Ifeorah Ifeanyi Kanayo, Brown Biobele J, Sodeinde Olugbemiro O
Nigerian Air Force; Nigerian Air Force Hospital, Bill Clinton Drive Abuja, Nigeria.
University of Ibadan, University College Hospital Ibadan.
Afr J Infect Dis. 2017 Jun 8;11(2):31-38. doi: 10.21010/ajid.v11i2.5. eCollection 2017.
The World Health Organization (WHO) considers early and rapid diagnosis as one of the strategies to control malaria. This study compared the performance of Quantitative Buffy Coat (QBC) test and the Plasmodium lactate dehydrogenase (pLDH) rapid diagnostic test (RDT) with microscopy as the gold standard.
The study involved children ages 0-5 years who presented with a history of fever at the University College Hospital, Ibadan, Nigeria. Blood was collected from each patient and used for RDT, QBC and Giemsa-stained blood films for malaria parasites (MP). Results of QBC and RDT were compared with microscopy results for the diagnosis of malaria.
A total of 370 cases (194 boys and 176 girls) were studied giving a male: female ratio of 1.1:1. Of the 370 cases tested using Giemsa-stained thick blood films for MP, 78 (21 %) were positive. For the QBC test, 78 (21%) of the cases were positive with sensitivity, specificity, positive and negative predictive values of 70.5 %, 92.1%, 70.5 % and 92.1 % respectively. Seventy-six (20%) of the cases were positive by RDT with sensitivity, specificity, positive and negative predictive values of 84.2 %, 95.2 %, 82.1 %, and 95.9 % respectively. There was no significant difference in the sensitivity of QBC compared with the RDT.
Both the QBC and the pfLDH (RDT) performed reasonably well in this study Malaria rapid diagnostic tests are recommended in malaria endemic clinical settings to avoid unnecessary antimalarial treatment. AO: Acridine orange, AIDS: Acquired immunodeficiency syndrome, ACT: Artemisinin-based combination therapy, CM:Cerebral malaria, BCP:Benzothiocarboxypurine, DDT:Dichloro-diphenyl-trichloroethane, DNA:DeoxyriboNucleic Acid, ELAM-1: Endothelial leukocyte adhesion molecule, G6PD: Glucose-6-Phosphate Dehydrogenase, HIV: Human immuno deficiency virus, HRP 2: Histidine Rich Protein 2, ICAM -1: Inter cellular adhesion molecule1, ICER: Incremental cost effectiveness ratio, IL-1: Interleukin -1, IFN-g: Interferon-gamma, IgG: Immunoglobulin G, MP: Malaria parasite, NADP: Oxidised Nicotinamide Adenine Dinucleotide Phosphate, NADPH: Reduced Nicotinamide Adenine Dinucleotide Phosphate, PCV: Packed Cell Volume (haematocrit), P. Plasmodium , PLDH: Plasmodium lactate dehydrogenase, PCR: Polymerase Chain Reaction, PPV: Positive predictive value, QBC: Quantitative Buffy Coat examination, TNF: Tumour necrosis factor, NPV: Negative predictive value, RDT: Rapid diagnostic test, SP: Sulphadoxine -Pyrimethamine, SMA: Severe malarial anaemia, UM: Uncomplicated malaria, , WBC: White Blood Cell, WHO: World Health Organization.
世界卫生组织（WHO）将早期快速诊断视为控制疟疾的策略之一。本研究以显微镜检查作为金标准，比较了定量血沉棕黄层（QBC）检测和疟原虫乳酸脱氢酶（pLDH）快速诊断检测（RDT）的性能。
该研究纳入了尼日利亚伊巴丹大学学院医院0至5岁有发热病史的儿童。采集每位患者的血液，用于RDT、QBC检测以及制作用于检测疟原虫（MP）的吉姆萨染色血涂片。将QBC和RDT的结果与显微镜检查结果进行比较，以诊断疟疾。
共研究了370例病例（194名男孩和176名女孩），男女比例为1.1:1。在使用吉姆萨染色厚血涂片检测MP的370例病例中，78例（21%）呈阳性。对于QBC检测，78例（21%）病例呈阳性，其灵敏度、特异度、阳性预测值和阴性预测值分别为70.5%、92.1%、70.5%和92.1%。76例（20%）病例通过RDT检测呈阳性，其灵敏度、特异度、阳性预测值和阴性预测值分别为84.2%、95.2%、82.1%和95.9%。与RDT相比，QBC的灵敏度无显著差异。
在本研究中，QBC和pfLDH（RDT）的表现都相当不错。在疟疾流行的临床环境中，建议使用疟疾快速诊断检测，以避免不必要的抗疟治疗。AO：吖啶橙，AIDS：获得性免疫缺陷综合征，ACT：青蒿素联合疗法，CM：脑型疟疾，BCP：苯并硫代羧嘌呤，DDT：二氯二苯三氯乙烷，DNA：脱氧核糖核酸，ELAM -1：内皮白细胞黏附分子，G6PD：葡萄糖-6-磷酸脱氢酶，HIV：人类免疫缺陷病毒，HRP 2：富含组氨酸蛋白2，ICAM -1：细胞间黏附分子1，ICER：增量成本效益比，IL -1：白细胞介素-1，IFN -γ：干扰素-γ，IgG：免疫球蛋白G，MP：疟原虫，NADP：氧化型烟酰胺腺嘌呤二核苷酸磷酸，NADPH：还原型烟酰胺腺嘌呤二核苷酸磷酸，PCV：红细胞压积，P.：疟原虫属，PLDH：疟原虫乳酸脱氢酶，PCR：聚合酶链反应，PPV：阳性预测值，QBC：定量血沉棕黄层检查，TNF：肿瘤坏死因子，NPV：阴性预测值，RDT：快速诊断检测，SP：磺胺多辛-乙胺嘧啶，SMA：严重疟疾贫血，UM：非复杂性疟疾，WBC：白细胞，WHO：世界卫生组织
