ArticleThe Journal of infectious diseases2022
Fitness Costs of pfhrp2 and pfhrp3 Deletions Underlying Diagnostic Evasion in Malaria Parasites.
Article in The Journal of infectious diseases, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 24 citations in OpenAlex.
- Mechanistic insights into subclinicaliScience · 2026Review
- Are HRP2/3 deletions silently crippling malaria rapid diagnostic tests?The Indian journal of medical research · 2026Review
- Malaria control and the unexpected spread of diagnostic-resistantbioRxiv : the preprint server for biology · 2026Article
- Global risk of selection and spread of Plasmodium falciparum histidine-rich protein 2 and 3 gene deletions.Nature medicine · 2025Article
- Analysis of pfhrp2 and pfhrp3 gene deletions, and the structure and variability of PfHRP2 and PfHRP3 proteins: implications for the performance of malaria rapid diagnostic tests in Cubal, Angola.Malaria journal · 2025Article
- The spread of molecular markers of artemisinin partial resistance and diagnostic evasion in Eritrea: a retrospective molecular epidemiology study.The Lancet. Microbe · 2025Article
- Plasmodium falciparum with pfhrp2 and pfhrp3 gene deletions in asymptomatic malaria infections in the Lake Victoria region, Kenya.Tropical medicine and health · 2024Article
- A Countrywide Survey of hrp2/3 Deletions and kelch13 Mutations Co-occurrence in Ethiopia.The Journal of infectious diseases · 2024Article
- Article
- Malaria diagnosis challenges andPathogens and global health · 2024Article
- Evolution of pfhrp2 and pfhrp3 deletions in Equatorial Guinea between the pre- and post-RDT introduction.Malaria journal · 2024Article
- Temporal and spatial dynamics of Plasmodium falciparum clonal lineages in Guyana.PLoS pathogens · 2024Article
- Temporal and spatial dynamics ofbioRxiv : the preprint server for biology · 2024Article
- Assessment of the Performance of Lactate Dehydrogenase-Based Rapid Diagnostic Test for Malaria in Djibouti in 2022-2023.Diagnostics (Basel, Switzerland) · 2024Article
- Low Prevalence ofPathogens (Basel, Switzerland) · 2023Article
- Portable and cost-effective genetic detection and characterization of Plasmodium falciparum hrp2 using the MinION sequencer.Scientific reports · 2023Article
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4 authors at 2 institutions in 1 country.
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Abstract
backgroundRapid diagnostic tests based on detection of histidine-rich proteins (HRPs) are widely used for malaria diagnosis, but parasites carrying pfhrp deletions can evade detection and are increasing in frequency in some countries. Models aim to predict conditions under which pfhrp2 and/or pfhrp3 deletions will increase, but a key parameter-the fitness cost of deletions-is unknown.
methodsWe removed pfhrp2 and/or pfhrp3 from a Malawian parasite clone using gene editing approaches) and measured fitness costs by conducting pairwise competition experiments.
resultsWe observed significant fitness costs of 0.087 ± 0.008 (1 standard error) per asexual cycle for pfhrp2 deletion and 0.113 ± 0.008 for the pfhrp2/3 double deletion, relative to the unedited progenitor parasite. Selection against deletions is strong and comparable to that resulting from drug resistance mutations.
conclusionsPrior modeling suggested that diagnostic selection may drive increased frequency of pfhrp deletions only when fitness costs are mild. Our experiments show that costs of pfhrp deletions are higher than these thresholds, but modeling and empirical results can be reconciled if the duration of infection is short. These results may inform future modeling to understand why pfhrp2/3 deletions are increasing in some locations (Ethiopia and Eritrea) but not in others (Mekong region).
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