A Novel Nested Multiplex Polymerase Chain Reaction Assay for Malaria Diagnosis Using the Hydroxymethyl Dihydropterin Pyrophosphokinase-Dihydropteroate Synthase (hppk-dhps) Gene

Am J Trop Med Hyg. 2023 Sep 11;109(4):770-777. doi: 10.4269/ajtmh.23-0130. Print 2023 Oct 4.

Abstract

There are many techniques for malaria diagnosis. Currently, the nested polymerase chain reaction (PCR) method based on a small subunit ribosomal RNA gene (18S rRNA) has been used as a confirmatory method. However, this method is time-consuming, laborious, and costly. Therefore, the objective of this study was to develop nested multiplex PCR for Plasmodium species identification using the dihydropterin pyrophosphokinase-dihydropteroate synthase (hppk-dhps) gene. Genus- and species-specific primers for the hppk-dhps gene were designed. The performance of the novel nested multiplex PCR was compared with 18S rRNA nested PCR. A total of 115 blood samples were used in this study, including 84 infected samples and 31 uninfected samples. Analysis of the blood samples by nested multiplex PCR targeting the hppk-dhps gene identified 81 infected cases. The level of agreement between this novel method and 18S rRNA nested PCR was 97.4%. Further, the novel method successfully detected all human malaria parasites except Plasmodium ovale and detected mixed Plasmodium falciparum/Plasmodium vivax infections. The sensitivity and specificity obtained from this novel method were 96.4% and 100%, respectively. The limit of detection of the hppk-dhps nested multiplex PCR for P. falciparum and P. vivax was 500 parasites/µL and 4 parasites/µL, respectively. The lowest parasite gDNA detected by this method was 0.5 ng/µL for P. falciparum and 0.1 ng/µL for P. vivax. These results corroborate that the hppk-dhps gene is a novel amplification target for the detection of human malaria. This novel target PCR-based method is a beneficial approach for malaria diagnosis, as well as species identification and differentiation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • DNA, Protozoan / genetics
  • Dihydropteroate Synthase* / genetics
  • Diphosphotransferases / genetics
  • Humans
  • Malaria* / diagnosis
  • Malaria* / parasitology
  • Multiplex Polymerase Chain Reaction* / methods
  • Plasmodium falciparum / enzymology
  • Plasmodium falciparum / genetics
  • Plasmodium vivax / enzymology
  • Plasmodium vivax / genetics
  • Plasmodium* / enzymology
  • Plasmodium* / genetics
  • Plasmodium* / isolation & purification
  • Polymerase Chain Reaction / methods
  • RNA, Ribosomal, 18S / genetics
  • Sensitivity and Specificity

Substances

  • Dihydropteroate Synthase
  • RNA, Ribosomal, 18S
  • Diphosphotransferases
  • 2-amino-4-hydroxy-6-hydroxymethyldihydropteridine pyrophosphokinase
  • DNA, Protozoan