VHOSPITAL.CLINIC · Point-of-Care Test

Malaria RDT (HRP2/pLDH): Diagnosing Malaria

The malaria RDT (rapid diagnostic test) delivers a positive or negative result in 15–20 minutes from a finger-prick blood sample — enabling immediate treatment decisions without laboratory infrastructure.

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About Malaria RDT (HRP2/pLDH)

Lateral flow test detecting P. falciparum HRP2 antigen or pan-Plasmodium pLDH — the WHO-recommended point-of-care malaria test for endemic settings.

What Malaria RDT (HRP2/pLDH) Reveals About Malaria

RDTs detect Plasmodium-specific antigens (HRP2 for P. falciparum; pLDH or aldolase for other species) using lateral flow technology. The WHO recommends RDT-confirmed diagnosis before treatment in all settings.

Test Procedure

A finger-prick blood sample (5 μL) is applied to the test cassette with buffer. Results appear as lines within 15–20 minutes. Two lines = positive; one line (control only) = negative; no lines = invalid. The HRP2 line persists for up to 4 weeks after successful treatment.

Result Interpretation

A positive HRP2 line indicates P. falciparum (or mixed infection). A positive pLDH-only line indicates non-falciparum malaria. All positive RDTs should trigger immediate treatment. False positives occur with rheumatoid factor; false negatives occur with HRP2-deletion P. falciparum strains (emerging in sub-Saharan Africa).

Sensitivity & Specificity

Sensitivity: 95–99% for P. falciparum (HRP2-based); 74–90% for non-falciparum species (pLDH-based). Specificity: 95–99%. Sensitivity decreases below 100 parasites/μL. HRP2 antigen persists 3–4 weeks post-treatment, causing false positives in treated patients.

Clinical Indications

  • Suspected malaria where microscopy is unavailable
  • Febrile traveller returning from endemic area requiring same-day results
  • Point-of-care testing in field or resource-limited setting
  • Screening in malaria-endemic communities

Results Requiring Urgent Action

  • ⚠️Positive RDT with confusion, seizures, or jaundice — severe malaria protocol immediately
  • ⚠️Negative RDT with high clinical suspicion — proceed to blood smear
  • ⚠️HRP2-negative RDT in patient from sub-Saharan Africa (HRP2-deletion strains)

FAQ: Malaria RDT (HRP2/pLDH) for Malaria

How accurate are malaria RDTs?

For P. falciparum, HRP2-based RDTs achieve 95–99% sensitivity and specificity. They perform less well for non-falciparum species (74–90% sensitivity) and at very low parasitaemia. A negative RDT with high clinical suspicion should be followed by blood smear.

Can an RDT still be positive after malaria treatment?

Yes. The HRP2 antigen from P. falciparum persists in the blood for 3–4 weeks after successful treatment. Do not use RDT to confirm cure — use blood smear or PCR for treatment response monitoring.

Why might an RDT miss malaria?

HRP2-deletion P. falciparum strains (increasingly common in parts of Africa) do not express the HRP2 antigen detected by most RDTs. Low parasitaemia early in infection, improper storage of test strips (heat/humidity), and technical errors can also cause false negatives.

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Malaria — Full Clinical Guide

Malaria is a life-threatening parasitic disease transmitted by Anopheles mosquitoes, causing cyclical fever, chills, and anemia. Plasmodium falciparum causes the most severe form; artemisinin-based combination therapy is the first-line treatment.

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Medical References

Content on this page is informed by evidence-based clinical sources including: