在存在非疟疾发热、先前使用抗疟药物和季节性疟疾传播的情况下，疟原虫特异性组氨酸丰富蛋白 2 快速诊断检测的准确性。
Accuracy of a Plasmodium falciparum specific histidine-rich protein 2 rapid diagnostic test in the context of the presence of non-malaria fevers, prior anti-malarial use and seasonal malaria transmission.
机构信息
Institut de Recherche en Science de la Sante-Unite de Recherche Clinique de Nanoro, Nanoro, Burkina Faso.
Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
出版信息
Malar J. 2017 Jul 20;16(1):294. doi: 10.1186/s12936-017-1941-6.
BACKGROUND
It remains challenging to distinguish malaria from other fever causing infections, as a positive rapid diagnostic test does not always signify a true active malaria infection. This study was designed to determine the influence of other causes of fever, prior anti-malarial treatment, and a possible seasonality of the performance of a PfHRP2 RDT for the diagnosis of malaria in children under-5 years of age living in a malaria endemic area.
METHODS
A prospective etiology study was conducted in 2015 among febrile children under 5 years of age in Burkina Faso. In order to assess the influence of other febrile illnesses, prior treatment and seasonality on the performance of a PfHRP2 RDT in diagnosing malaria, the RDT results were compared with the gold standard (expert microscopic diagnosis of Plasmodium falciparum) and test results were analysed by assuming that prior anti-malarial use and bacterial/viral infection status would have been known prior to testing. To assess bacterial and viral infection status blood, urine and stool samples were analysed.
RESULTS
In total 683 blood samples were analysed with microscopy and RDT-PfHRP2. Plasmodium falciparum malaria was diagnosed in 49.8% (340/683) by microscopy compared to 69.5% (475/683) by RDT-PfHRP2. The RDT-PfHRP2 reported 29.7% (141/475) false positive results and 1.8% (6/340) false negative cases. The RDT-PfHRP2 had a high sensitivity (98.2%) and negative predictive value (97.1%), but a low specificity (58.9%) and positive predictive value (70.3%). Almost 50% of the alternative cause of fever were diagnosed by laboratory testing in the RDT false positive malaria group.
CONCLUSIONS
The use of a malaria RDT-PfHRP2 in a malaria endemic area may cause misdiagnosis of the actual cause of fever due to false positive test results. The development of a practical diagnostic tool to screen for other causes of fever in malaria endemic areas is required to save lives.
背景
鉴别疟疾与其他发热性感染仍然具有挑战性，因为快速诊断检测呈阳性并不总是意味着真正的疟疾感染。本研究旨在确定其他发热原因、先前抗疟治疗以及 PfHRP2 RDT 诊断 5 岁以下儿童疟疾的表现可能存在的季节性对在疟疾流行地区生活的 5 岁以下发热儿童的影响。
方法
2015 年在布基纳法索对 5 岁以下发热儿童进行了一项前瞻性病因研究。为了评估其他发热性疾病、先前治疗和季节性对 PfHRP2 RDT 诊断疟疾的影响，将 RDT 结果与金标准（专家镜检诊断恶性疟原虫）进行比较，并假设在检测之前已知先前使用抗疟药物和细菌/病毒感染状态，对检测结果进行分析。为了评估细菌和病毒感染状态，对血液、尿液和粪便样本进行了分析。
结果
共分析了 683 份血液样本，包括显微镜检查和 RDT-PfHRP2。通过显微镜检查诊断为恶性疟原虫疟疾的比例为 49.8%（340/683），而通过 RDT-PfHRP2 为 69.5%（475/683）。RDT-PfHRP2 报告了 29.7%（141/475）的假阳性结果和 1.8%（6/340）的假阴性病例。RDT-PfHRP2 的敏感性（98.2%）和阴性预测值（97.1%）较高，但特异性（58.9%）和阳性预测值（70.3%）较低。在 RDT 假阳性疟疾组中，约 50%的发热的其他原因通过实验室检测得到诊断。
结论
在疟疾流行地区使用 PfHRP2 RDT 可能会导致由于假阳性检测结果而误诊发热的实际原因。需要开发实用的诊断工具来筛查疟疾流行地区发热的其他原因，以拯救生命。
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