ArticleInfectious diseases of poverty2025
First report of pfhrp2 and pfhrp3 gene deletions compromising HRP2-based malaria rapid diagnostic tests in Malawi.
Article in Infectious diseases of poverty, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Asymptomatic malaria: a hidden reservoir for the transmission and circulation of artemisinin partial-resistantEmerging microbes & infections · 2026Article
- Peptide-Enabled Nanoplatforms for Malaria and Leishmaniasis: From Intracellular Targeting to Translational Diagnostic Perspectives.ChemMedChem · 2026Review
- Diagnostic challenges of histidine-rich protein 2-based rapid diagnostic tests due to pfhrp2 and pfhrp3 gene deletions in asymptomatic malaria in Tanzania.Infectious diseases of poverty · 2026Article
- Who uses the only mosquito net? Sex and age disparities.Tropical medicine and health · 2026Article
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Abstract
backgroundHistidine Rich Protein 2-based rapid diagnostic tests (HRP2-based RDTs) are widely used for malaria diagnosis in Malawi, but their accuracy may be compromised by Plasmodium falciparum parasites lacking the P. falciparum histidine rich protein 2 (pfhrp2) and P. falciparum histidine rich protein 3 (pfhrp3) genes. While such deletions have been reported in other malaria-endemic countries, their presence and diagnostic impact in Malawi remain unknown. This study aimed to determine the prevalence of pfhrp2/pfhrp3 gene deletions in Malawi and their effect on the diagnostic accuracy of HRP2-based RDTs relative to light microscopy and qPCR.
methodsA cross-sectional study was conducted between December 2020 and June 2021, enrolling 1582 participants from referral hospitals in Mzuzu (n = 1186) and Lilongwe (n = 396). Malaria diagnosis was performed using RDTs, microscopy, and qPCR. A total of 391 P. falciparum positive samples were analyzed for pfhrp2/pfhrp3 gene deletions using multiplex qPCR. Diagnostic accuracy metrics, such as sensitivity and specificity, were calculated with 95% confidence intervals. Spearman correlation was applied to assess associations involving log-transformed parasitemia, unpaired t-tests were used to compare diagnostic methods, and Mann-Whitney tests were used to compare symptomatic and asymptomatic groups.
resultsMalaria prevalence was higher in Lilongwe (45.2%) than in Mzuzu (22.9%). Infections in Lilongwe were predominantly asymptomatic (94.2%), whereas Mzuzu had mostly symptomatic cases (97.1%) (P < 0.0002). RDTs demonstrated higher sensitivity of 78.5% (95% CI: 74.6-82.1%) than microscopy 64.8% (95% CI: 60.3-69.1), but slightly lower specificity, with 93.6% (95% CI: 92.0-95.0%) for RDT compared to 95.4% (95% CI: 94.0-96.6%) for microscopy. Dual pfhrp2/3 gene deletions were found in 24 (15.0%) isolates from Lilongwe and 24 (10.4%) from Mzuzu. All dual-deleted samples were false negative by RDT but were positive by microscopy and qPCR.
conclusionsThis study is the first to report pfhrp2/3 gene deletions in Malawi. The presence of these deletions may compromise the performance of HRP2-based RDTs, indicating the need to reassess diagnostic strategies in affected regions.
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