%0 Journal Article
%T Country-wide assessment of the genetic polymorphism in Plasmodium falciparum and Plasmodium vivax antigens detected with rapid diagnostic tests for malaria
%A Natacha Mariette
%A C¨¦line Barnadas
%A Christiane Bouchier
%A Magali Tichit
%A Didier M¨¦nard
%J Malaria Journal
%D 2008
%I BioMed Central
%R 10.1186/1475-2875-7-219
%X A country-wide assessment of polymorphism of the PfHRP2, PfHRP3, pLDH and aldolase antigens was carried out in 260 Plasmodium falciparum and 127 Plasmodium vivax isolates, by sequencing the genes encoding these antigens in parasites originating from the various epidemiological strata for malaria in Madagascar.Higher levels of polymorphism were observed for the pfhrp2 and pfhrp3 genes than for the P. falciparum and P. vivax aldolase and pldh genes. Pfhrp2 sequence analysis predicted that 9% of Malagasy isolates would not be detected at parasite densities ¡Ü 250 parasites/¦Ìl (ranging from 6% in the north to 14% in the south), although RDTs based on PfHRP2 detection are now recommended in Madagascar.These findings highlight the importance of training of health workers and the end users of RDTs in the provision of information about the possibility of false-negative results for patients with clinical symptoms of malaria, particularly in the south of Madagascar.Since the emergence and spread of Plasmodium falciparum parasites resistant to inexpensive anti-malarial drugs, such as chloroquine (CQ) and sulphadoxine-pyrimethamine (SP), routine malaria case management has changed in endemic countries, such as Madagascar. Malaria diagnosis in these areas ¨C particularly in zones not well covered by healthcare facilities ¨C was entirely based on clinical examination, with CQ widely administered for any fever with no obvious alternative cause [1-3]. Since the introduction of more effective, more expensive anti-malarial drug combinations, such as artemisinin combination therapy (ACT), the WHO recommends the establishment of an accurate biological diagnosis before treatment and the withdrawal of presumptive anti-malarial treatment for all patients other than children under the age of five years in hyperendemic areas. This change in medical practice is now a public health priority in Africa, ensuring that effective anti-malarial drugs are administered only to the patients who need them
%U http://www.malariajournal.com/content/7/1/219