Antigen persistence of rapid diagnostic tests in pregnant women in Nanoro, Burkina Faso, and the implications for the diagnosis of malaria in pregnancy

Johanna H Kattenberg, Christian M Tahita, Inge A J Versteeg, Halidou Tinto, Maminata Traoré-Coulibaly, Henk D F H Schallig, Petra F Mens

Research output: Contribution to journalA1: Web of Science-articlepeer-review


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 28 days 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 haeme 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 28 days 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.

Original languageEnglish
JournalTropical Medicine and International Health
Issue number5
Pages (from-to)550-557
Number of pages8
Publication statusPublished - 2012
Externally publishedYes


  • Adult
  • Analysis of Variance
  • Anti-Infective Agents
  • Antigens, Protozoan
  • Artemisinins
  • Biomarkers
  • Burkina Faso
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Follow-Up Studies
  • Humans
  • L-Lactate Dehydrogenase
  • Malaria, Falciparum
  • Multienzyme Complexes
  • Plasmodium falciparum
  • Pregnancy
  • Pregnancy Complications, Parasitic
  • Protozoan Proteins
  • Real-Time Polymerase Chain Reaction
  • Tetrahydrofolate Dehydrogenase
  • Thymidylate Synthase
  • Treatment Outcome
  • Journal Article
  • Research Support, Non-U.S. Gov't


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