Emerg Infect Dis. 2018 Mar;24(3):462-470. doi: 10.3201/eid2403.171723.
False-negative results for Plasmodium falciparum histidine-rich protein (HRP) 2-based rapid diagnostic tests (RDTs) are increasing in Eritrea. We investigated HRP gene 2/3 (pfhrp2/pfhrp3) status in 50 infected patients at 2 hospitals. We showed that 80.8% (21/26) of patients at Ghindae Hospital and 41.7% (10/24) at Massawa Hospital were infected with pfhrp2-negative parasites and 92.3% (24/26) of patients at Ghindae Hospital and 70.8% (17/24) at Massawa Hospital were infected with pfhrp3-negative parasites. Parasite densities between pfhrp2-positive and pfhrp2-negative patients were comparable. All pfhrp2-negative samples had no detectable HRP2/3 antigen and showed negative results for HRP2-based RDTs. pfhrp2-negative parasites were genetically less diverse and formed 2 clusters with no close relationships to parasites from Peru. These parasites probably emerged independently by selection in Eritrea. High prevalence of pfhrp2-negative parasites caused a high rate of false-negative results for RDTs. Determining prevalence of pfhrp2-negative parasites is urgently needed in neighboring countries to assist case management policies.
在厄立特里亚，恶性疟原虫 HRP2 快速诊断检测（RDT）的假阴性结果正在增加。我们在两家医院的 50 名感染患者中调查了 HRP 基因 2/3（pfhrp2/pfhrp3）的情况。我们表明，在 Ghindae 医院的 80.8%（21/26）的患者和 Massawa 医院的 41.7%（10/24）的患者感染了 pfhrp2 阴性寄生虫，在 Ghindae 医院的 92.3%（24/26）的患者和 Massawa 医院的 70.8%（17/24）的患者感染了 pfhrp3 阴性寄生虫。pfhrp2 阳性和 pfhrp2 阴性患者之间的寄生虫密度相当。所有 pfhrp2 阴性样本均未检测到 HRP2/3 抗原，并且 HRP2 基于 RDT 的检测结果呈阴性。pfhrp2 阴性寄生虫的遗传多样性较低，形成了 2 个簇，与来自秘鲁的寄生虫没有密切关系。这些寄生虫可能是在厄立特里亚通过选择独立出现的。pfhrp2 阴性寄生虫的高流行率导致 RDT 的假阴性率很高。迫切需要在邻国确定 pfhrp2 阴性寄生虫的流行率，以协助病例管理政策。
