Gabrielli Simona, Bellina Livia, Milardi Giovanni Luigi, Katende Boniface Kabasele, Totino Valentina, Fullin Valerio, Cancrini Gabriella
Dip. Sanità Pubblica e Malattie infettive, Università "Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy.
MobileDiagnosis Onlus, via Sciuti 180, 90144, Palermo, Italy.
Malar J. 2016 Feb 11;15:81. doi: 10.1186/s12936-016-1142-8.
The literature data on malaria in Western Kasai, DRC, are limited and inadequate. A recent molecular survey there has detected Plasmodium ovale and Plasmodium malariae as mixed infections with Plasmodium falciparum. In Tshimbulu, Western Kasai, during a humanitarian initiative designed to provide children with free preventive screening and to reduce the local high malaria death rate, accurate species identification was performed, in order to collect unambiguous epidemiological data and to evaluate the reliability of locally applied diagnostics.
Finger pricks provided fresh blood for microscopic analysis (MA), for rapid diagnostic test (RDT) and for molecular diagnostics (MD). MA and RDT were first performed by the local team and then a re-interpretation of the results (on the same slides and on RDT's taken pictures) was conducted in Italy, where MD were performed.
The analysis was conducted on 306 children; RDT found 80.9 % as P. falciparum-positive (37.4 % as two-band positive, P. falciparum single infection). MA identified a further four children as positive to P. falciparum and six co-infections with P. ovale. The second RDT evaluation confirmed a similar infection rate (78.2 %) but interpreted as two-band positive a significantly higher share of tests (56.8 %). MA confirmed 80.0 % of the children as malaria positive and, in addition to P. falciparum, identified P. malariae (13.8 %), P. vivax (3.4 %) and P. ovale (2.4 %), and detected Babesia microti in 19 smears. MD confirmed all of the species found (Babesia microti included), classified as mono-infection with P. falciparum a rate of spots comparable to MA revision, and identified all P. ovale as Plasmodium ovale wallikeri. The RDT used locally proved 93.1 % sensitive and 92.1 % specific for P. falciparum.
The malaria prevalence among the children and the presence of four Plasmodium species, highlighted in this study, identified a sanitary issue which proved to be more alarming than expected, as it was worsened by the unpredictable presence of P. vivax and Babesia microti (never before reported in DRC). Each diagnostic tool showed its point of weakness. Therefore, the most correct approach is by the combined use of different, locally available, diagnostic tools.
关于刚果民主共和国开赛西部疟疾的文献资料有限且不充分。最近在那里进行的一项分子调查检测到卵形疟原虫和三日疟原虫与恶性疟原虫的混合感染。在开赛西部的钦布卢，在一项旨在为儿童提供免费预防性筛查并降低当地高疟疾死亡率的人道主义倡议期间，进行了准确的物种鉴定，以便收集明确的流行病学数据并评估当地应用诊断方法的可靠性。
手指针刺采集新鲜血液用于显微镜分析（MA）、快速诊断测试（RDT）和分子诊断（MD）。MA和RDT首先由当地团队进行，然后在意大利对结果进行重新解读（在同一张玻片和RDT拍摄的照片上），并在意大利进行MD检测。
对306名儿童进行了分析；RDT检测到80.9%的儿童恶性疟原虫呈阳性（37.4%为双条带阳性，即恶性疟原虫单一感染）。MA又鉴定出4名儿童恶性疟原虫呈阳性，6名儿童为卵形疟原虫合并感染。第二次RDT评估确认了相似的感染率（78.2%），但将双条带阳性检测的比例显著提高（56.8%）。MA确认80.0%的儿童疟疾呈阳性，除恶性疟原虫外，还鉴定出三日疟原虫（13.8%）、间日疟原虫（3.4%）和卵形疟原虫（2.4%），并在19份涂片检测到微小巴贝斯虫。MD确认了所有检测到的物种（包括微小巴贝斯虫），将恶性疟原虫单一感染的斑点率分类为与MA复查相当，并将所有卵形疟原虫鉴定为沃氏卵形疟原虫。当地使用的RDT对恶性疟原虫的敏感性为93.1%，特异性为92.1%。
本研究突出了儿童中的疟疾流行情况以及四种疟原虫的存在，这表明卫生问题比预期更为严重，因为间日疟原虫和微小巴贝斯虫的意外出现（刚果民主共和国此前从未报告过）使其更加恶化。每种诊断工具都显示出其弱点。因此，最正确的方法是联合使用不同的、当地可获得的诊断工具。
