Feleke Sendeaw M, Animut Abebe, Belay Mulugeta
Ethiopian Health and Nutrition Research Institute.
Jpn J Infect Dis. 2015;68(1):55-9. doi: 10.7883/yoken.JJID.2013.062. Epub 2014 Nov 25.
Malaria diagnosis is a common challenge in developing countries with limited diagnostic services. Common febrile illnesses were assessed in 280 malaria-suspected patients, and each case was subjected to clinical and laboratory examinations for malaria, relapsing fever, typhoid fever, typhus, and brucellosis. Data were entered and analyzed using Epi Info version 3.1 software. Malaria accounted for 17% (CI, 12.6-21.4%) of febrile illnesses. The remaining cases were associated with typhoid fever (18.5%; CI, 13.95-23.05%), typhus (17.8%; CI, 13.32-22.28%), brucellosis (1%; CI, -0.17-2.17%), relapsing fever (2%; CI, 0.36-3.64%), and unknown causes (44%). Approximately 7% of patients had coinfections, and 2% of patients treated as monoinfections. Approximately 1.4% of the nonmalarial patients received antimalarial treatment. The sensitivity and specificity of the CareStart Pf/pan rapid diagnostic tests in comparison with those of microscopy were 100% and 91%, respectively, with positive- and negative-predictive values of 94% and 100%, respectively. Compared with microscopy, the positive-predictive value of each malaria symptom was much lower than that of the symptoms combined: fever, 17%; sweating, 30%; headache, 18%; general body ache, 22%; loss of appetite, 21%. The study findings revealed a high proportion of nonmalarial illnesses were clinically categorized as malaria. Parasite-based diagnosis is recommended for the management of malarial and nonmalarial cases.
在诊断服务有限的发展中国家,疟疾诊断是一项常见挑战。对280名疑似疟疾患者的常见发热疾病进行了评估,每例患者均接受了疟疾、回归热、伤寒、斑疹伤寒和布鲁氏菌病的临床及实验室检查。使用Epi Info 3.1版软件录入并分析数据。疟疾占发热疾病的17%(置信区间为12.6 - 21.4%)。其余病例与伤寒(18.5%;置信区间为13.95 - 23.05%)、斑疹伤寒(17.8%;置信区间为13.32 - 22.28%)、布鲁氏菌病(1%;置信区间为 - 0.17 - 2.17%)、回归热(2%;置信区间为0.36 - 3.64%)以及不明病因(44%)有关。约7%的患者存在合并感染,2%的患者被当作单一感染进行治疗。约1.4%的非疟疾患者接受了抗疟治疗。与显微镜检查相比,CareStart Pf/pan快速诊断检测的灵敏度和特异度分别为100%和91%,阳性预测值和阴性预测值分别为94%和100%。与显微镜检查相比,每种疟疾症状的阳性预测值远低于多种症状组合后的阳性预测值:发热为17%;出汗为30%;头痛为18%;全身疼痛为22%;食欲不振为21%。研究结果显示,很大一部分非疟疾疾病在临床上被归类为疟疾。建议采用基于寄生虫的诊断方法来管理疟疾和非疟疾病例。