|LETTER TO THE EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 85-86
Deletions in the Plasmodium falciparum histidine-rich protein 2 gene: An emerging threat to the elimination of malaria in India
Vineeta Singh, Loick Pradel Kojom
Cell Biology Laboratory and Malaria Parasite Bank, ICMR–National Institute of Malaria Research, New Delhi–110 077, India
|Date of Submission||28-Feb-2019|
|Date of Web Publication||7-May-2019|
Dr Vineeta Singh
Cell Biology Laboratory and Malaria Parasite Bank, ICMR–National Institute of Malaria Research, New Delhi–110 077
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh V, Kojom LP. Deletions in the Plasmodium falciparum histidine-rich protein 2 gene: An emerging threat to the elimination of malaria in India. J Vector Borne Dis 2019;56:85-6
|How to cite this URL:|
Singh V, Kojom LP. Deletions in the Plasmodium falciparum histidine-rich protein 2 gene: An emerging threat to the elimination of malaria in India. J Vector Borne Dis [serial online] 2019 [cited 2020 May 26];56:85-6. Available from: http://www.jvbd.org/text.asp?2019/56/1/85/257781
The advent of immunochromatographic rapid diagnostic tests (RDTs) as part of strategies for control and elimination of malaria has greatly improved the management of this infectious disease in endemic countries. RDTs rely on the recognition of malarial antigens in circulating blood like parasite lactate dehydrogenase (pLDH), aldolase which are produced by all the five human malarial species, and histidine-rich protein 2 (HRP2) which is more specific to Plasmodium falciparum. RDTs targeting PfHRP2 constitute the bulk of RDTs available commercially given that P. falciparum is the most prevalent and dangerous malaria species across the world.
Malaria is highly prevalent in India and accounts for 68% of cases and 65% of deaths in the Southeast Asia region. In India, P. falciparum (Pf) and P. vivax (Pv) are the species mainly responsible for malaria cases and deaths. The country has outlined the elimination objectives defined by the World Health Organization (WHO) in the Global Technical Strategy 2016–2030. The WHO is aiming for the elimination of malaria by 2025–2030 in at least 20–30 countries which were malaria endemic in 2015. Malaria elimination in India calls for a complete understanding of the current scenario of burden inflicted by the disease as well as massive scaling-up of different fight/control strategies including a reliable diagnosis of malaria cases.
RDTs are an essential part of diagnosis policies in India as witnessed by increase in their utilization in the last few years. However, their utilization, especially those targeting PfHRP2, could probably become an important future diagnostic challenge given the possibility of falsenegative results due to the presence of deletions in gene encoding PfHRP2 protein. The utilization of PfHRP2-based RDTs is no longer recommended in some Latin American countries where a high proportion of falsenegative results were attributed to PfHRP2 gene deletions. Some studies in India have reported the circulation of strains with deleted PfHRP2 gene which was responsible for 65.5–100% of false-negative results,,. The misclassification of P. falciparum with P. vivax mixed infections as P. vivax single infection using RDTs targeting PfHRP2 or other malarial antigens is another diagnostic consequence of PfHRP2 gene deletions. The successive consequences of misdiagnosis would lead to disease complications or deaths due to delay in providing an effective and reliable antimalarial treatment.
Thus, the protection/safeguard of diagnostic effectiveness of RDTs through ongoing surveillance of deletions in PfHRP2 gene is of utmost importance in India to achieve the target of malaria elimination by 2030.
Conflict of interest: None.
| References|| |
Moody A. Rapid diagnostic tests for malaria parasites. Clin Microbiol Rev
2002; 15(1): 66–78. doi: 10.1128/CMR.15.1.66-78.2002
Gupta B, Gupta P, Sharma A, Singh V, Dash AP, Das A. High proportion of mixed-species Plasmodium
infections in India revealed by PCR diagnostic assay. Trop Med Int Health
(7): 819–24. doi: org/10.1111/j.1365–3156. 2010. 02549x.
Patankar S, Sharma S, Rathod PK, Duraisingh MT. Malaria in India: The need for new targets for diagnosis and detection of Plasmodium vivax. Proteomics Clin Appl
2018; 12(4): e1700024. doi: 10.1002/prca.201700024.
Gendrot M, Fawaz R, Dormoi J, Madamet M, Pradines B. Genetic diversity and deletion of Plasmodium falciparum
histidinerich protein 2 and 3: A threat to diagnosis of P. falciparum
malaria. Clin Microbiol Infect
2018; pii: S1198-743X(18)30631-1. doi: 10.1016/j.cmi.2018.09.009.
Gamboa D, Ho MF, Bendezu J, Torres K, Chiodini PL, Barnwell JW, et al
. A large proportion of P. falciparum
isolates in the Amazon region of Peru lack Pfhrp2
Implications for malaria rapid diagnostic tests. PLoS One
2010; 5: e8091
. doi: 10.1371/journal.pone.0008091.
Kumar N, Pande V, Bhatt RM, Shah NK, Mishra N, Srivastava B, et al
. Genetic deletion of HRP2 and HRP3 in Indian Plasmodium falciparum
population and false negative malaria rapid diagnostic test. Acta Trop
119–21. doi: 10.1016/ j.actatropica.2012.09.015.
Bharti PK, Chandel HS, Ahmad A, Krishna S, Udhayakumar V, Singh N. Prevalence of Pfhrp2
gene deletion in Plasmodium falciparum
population in eight highly endemic states in India. PLoS One
2016; 11(8): e0157949. doi: https:// doi.10.1371/journal.pone.0157949
Pati P, Dhangadamajhi G, Bal M, Ranjit M. High proportions of Pfhrp2
gene deletion and performance of HRP2-based rapid diagnostic test in Plasmodium falciparum
field isolates of Odisha. Malar J