Genetic mutations are making Plasmodium falciparum, parasites that cause malaria, invisible to rapid tests. New, more sensitive tests could help.
Over the last couple of decades, rapid diagnostic tests have emerged as a vital tool in the global fight to control malaria. The relatively inexpensive test strips have diagnosed millions of cases in just minutes, hastening access to lifesaving treatment. They’ve alsoin harder-to-reach rural areas, sharpening public health experts’ view of the toll of this mosquito-borne disease that kills around half a million people globally each year.
Scientists first reported these mutations in 2010, after reviewing blood samples from patients in Peru. Though malaria parasites showed up in the samples under the microscope, the patients’ rapid test results were negative. Most malaria rapid tests work by detectinghistidine-rich protein 2 and 3, which are usually reliable indicators of infection. But in malaria parasites isolated from these Peruvian samples, portions of the, which code for the proteins, had been deleted, the team found.
When rapid tests fail due to genetic mutations in malaria parasites, more precise methods such as microscopy are required to confirm that a false-negative result is actually positive. In this microscope image of human red blood cells, the parasites show up as purple rings.across South America, Africa and Asia.
“It’s not an automatic thing to detect these mutant parasites,” says Carlton. It requires extensive testing of samples via more precise methods, like microscopy or detecting the parasite by DNA, to confirm that a negative rapid test is actually positive and that the parasite contains test-evading deletions. “It can be quite expensive to do that,” she says, so the quality of existing studies assessing the prevalence of these mutations, known as surveys, is highly variable.
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