ArticleMalaria journal2011
Laboratory demonstration of a prozone-like effect in HRP2-detecting malaria rapid diagnostic tests: implications for clinical management.
Article in Malaria journal, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 1 of them a synthesis that pooled it.
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Who cites it
43 citing papers in PubMed, 1 synthesis or guideline pooled it, 96 citations in OpenAlex.
- Prevalence of Plasmodium falciparum field isolates with deletions in histidine-rich protein 2 and 3 genes in context with sub-Saharan Africa and India: a systematic review and meta-analysis.Malaria journal · 2020Pooled it
- Prevalence ofThe American journal of tropical medicine and hygiene · 2020Trial
- Absence of Plasmodium falciparum Histidine-Rich Protein 2 and 3 (Pfhrp2/3) Gene Deletions in Rizal, Palawan, the Philippines.The American journal of tropical medicine and hygiene · 2026Article
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- Evaluating sensitivity and specificity of the DPP Vet TB assay in badgers using Bayesian latent class models.PloS one · 2025Article
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- A Diagnostic Accuracy Study to Evaluate Standard Rapid Diagnostic Test (RDT) Alone to Safely Rule Out Imported Malaria in Children Presenting to UK Emergency Departments.Journal of the Pediatric Infectious Diseases Society · 2023Article
- Molecular investigation of malaria-infected patients in Djibouti city (2018-2021).Malaria journal · 2023Article
- Performance Evaluation of Nested Polymerase Chain Reaction (Nested PCR), Light Microscopy, andPathogens (Basel, Switzerland) · 2022Article
- The Impact of Submicroscopic Parasitemia on Malaria Rapid Diagnosis in Northeastern Tanzania, an Area with Diverse Transmission Patterns.Infectious disease reports · 2022Article
- Factors Affecting the Performance of HRP2-Based Malaria Rapid Diagnostic Tests.Tropical medicine and infectious disease · 2022Review
- Article
- Digital microscopy and artificial intelligence could profoundly contribute to malaria diagnosis in elimination settings.Frontiers in artificial intelligence · 2022Article
- Potential Opportunities and Challenges of Deploying Next Generation Sequencing and CRISPR-Cas Systems to Support Diagnostics and Surveillance Towards Malaria Control and Elimination in Africa.Frontiers in cellular and infection microbiology · 2022Review
- The Brief Case: A 6-Year-Old with Fever, Abdominal Pain, and Recent Travel to Sierra Leone.Journal of clinical microbiology · 2021Article
- Failure of rapid diagnostic tests in Plasmodium falciparum malaria cases among travelers to the UK and Ireland: Identification and characterisation of the parasites.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2021Article
- Community-based surveys for Plasmodium falciparum pfhrp2 and pfhrp3 gene deletions in selected regions of mainland Tanzania.Malaria journal · 2020Article
- Multiplex Human Malaria Array: Quantifying Antigens for Malaria Rapid Diagnostics.The American journal of tropical medicine and hygiene · 2020Article
- Diagnostic Performance between Histidine-Rich Protein 2 (HRP-2), a Rapid Malaria Diagnostic Test and Microscopic-Based Staining Techniques for Diagnosis of Malaria.Journal of tropical medicine · 2020Article
- Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMalaria rapid diagnostic tests (RDTs) are now widely used for prompt on-site diagnosis in remote endemic areas where reliable microscopy is absent. Aberrant results, whereby negative test results occur at high parasite densities, have been variously reported for over a decade and have led to questions regarding the reliability of the tests in clinical use.
methodsIn the first trial, serial dilutions of recombinant HRP2 antigen were tested on an HRP2-detectiing RDT. In a second trial, serial dilutions of culture-derived Plasmodium falciparum parasites were tested against three HRP2-detecting RDTs.
resultsA prozone-like effect occurred in RDTs at a high concentration of the target antigen, histidine-rich protein-2 (above 15,000 ng/ml), a level that corresponds to more than 312000 parasites per μL. Similar results were noted on three RDT products using dilutions of cultured parasites up to a parasite density of 25%. While reduced line intensity was observed, no false negative results occurred.
conclusionsThese results suggest that false-negative malaria RDT results will rarely occur due to a prozone-like effect in high-density infections, and other causes are more likely. However, RDT line intensity is poorly indicative of parasite density in high-density infections and RDTs should, therefore, not be considered quantitative. Immediate management of suspected severe malaria should rely on clinical assessment or microscopy. Evaluation against high concentrations of antigen should be considered in malaria RDT product development and lot-release testing, to ensure that very weak or false negative results will not occur at antigen concentrations that might be seen clinically.
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