How long do rapid diagnostic tests remain positive after anti-malarial treatment?

Publisher: BioMed Central Country of Publication: England NLM ID: 101139802 Publication Model: Electronic Cited Medium: Internet ISSN: 1475-2875 (Electronic) Linking ISSN: 14752875 NLM ISO Abbreviation: Malar J Subsets: MEDLINE

Original Publication: London : BioMed Central, [2002-

Antigens, Protozoan/*blood ; Antimalarials/*administration & dosage ; Diagnostic Tests, Routine/*statistics & numerical data ; Plasmodium/*immunology; Antigens, Protozoan/classification ; Bayes Theorem ; Diagnostic Tests, Routine/instrumentation ; Humans ; Plasmodium/drug effects ; Plasmodium/isolation & purification

Background: Rapid diagnostic tests (RDTs) are increasingly becoming a paradigm for both clinical diagnosis of malaria infections and for estimating community parasite prevalence in household malaria indicator surveys in malaria-endemic countries. The antigens detected by RDTs are known to persist in the blood after treatment with anti-malarials, but reports on the duration of persistence (and the effect this has on RDT positivity) of these antigens post-treatment have been variable.
Methods: In this review, published studies on the persistence of positivity of RDTs post-treatment are collated, and a bespoke Bayesian survival model is fit to estimate the number of days RDTs remain positive after treatment.
Results: Half of RDTs that detect the antigen histidine-rich protein II (HRP2) are still positive 15 (5-32) days post-treatment, 13 days longer than RDTs that detect the antigen Plasmodium lactate dehydrogenase, and that 5% of HRP2 RDTs are still positive 36 (21-61) days after treatment. The duration of persistent positivity for combination RDTs that detect both antigens falls between that for HRP2- or pLDH-only RDTs, with half of RDTs remaining positive at 7 (2-20) days post-treatment. This study shows that children display persistent RDT positivity for longer after treatment than adults, and that persistent positivity is more common when an individual is treated with artemisinin combination therapy than when treated with other anti-malarials.
Conclusions: RDTs remain positive for a highly variable amount of time after treatment with anti-malarials, and the duration of positivity is highly dependent on the type of RDT used for diagnosis. Additionally, age and treatment both impact the duration of persistence of RDT positivity. The results presented here suggest that caution should be taken when using RDT-derived diagnostic outcomes from cross-sectional data where individuals have had a recent history of anti-malarial treatment.

Nature. 2015 Oct 8;526(7572):207-211. (PMID: 26375008)
Br J Haematol. 2000 Jun;109(4):891-4. (PMID: 10929047)
J Clin Microbiol. 2014 Oct;52(10):3784-7. (PMID: 25056333)
Elife. 2017 Oct 16;6:null. (PMID: 29034876)
Nat Rev Microbiol. 2006 Sep;4(9 Suppl):S7-20. (PMID: 17003770)
Trans R Soc Trop Med Hyg. 1993 Nov-Dec;87(6):646-8. (PMID: 8296363)
N Engl J Med. 2016 Dec 22;375(25):2435-2445. (PMID: 27723434)
Southeast Asian J Trop Med Public Health. 2005 May;36(3):552-61. (PMID: 16124416)
Malar J. 2013 Apr 11;12:123. (PMID: 23577630)
Malar J. 2014 Jan 27;13:30. (PMID: 24467946)
Malar J. 2009 Sep 07;8:211. (PMID: 19735557)
Malar J. 2017 May 15;16(1):196. (PMID: 28506275)
J Clin Microbiol. 1999 Aug;37(8):2412-7. (PMID: 10405377)
BMC Infect Dis. 2005 Jun 21;5:50. (PMID: 15969747)
Curr Opin Infect Dis. 2015 Oct;28(5):417-25. (PMID: 26237549)
J Parasitol Res. 2014;2014:194651. (PMID: 24800057)
Br J Haematol. 2001 May;113(2):558-9. (PMID: 11380433)
Malar J. 2016 Mar 15;15:163. (PMID: 26979286)
Malar J. 2015 Nov 17;14:460. (PMID: 26577805)
Malar J. 2007 May 16;6:58. (PMID: 17506881)
Trop Med Int Health. 2007 Feb;12(2):238-44. (PMID: 17300631)
Vector Borne Zoonotic Dis. 2004 Summer;4(2):123-30. (PMID: 15228812)
J Clin Microbiol. 2004 Sep;42(9):4237-41. (PMID: 15365017)
Trop Med Int Health. 2002 Apr;7(4):304-8. (PMID: 11952945)
Am J Trop Med Hyg. 2001 Oct;65(4):355-61. (PMID: 11693884)
Trans R Soc Trop Med Hyg. 2007 Apr;101(4):331-7. (PMID: 17212967)
Am J Trop Med Hyg. 2015 Mar;92(3):530-6. (PMID: 25624399)
Am J Trop Med Hyg. 2001 Jan-Feb;64(1-2):20-3. (PMID: 11425156)
Malar J. 2010 Jun 04;9:153. (PMID: 20525322)
J Clin Microbiol. 2007 Feb;45(2):627-30. (PMID: 17135432)
Ethiop J Health Sci. 2012 Jul;22(2):93-8. (PMID: 22876072)
Am J Trop Med Hyg. 2007 Jun;76(6):1092-7. (PMID: 17556616)
Nanobiomedicine (Rij). 2015;2:null. (PMID: 26594252)
Trans R Soc Trop Med Hyg. 2001 Mar-Apr;95(2):179-82. (PMID: 11355555)
Trans R Soc Trop Med Hyg. 2008 Jan;102(1):25-31. (PMID: 18031779)
Malar J. 2014 Jan 13;13:20. (PMID: 24418119)
J Infect Dis. 2009 Nov 15;200(10):1509-17. (PMID: 19848588)
Am J Trop Med Hyg. 1999 Jul;61(1 Suppl):4-19. (PMID: 10432041)
J Clin Microbiol. 2001 Mar;39(3):1025-31. (PMID: 11230422)
Clin Microbiol Rev. 2009 Jan;22(1):13-36, Table of Contents. (PMID: 19136431)
Nature. 2015 Dec 3;528(7580):S86-93. (PMID: 26633770)
Trans R Soc Trop Med Hyg. 1996 Sep-Oct;90(5):513-5. (PMID: 8944258)
Malar J. 2014 Oct 15;13:405. (PMID: 25318705)
J Infect Dis. 2016 Sep 1;214(5):753-61. (PMID: 27252475)
Pan Afr Med J. 2015 Nov 25;22:304. (PMID: 26966500)
Am J Trop Med Hyg. 2007 Dec;77(6 Suppl):119-27. (PMID: 18165483)
Malar J. 2016 Oct 4;15(1):496. (PMID: 27716244)

OPP1068048 Bill & Melinda Gates Foundation

Keywords: Fever; Malaria; RDT

0 (Antigens, Protozoan)
0 (Antimalarials)

Date Created: 20180610 Date Completed: 20190102 Latest Revision: 20220409

20240105

PMC5994115

10.1186/s12936-018-2371-9

29884184