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Malaria RDT interpretation — DTM&H MCQ

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ModerateMalariaMalaria RDT interpretationDTM&H

A rapid diagnostic test in a febrile traveller from Nigeria shows a positive HRP2 band but negative pLDH band. He was treated for P. falciparum 4 weeks ago with artemether-lumefantrine and clinically recovered. What is the most appropriate interpretation?

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Correct answer: C — Persistent HRP2 antigenaemia from the previous infection

HRP2 persists in blood for up to 4-6 weeks after successful treatment, causing persistent RDT positivity. The negative pLDH band suggests no active parasite metabolism. A blood film should confirm absence of parasites. True treatment failure with ACTs typically presents earlier and shows positive pLDH. Rheumatoid factor can cause false positive RDTs but is a diagnosis of exclusion. This underscores the importance of microscopy alongside RDTs for test of cure.

Reference: WHO Malaria RDT Performance Reports; Manson's Tropical Diseases