{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T11:50:02Z","timestamp":1793015402964,"version":"4.5.0"},"reference-count":39,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,5,1]]},"abstract":"<jats:p>Current malaria rapid diagnostic tests (RDTs) contain antibodies against <jats:italic>Plasmodium falciparum<\/jats:italic>\u2013specific histidine-rich protein 2 (PfHRP2), <jats:italic>Plasmodium<\/jats:italic> lactate dehydrogenase (pLDH), and aldolase in various combinations. Low or high parasite densities\/target antigen concentrations may influence the accuracy and sensitivity of PfHRP2-detecting RDTs. We analyzed the SD Bioline Malaria Ag P.f\/Pan RDT performance in relation to <jats:italic>P. falciparum<\/jats:italic> parasitemia in Madagascar, where clinical <jats:italic>Plasmodium vivax<\/jats:italic> malaria exists alongside <jats:italic>P. falciparum<\/jats:italic>. Nine hundred sixty-three samples from patients seeking care for suspected malaria infection were analyzed by RDT, microscopy, and <jats:italic>Plasmodium<\/jats:italic> species\u2013specific, ligase detection reaction-fluorescent microsphere assay (LDR-FMA). <jats:italic>Plasmodium<\/jats:italic> infection positivity by these diagnostics was 47.9%, 46.9%, and 58%, respectively. <jats:italic>Plasmodium falciparum<\/jats:italic>\u2013only infections were predominant (microscopy, 45.7%; LDR-FMA, 52.3%). In all, 16.3% of <jats:italic>P. falciparum<\/jats:italic>, 70% of <jats:italic>P. vivax<\/jats:italic>, and all of <jats:italic>Plasmodium malariae<\/jats:italic>, <jats:italic>Plasmodium ovale<\/jats:italic>, and mixed-species infections were submicroscopic. In 423 <jats:italic>P. falciparum<\/jats:italic> mono-infections, confirmed by microscopy and LDR-FMA, the parasitemia in those who were positive for both the PfHRP2 and pan-pLDH test bands was significantly higher than that in those who were positive only for the PfHRP2 band (<jats:italic>P<\/jats:italic> &lt; 0.0001). <jats:italic>Plasmodium falciparum<\/jats:italic> parasitemia in those that were detected as <jats:italic>P. falciparum<\/jats:italic>\u2013only infections by microscopy but <jats:italic>P. falciparum<\/jats:italic> mixed infections by LDR-FMA also showed similar outcome by the RDT band positivity. In addition, we used varying parasitemia (3\u20130.0001%) of the laboratory-maintained 3D7 strain to validate this observation. A positive pLDH band in high <jats:italic>P. falciparum<\/jats:italic>\u2013parasitemic individuals may complicate diagnosis and treatment, particularly when the microscopy is inconclusive for <jats:italic>P. vivax<\/jats:italic>, and the two infections require different treatments.<\/jats:p>","DOI":"10.4269\/ajtmh.18-1013","type":"journal-article","created":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T07:00:44Z","timestamp":1551769244000},"page":"1196-1201","source":"Crossref","is-referenced-by-count":21,"title":["Plasmodium falciparum Parasitemia and Band Sensitivity of the SD Bioline Malaria Ag P.f\/Pan Rapid Diagnostic Test in Madagascar"],"prefix":"10.4269","volume":"100","author":[{"given":"Rajeev K.","family":"Mehlotra","sequence":"first","affiliation":[{"name":"Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalind E.","family":"Howes","sequence":"additional","affiliation":[{"name":"Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio;"},{"name":"Nuffield Department of Medicine, Oxford Big Data Institute, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estee Y.","family":"Cramer","sequence":"additional","affiliation":[{"name":"Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riley E.","family":"Tedrow","sequence":"additional","affiliation":[{"name":"Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tovonahary A.","family":"Rakotomanga","sequence":"additional","affiliation":[{"name":"National Malaria Control Program, Ministry of Health, Antananarivo, Madagascar;"},{"name":"Faculty of Sciences, University of Antananarivo, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie","family":"Ramboarina","sequence":"additional","affiliation":[{"name":"Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio;"},{"name":"Faculty of Sciences, University of Antananarivo, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ars\u00e8ne C.","family":"Ratsimbasoa","sequence":"additional","affiliation":[{"name":"National Malaria Control Program, Ministry of Health, Antananarivo, Madagascar;"},{"name":"Faculty of Sciences, University of Antananarivo, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"J Med Microbiol","first-page":"1491","article-title":"Malaria rapid diagnostic tests: challenges and prospects","volume":"62","author":"Mouatcho","year":"2013"},{"key":"b2","series-title":"Curr Infect Dis Rep","first-page":"49","article-title":"An update on malaria rapid diagnostic tests","volume":"20","author":"Mukkala","year":"2018"},{"key":"b3","series-title":"J Clin Microbiol","first-page":"2773","article-title":"Effect of sequence variation in Plasmodium falciparum histidine- rich protein 2 on binding of specific monoclonal antibodies: implications for rapid diagnostic tests for malaria","volume":"44","author":"Lee","year":"2006"},{"key":"b4","series-title":"J Clin Microbiol","first-page":"1397","article-title":"Identification of optimal epitopes for Plasmodium falciparum rapid diagnostic tests that target histidine-rich proteins 2 and 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