"Resistance" to diagnostics: A serious biological challenge for malaria control and elimination

Delay in diagnosis and treatment is the leading cause of death in malaria patients. The recommendation issued in 2010 by the World Health Organization (WHO) to reserve malaria treatment to parasitologically confirmed malaria infections has boosted the use of malaria rapid diagnostic tests (RDTs), which have now become a critical component of management and surveillance of malaria. Indeed, it has been estimated that over 280 million RDTs are now used annually, at a cost of hundreds of millions of euros [1]. Beyond their use as a diagnostic tool for patients with suspected malaria, the detection of Plasmodium antigens in blood samples is also used in in vitro tests of sensitivity to antimalarial drugs, as a marker of clinical severity and to verify the elimination of the parasite after treatment, although the decay of parasite antigens may take longer than the clearance of parasitaemia.2 p