Barat L, Chipipa J, Kolczak M, Sukwa T
Malaria Epidemiology Section, Division of Parasitic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
Am J Trop Med Hyg. 1999 Jun;60(6):1024-30. doi: 10.4269/ajtmh.1999.60.1024.
Some Ministries of Health in Africa plan to make blood slide microscopy available in peripheral health centers to improve malaria diagnosis over the current practice, which relies solely on clinical findings. To assess whether microscopy improves the management of febrile persons in health centers, we prospectively reviewed medical records of all outpatients visiting six health centers with laboratories in Zambia during a 2-3-day period. Staff interviews and a blinded review of a series of blood slides from each facility by two expert microscopists were also conducted. Of 1,442 outpatients, 655 (45%) reported fevers or had a temperature > or = 37.5 degrees C. Blood slide microscopy was ordered in 28-93% of patients with fever (mean = 46%). Eighty-eight (35%) patients without parasitemia were prescribed an antimalarial drug. Antimalarial drugs were prescribed with equal frequency to those who were referred for a blood slide (56%) and those not referred (58%). The sensitivity of microscopy was 88% and the specificity was 91%. Use of malaria microscopy varied widely, indicating that clinicians are not using standard criteria for ordering this test. Although diagnosis by microscopy was generally accurate, it appeared to have had little impact on the treatment of persons with fever. Guidelines for using blood slide microscopy are needed and prescription of antimalarial drugs should be discouraged when slide results are negative.
非洲的一些卫生部计划在基层医疗中心配备血液涂片显微镜检查设备，以改进疟疾诊断，改变目前仅依靠临床症状的做法。为评估显微镜检查能否改善医疗中心发热患者的治疗情况，我们前瞻性地查阅了赞比亚6个设有实验室的医疗中心在2至3天内所有门诊患者的病历。我们还进行了工作人员访谈，并让两位专业显微镜检查人员对每个机构的一系列血涂片进行盲法检查。在1442名门诊患者中，655名（45%）报告有发热症状或体温≥37.5摄氏度。发热患者中28%至93%（平均46%）接受了血液涂片显微镜检查。88名（35%）无疟原虫血症的患者被开了抗疟药。接受血液涂片检查转诊的患者（56%）和未转诊的患者（58%）接受抗疟药治疗的频率相同。显微镜检查的敏感性为88%，特异性为91%。疟疾显微镜检查的使用差异很大，这表明临床医生在开具此项检查时未采用标准标准。虽然显微镜诊断总体上较为准确，但似乎对发热患者的治疗影响不大。需要制定血液涂片显微镜检查的使用指南，当涂片结果为阴性时，应不鼓励开具抗疟药。
