Overcoming the challenges of Plasmodium falciparum histidine-rich protein 2 and 3 deletions in malaria diagnosis and control.

Abstract

Malaria is a major public health concern responsible for significant mortality and morbidity, especially in sub-Saharan Africa. Accurate diagnosis is crucial for effective malaria control and elimination strategies. Recent studies have confirmed the existence of Plasmodium falciparum histidine-rich protein 2 and 3 (Pfhrp2/3) deficient malaria parasites, which pose significant challenges to malaria diagnosis and control. This review provides a comprehensive overview of the existing literature on Pfhrp2/3 deletions and their implications on malaria diagnosis and control. A literature search was conducted using a combination of keywords (Pfhrp2/3 deletions, malaria diagnosis, malaria control, rapid diagnostic tests) and medical subject headings (MeSH) terms (Malaria/diagnosis, Malaria/parasitology, Plasmodium falciparum/genetics) in ScienceDirect, Springer, Google Scholar, and PubMed. Studies published in English between 2018 and 2024 were included, and a total of 83 studies were selected for inclusion in the review based on predefined inclusion and exclusion criteria. This review highlights the significant challenges posed by Pfhrp2/3 deletions to malaria diagnosis and control and identifies potential solutions, including alternative diagnostic approaches and novel RDTs targeting multiple antigens.