Evolution and spread of pfhrp2-deleted Plasmodium falciparum in the Democratic Republic of the Congo
BACKGROUND: Malaria killed over 300,000 children under 5 years of age in 2015, with 97% of these deaths occurring in sub-Saharan Africa. One of the cornerstones of modern malaria programs is the use of rapid diagnostic tests (RDTs) instead of traditional microscopy for diagnosis. Recently, false-negative RDT results have been reported in individuals infected with Plasmodium falciparum parasites harboring a deletion of the the pfhrp2 gene.
GAP: It is unknown whether this mutation is evolving and spreading within communities in sub-Saharan Africa.
HYPOTHESIS: Use of RDTs as indicators for treatment is exerting evolutionary pressure favoring the spread of “stealth” parasites, resistant to detection by currently used RDTs.
METHODS: We will perform whole-genome sequencing on pfhrp2-deleted parasites identified among children in the Democratic Republic of the Congo and look for evidence of evolutionary selection.
IMPACT: Analysis of these pfhrp2-deleted parasite genomes will provide important information regarding the evolution of these mutations and their transmission within affected communities. Evidence confirming the recent development and spread of pfhrp2-deleted parasites among African children would have immediate policy implications for malaria diagnosis and surveillance.