Center for Global Health, Weill Cornell Medicine, New York, New York, USA
Department of Microbiology & Immunology, Weill Cornell Medicine, New York, New York, USA.
J Clin Microbiol. 2021 Mar 19;59(4). doi: 10.1128/JCM.01508-20.
The emergence of multidrug-resistant malaria in Southeast Asia (SEA) has accelerated regional malaria elimination efforts. Most malaria in this and other low-transmission settings exists in asymptomatic individuals, which conventional diagnostic tests lack the sensitivity to detect. This has led to the development of new ultrasensitive diagnostics that are capable of detecting these low-parasitemia infections. This review summarizes the current status of ultrasensitive technologies, including PCR and loop-mediated isothermal amplification (LAMP)-based methods, as well as a newly developed ultrasensitive rapid diagnostic test (uRDT). The sensitivity, specificity, and field performance of these platforms will be examined, as well as their suitability for use in resource-limited settings to aid in malaria elimination efforts. uRDTs, with their improved sensitivity, are now able to detect approximately half of asymptomatic infections, providing a useful point-of-contact tool for malaria surveillance. The increased sensitivity and high-throughput nature of PCR-based tests make them ideal for screening large populations in places where laboratory capacity exists, and the recent commercialization of malaria LAMP kits should facilitate their adoption as a public health tool in places where such infrastructure is lacking. Finally, recent advances with dried blood spots may enable utilization of the extensive laboratory infrastructure of higher-income countries to assist with molecular surveillance in support of malaria elimination. If malaria is to be eliminated in SEA and other low-endemicity regions, then ultrasensitive diagnostics will likely play a key role in identifying and clearing the vast asymptomatic pool of infections that are common to these regions.
东南亚（SEA）出现耐多药疟疾加速了区域消除疟疾的努力。在这些地区和其他低传播地区，大多数疟疾存在于无症状个体中，常规诊断检测缺乏检测这些低寄生虫血症感染的敏感性。这导致了新的超敏诊断技术的发展，这些技术能够检测到这些低寄生虫血症感染。本综述总结了超敏技术的现状，包括基于 PCR 和环介导等温扩增（LAMP）的方法，以及新开发的超敏快速诊断测试（uRDT）。将检查这些平台的灵敏度、特异性和现场性能，以及它们在资源有限的环境中的适用性，以帮助消除疟疾的努力。uRDT 的灵敏度提高，现在能够检测到大约一半的无症状感染，为疟疾监测提供了一个有用的接触点工具。基于 PCR 的测试的灵敏度提高和高通量性质使它们成为在存在实验室能力的地方筛选大量人群的理想选择，最近疟疾 LAMP 试剂盒的商业化应该促进它们在缺乏此类基础设施的地方作为公共卫生工具的采用。最后，干血斑的最新进展可能使人们能够利用高收入国家广泛的实验室基础设施来协助支持分子监测，以支持消除疟疾。如果要在东南亚和其他低流行地区消除疟疾，那么超敏诊断很可能在识别和清除这些地区常见的大量无症状感染方面发挥关键作用。
