Hopkins Heidi, Kambale Wilson, Kamya Moses R, Staedke Sarah G, Dorsey Grant, Rosenthal Philip J
University of California, San Francisco, San Francisco, California 94143, USA.
Am J Trop Med Hyg. 2007 Jun;76(6):1092-7.
Presumptive treatment of malaria results in significant overuse of antimalarials. Malaria rapid diagnostic tests (RDTs) may offer a reliable alternative for case management, but the optimal RDT strategy is uncertain. We compared the diagnostic accuracy of histidine-rich protein 2 (HRP2)- and plasmodium lactate dehydrogenase (pLDH)-based RDTs, using expert microscopy as the gold standard, in a longitudinal study of 918 fever episodes over an 8-month period in a cohort of children in Kampala, Uganda. Sensitivity was 92% for HRP2 and 85% for pLDH, with differences primarily due to better detection with HRP2 at low parasite densities. Specificity was 93% for HRP2 and 100% for pLDH, with differences primarily due to rapid clearance of pLDH antigenemia after treatment of a previous malaria episode. RDTs may provide an effective strategy for improving rational delivery of antimalarial therapy; in Kampala, either test could dramatically decrease inappropriate presumptive treatments.
疟疾的推定治疗导致抗疟药物的大量过度使用。疟疾快速诊断检测（RDTs）可能为病例管理提供可靠的替代方法，但最佳的RDT策略尚不确定。在乌干达坎帕拉一个儿童队列中，我们在为期8个月的918次发热发作的纵向研究中，以专家显微镜检查作为金标准，比较了基于富含组氨酸蛋白2（HRP2）和疟原虫乳酸脱氢酶（pLDH）的RDTs的诊断准确性。HRP2的敏感性为92%，pLDH的敏感性为85%，差异主要是由于HRP2在低寄生虫密度时检测效果更好。HRP2的特异性为93%，pLDH的特异性为100%，差异主要是由于前一次疟疾发作治疗后pLDH抗原血症的快速清除。RDTs可能为改善抗疟治疗的合理应用提供一种有效策略；在坎帕拉，两种检测方法都可以显著减少不适当的推定治疗。
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