Division of International and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Clin Microbiol Infect. 2013 May;19(5):422-31. doi: 10.1111/1469-0691.12154. Epub 2013 Feb 15.
The recent roll-out of rapid diagnostic tests (RDTs) for malaria has highlighted the decreasing proportion of malaria-attributable illness in endemic areas. Unfortunately, once malaria is excluded, there are few accessible diagnostic tools to guide the management of severe febrile illnesses in low resource settings. This review summarizes the current state of RDT development for several key infections, including dengue fever, enteric fever, leptospirosis, brucellosis, visceral leishmaniasis and human African trypanosomiasis, and highlights many remaining gaps. Most RDTs for non-malarial tropical infections currently rely on the detection of host antibodies against a single infectious agent. The sensitivity and specificity of host-antibody detection tests are both inherently limited. Moreover, prolonged antibody responses to many infections preclude the use of most serological RDTs for monitoring response to treatment and/or for diagnosing relapse. Considering these limitations, there is a pressing need for sensitive pathogen-detection-based RDTs, as have been successfully developed for malaria and dengue. Ultimately, integration of RDTs into a validated syndromic approach to tropical fevers is urgently needed. Related research priorities are to define the evolving epidemiology of fever in the tropics, and to determine how combinations of RDTs could be best used to improve the management of severe and treatable infections requiring specific therapy.
近年来，快速诊断检测（RDT）在疟疾方面的应用得到了推广，这突显了在流行地区疟疾相关疾病比例的下降。不幸的是，一旦排除了疟疾，在资源匮乏的环境中，几乎没有可用的诊断工具来指导严重发热疾病的管理。本综述总结了目前几种关键感染性疾病（包括登革热、肠热病、钩端螺旋体病、布鲁氏菌病、内脏利什曼病和非洲人类锥虫病）的 RDT 开发现状，并强调了许多仍然存在的差距。目前，大多数用于非疟疾热带感染的 RDT 都依赖于对单一感染原的宿主抗体的检测。宿主抗体检测试验的敏感性和特异性都固有地受到限制。此外，许多感染后的抗体持续时间较长，使得大多数血清学 RDT 无法用于监测治疗反应和/或诊断复发。考虑到这些局限性，迫切需要基于病原体检测的敏感 RDT，因为这些 RDT 已经成功地应用于疟疾和登革热的检测。最终，需要将 RDT 整合到一个经过验证的热带发热综合诊断方法中。相关的研究重点是定义热带地区发热的不断变化的流行病学，并确定如何最好地使用 RDT 组合来改善对需要特定治疗的严重和可治疗感染的管理。
