抗疟治疗后快速诊断检测的阳性结果能持续多久？

How long do rapid diagnostic tests remain positive after anti-malarial treatment?

机构信息

Department of Zoology, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, UK.

Big Data Institute, University of Oxford, Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF, UK.

出版信息

Malar J. 2018 Jun 8;17(1):228. doi: 10.1186/s12936-018-2371-9.

BACKGROUND

Rapid diagnostic tests (RDTs) are increasingly becoming a paradigm for both clinical diagnosis of malaria infections and for estimating community parasite prevalence in household malaria indicator surveys in malaria-endemic countries. The antigens detected by RDTs are known to persist in the blood after treatment with anti-malarials, but reports on the duration of persistence (and the effect this has on RDT positivity) of these antigens post-treatment have been variable.

METHODS

In this review, published studies on the persistence of positivity of RDTs post-treatment are collated, and a bespoke Bayesian survival model is fit to estimate the number of days RDTs remain positive after treatment.

RESULTS

Half of RDTs that detect the antigen histidine-rich protein II (HRP2) are still positive 15 (5-32) days post-treatment, 13 days longer than RDTs that detect the antigen Plasmodium lactate dehydrogenase, and that 5% of HRP2 RDTs are still positive 36 (21-61) days after treatment. The duration of persistent positivity for combination RDTs that detect both antigens falls between that for HRP2- or pLDH-only RDTs, with half of RDTs remaining positive at 7 (2-20) days post-treatment. This study shows that children display persistent RDT positivity for longer after treatment than adults, and that persistent positivity is more common when an individual is treated with artemisinin combination therapy than when treated with other anti-malarials.

CONCLUSIONS

RDTs remain positive for a highly variable amount of time after treatment with anti-malarials, and the duration of positivity is highly dependent on the type of RDT used for diagnosis. Additionally, age and treatment both impact the duration of persistence of RDT positivity. The results presented here suggest that caution should be taken when using RDT-derived diagnostic outcomes from cross-sectional data where individuals have had a recent history of anti-malarial treatment.

背景

快速诊断检测（RDT）越来越成为疟疾感染临床诊断和在疟疾流行国家进行家庭疟疾指示性调查以估计社区寄生虫流行率的范例。RDT 检测到的抗原已知在抗疟药物治疗后仍存在于血液中，但关于这些抗原治疗后持续存在的时间（以及这对 RDT 阳性的影响）的报告一直存在差异。

方法

在本综述中，收集了关于 RDT 治疗后阳性持续时间的已发表研究，并拟合了一个定制的贝叶斯生存模型，以估计 RDT 在治疗后仍保持阳性的天数。

结果

检测抗原组氨酸丰富蛋白 II（HRP2）的 RDT 中有一半在治疗后 15 天（5-32 天）仍呈阳性，比检测抗原乳酸脱氢酶的 RDT 长 13 天，而 5%的 HRP2 RDT 在治疗后 36 天（21-61 天）仍呈阳性。同时检测两种抗原的组合 RDT 的持续阳性时间介于 HRP2 或 pLDH 单检测 RDT 之间，治疗后 7 天（2-20 天）仍有一半的 RDT 呈阳性。本研究表明，儿童在治疗后比成人显示出更长时间的持续 RDT 阳性，并且当个体接受青蒿素联合疗法治疗时，比接受其他抗疟药物治疗时更常见持续阳性。