2021年加纳有症状疟疾患者中携带pfhrp2外显子2基因缺失的恶性疟原虫寄生虫的流行情况。
Prevalence of Plasmodium falciparum parasites with pfhrp2 exon 2 gene deletion in symptomatic malaria patients across Ghana in 2021.
作者信息
Bredu Dorcas G, Asamoah Alexander, Adu George A, Abban Bernice C, Anang Sherik-Fa, Peprah Nana Y, Tey Prosper K, Kwapong Sebastian S, Chamai Martin, Amoako Eunice O, Abuaku Benjamin, Amoah Linda E, Malm Keziah L
机构信息
Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
National Malaria Elimination Programme, Accra, Ghana.
出版信息
Malar J. 2025 May 28;24(1):170. doi: 10.1186/s12936-025-05419-1.
BACKGROUND
Plasmodium falciparum histidine-rich protein 2-based rapid diagnostic tests (PfHRP2-based RDTs) are the most widely used malaria RDTs across Africa. The emergence and spread of pfhrp2 gene-deleted parasites have prompted nationwide surveillance to monitor trends and potential hotspots for P. falciparum with pfhrp2 gene deletions. This study evaluated the prevalence and distribution of P. falciparum with pfhrp2 gene deletions in Ghana in 2021.
METHODS
This cross-sectional study utilized the First Response HRP2 RDT (First Response RDT) and the CareStart™ HRP2/panLDH Combo RDT (Combo kit) to screen individuals with suspected malaria seeking care in 160 public healthcare facilities across the 16 regions of Ghana between June and August 2021. Whole blood was collected from each study participant and used to prepare filter paper blood spots. Genomic DNA (gDNA) was extracted from the dried blood spots. Polymerase chain reaction (PCR) was used to amplify and confirm the presence of P. falciparum and, subsequently, the pfhrp2 gene in each sample .
RESULTS
The overall malaria positivity for the two RDTs was similar: 72.3% (95% CI: 71.4-73.2) for the First Response RDT and 71.5% (95% CI: 70.6-72.4) for the HRP2/panLDH Combo kit (p = 0.215). There were no pfhrp2 exon 2 gene deletions resulting from a false negative RDT, however, deletions were identified in 0.3% (19/5,611) of samples that tested positive for both the First Response RDT and the panLDH band of the Combo kit, and 9.1% (2/22) of the missed infections, leading to an overall pfhrp2 exon 2 gene deletion of 0.4% (21/5,633) in the population.
CONCLUSION
No false negative sample was identified in this study, and less than 1% of parasites with pfhrp2 gene deletions (mainly from RDT positive samples) were found in the population . This finding offers assurance for the continued reliance on HRP2-based RDTs for malaria screening in public health clinics in Ghana. Nonetheless, continued surveillance is needed to determine the expansion of P. falciparum with these gene deletions.
背景
基于恶性疟原虫富含组氨酸蛋白2的快速诊断检测（基于PfHRP2的快速诊断检测）是非洲使用最广泛的疟疾快速诊断检测方法。pfhrp2基因缺失寄生虫的出现和传播促使开展全国性监测，以监测恶性疟原虫pfhrp2基因缺失的趋势和潜在热点地区。本研究评估了2021年加纳恶性疟原虫pfhrp2基因缺失的流行情况和分布。
方法
这项横断面研究使用First Response HRP2快速诊断检测（First Response快速诊断检测）和CareStart™ HRP2/panLDH组合快速诊断检测（组合试剂盒），于2021年6月至8月期间，在加纳16个地区的160家公共医疗机构中，对疑似疟疾并寻求治疗的个体进行筛查。从每位研究参与者采集全血，并用于制备滤纸血斑。从干血斑中提取基因组DNA（gDNA）。使用聚合酶链反应（PCR）扩增并确认每个样本中恶性疟原虫的存在，随后确认pfhrp2基因的存在。
结果
两种快速诊断检测的总体疟疾阳性率相似：First Response快速诊断检测为72.3%（95%CI：71.4 - 73.2），HRP2/panLDH组合试剂盒为71.5%（95%CI：70.6 - 72.4）（p = 0.215）。没有因快速诊断检测假阴性导致的pfhrp2外显子2基因缺失，然而，在First Response快速诊断检测和组合试剂盒的panLDH条带均呈阳性的样本中，有0.3%（19/5,611）检测到缺失，在漏检感染中有9.1%（2/22）检测到缺失，导致总体人群中pfhrp2外显子2基因缺失率为0.4%（21/5,633）。
结论
本研究未发现假阴性样本，人群中发现的pfhrp2基因缺失寄生虫不到1%（主要来自快速诊断检测阳性样本）。这一发现为加纳公共卫生诊所继续依赖基于HRP2的快速诊断检测进行疟疾筛查提供了保证。尽管如此，仍需要持续监测以确定这些基因缺失的恶性疟原虫的扩散情况。
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