Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand; Centre for Tropical Medicine, Churchill Hospital, Oxford University, Oxford, United Kingdom; London School of Tropical Medicine and Hygiene, London, United Kingdom; National Institute for Medical Research, Amani Centre, Tanga, Tanzania; Joint Malaria Programme, Tanzania; National Institute for Medical Research, Tanga, Tanzania; Hospital Central da Beira, Beira, Mozambique; Menzies School of Health Research, Casuarina, NT, Australia
Hendriksen, I.C.E., Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand, Centre for Tropical Medicine, Churchill Hospital, Oxford University, Oxford, United Kingdom; Mtove, G., National Institute for Medical Research, Amani Centre, Tanga, Tanzania; Pedro, A.J., Hospital Central da Beira, Beira, Mozambique; Gomes, E., Hospital Central da Beira, Beira, Mozambique; Silamut, K., Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand; Lee, S.J., Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand, Centre for Tropical Medicine, Churchill Hospital, Oxford University, Oxford, United Kingdom; Mwambuli, A., Joint Malaria Programme, Tanzania; Gesase, S., National Institute for Medical Research, Tanga, Tanzania; Reyburn, H., London School of Tropical Medicine and Hygiene, London, United Kingdom, Joint Malaria Programme, Tanzania; Day, N.P.J., Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand, Centre for Tropical Medicine, Churchill Hospital, Oxford University, Oxford, United Kingdom; White, N.J., Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand, Centre for Tropical Medicine, Churchill Hospital, Oxford University, Oxford, United Kingdom; Von Seidlein, L., Menzies School of Health Research, Casuarina, NT, Australia; Dondorp, A.M., Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand, Centre for Tropical Medicine, Churchill Hospital, Oxford University, Oxford, United Kingdom
Background. Rapid diagnostic tests (RDTs) now play an important role in the diagnosis of falciparum malaria in many countries where the disease is endemic. Although these tests have been extensively evaluated in uncomplicated falciparum malaria, reliable data on their performance for diagnosing potentially lethal severe malaria is lacking. Methods. We compared a Plasmodium falciparum histidine-rich-protein2 (PfHRP2)-based RDT and a Plasmodium lactate dehydrogenase (pLDH)-based RDT with routine microscopy of a peripheral blood slide and expert microscopy as a reference standard for the diagnosis of severe malaria in 1898 children who presented with severe febrile illness at 2 centers in Mozambique and Tanzania. Results. The overall sensitivity, specificity, positive predictive value, and negative predictive values of the PfHRP2-based test were 94.0%, 70.9%, 85.4%, and 86.8%, respectively, and for the pLDH-based test, the values were 88.0%, 88.3%, 93.2%, and 80.3%, respectively. At parasite counts <1000 parasites/μL (n = 173), sensitivity of the pLDH-based test was low (45.7%), compared with that of the PfHRP2-based test (69.9%). Both RDTs performed better than did the routine slide reading in a clinical laboratory as assessed in 1 of the centers. Conclusion. The evaluated PfHRP2-based RDT is an acceptable alternative to routine microscopy for diagnosing severe malaria in African children and performed better than did the evaluated pLDH-based RDT. © 2011 The Author.