.05). Conclusions: HRP2 can persist up to 28days after ACT treatment; therefore, this test is not suitable for treatment follow-up in pregnant women and can generate problems when using this test during intermittent preventive treatment (IPTp). DHFR-TS is less persistent than HRP2, making it a potentially interesting target for diagnosis.[PUBLICATION ABSTRACT]