Overcoming the challenges of <i>Plasmodium falciparum</i> 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 <i>Plasmodium falciparum</i> histidine-rich protein 2 and 3 (<i>Pfhrp2/3</i>) deficient malaria parasites, which pose significant challenges to malaria diagnosis and control. This review provides a comprehensive overview of the existing literature on <i>Pfhrp2/3</i> deletions and their implications on malaria diagnosis and control. A literature search was conducted using a combination of keywords (<i>Pfhrp2/3</i> deletions, malaria diagnosis, malaria control, rapid diagnostic tests) and medical subject headings (MeSH) terms (Malaria/diagnosis, Malaria/parasitology, <i>Plasmodium falciparum</i>/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 <i>Pfhrp2/3</i> deletions to malaria diagnosis and control and identifies potential solutions, including alternative diagnostic approaches and novel RDTs targeting multiple antigens.