基于快速诊断检测的疟原虫疟疾诊断策略在返回旅行者和移民中的安全性：一项回顾性研究。
Safety of falciparum malaria diagnostic strategy based on rapid diagnostic tests in returning travellers and migrants: a retrospective study.
机构信息
Travel Clinic, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, CH-1011, Switzerland.
出版信息
Malar J. 2012 Nov 16;11:377. doi: 10.1186/1475-2875-11-377.
BACKGROUND
Rapid diagnostic tests for malaria (RDTs) allow accurate diagnosis and prompt treatment. Validation of their usefulness in travellers with fever was needed. The safety of a strategy to diagnose falciparum malaria based on RDT followed by immediate or delayed microscopy reading at first attendance was evaluated in one referral hospital in Switzerland.
METHODS
A retrospective study was conducted in the outpatient clinic and emergency ward of University Hospital, covering a period of eight years (1999-2007). The study was conducted in the outpatient clinic and emergency ward of University Hospital. All adults suspected of malaria with a diagnostic test performed were included. RDT and microscopy as immediate tests were performed during working hours, and RDT as immediate test and delayed microscopy reading out of laboratory working hours. The main outcome measure was occurrence of specific complications in RDT negative and RDT positive adults.
RESULTS
2,139 patients were recruited. 1987 had both initial RDT and blood smear (BS) result negative. Among those, 2/1987 (0.1%) developed uncomplicated malaria with both RDT and BS positive on day 1 and day 6 respectively. Among the 152 patients initially malaria positive, 137 had both RDT and BS positive, four only BS positive and five only RDT positive (PCR confirmed) (six had only one test performed). None of the four initially RDT negative/BS positive and none of the five initially BS negative/RDT positive developed severe malaria while 6/137 of both RDT and BS positive did so. The use of RDT allowed a reduction of a median of 2.1 hours to get a first malaria test result.
CONCLUSIONS
A malaria diagnostic strategy based on RDTs and a delayed BS is safe in non-immune populations, and shortens the time to first malaria test result.
背景
快速诊断检测（RDT）可实现疟疾的准确诊断和及时治疗。因此，需要对其在发热旅行者中的应用价值进行验证。本研究评估了一种基于 RDT 的疟疾诊断策略的安全性，即在首次就诊时即时或延迟读取显微镜检查结果。该策略在瑞士的一家转诊医院实施。
方法
采用回顾性研究方法，对大学医院的门诊和急诊患者进行了为期 8 年（1999-2007 年）的调查。所有疑似疟疾的成年患者均接受了诊断性检测。即时检测使用 RDT 和显微镜检查，工作时间内进行；非工作时间内进行即时 RDT 检测和延迟的显微镜检查。主要结局指标为 RDT 阴性和 RDT 阳性成年人中出现特定并发症的情况。
结果
共纳入 2139 例患者。1987 例患者初始 RDT 和血涂片（BS）结果均为阴性。其中，2 例（0.1%）患者在 RDT 和 BS 均为阳性的情况下出现无并发症疟疾，且 RDT 结果分别于第 1 天和第 6 天转为阳性。在 152 例初始疟疾阳性患者中，137 例 RDT 和 BS 均为阳性，4 例仅 BS 阳性，5 例仅 RDT 阳性（PCR 证实）（6 例仅进行了一项检测）。4 例初始 RDT 阴性/BS 阳性和 5 例初始 BS 阴性/RDT 阳性患者均未发展为重症疟疾，而 137 例 RDT 和 BS 均为阳性的患者中有 6 例发展为重症疟疾。使用 RDT 可使首次疟疾检测结果的获取时间平均缩短 2.1 小时。
结论
基于 RDT 和延迟 BS 的疟疾诊断策略在非免疫人群中是安全的，可缩短首次疟疾检测结果的获取时间。
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