Laboratório de Ensaios Clínicos em Malária, Instituto Evandro Chagas, Ananindeua, Pará, Brazil.
Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, Pará, Brazil.
Parasitology. 2022 Jan;149(1):10-14. doi: 10.1017/S0031182021001165. Epub 2021 Jul 5.
This research aims to determine whether the combination of epidemiological and clinical features can predict malaria. Diagnostic investigation detected 22.3% of individuals with Plasmodium vivax (P. vivax) malaria, with significant predominance of the male gender. The malaria triad (fever, chills and headache) had a more expressive frequency (81.1%) in individuals with positive thick blood than those with negative thick blood smear (65.1%), although there was no statistical significance. Among the variables analysed as predictive for positive thick blood smear, it was observed that personal history of travel to an endemic malaria area and past malaria infection (PMI) were significantly associated with malaria, even in multiple logistic regression. Fever had the higher sensitivity (94.6%) and past malaria history had the greater specificity (68.2%), with accuracy of 23.5% and 67.5%, respectively. In combined analysis, fever with chills had the highest sensitivity (91.9%), but low accuracy (38.5%). High specificity (91.5%) was found in the association of malaria triad, PMI and history of travel to endemic malaria area (which along with anorexia, was higher 94.6%), with good accuracy (80.7%), suggesting that the screening of patients for performing thick blood smear can be based on these data. The epidemiological features and the malaria triad (fever, chills and headache) can be predictors for identification of malaria patients, concurring to precocious diagnosis and immediate treatment of individuals with malaria.
本研究旨在确定流行病学和临床特征的组合是否可以预测疟疾。诊断性检查发现 22.3%的个体患有间日疟原虫（P. vivax）疟疾，男性明显占优势。疟疾三联征（发热、寒战和头痛）在厚血涂片阳性的个体中比厚血涂片阴性的个体更频繁出现（81.1%对 65.1%），尽管没有统计学意义。在分析作为厚血涂片阳性的预测变量的变量中，观察到既往有疟疾流行地区旅行史和既往疟疾感染（PMI）与疟疾显著相关，即使在多因素逻辑回归中也是如此。发热的敏感性最高（94.6%），既往疟疾史的特异性最高（68.2%），准确性分别为 23.5%和 67.5%。在联合分析中，发热伴寒战的敏感性最高（91.9%），但准确性较低（38.5%）。疟疾三联征、PMI 和疟疾流行地区旅行史的关联具有较高的特异性（91.5%），同时伴有厌食症，特异性更高达 94.6%，准确性也较好（80.7%），提示可以根据这些数据对患者进行厚血涂片筛查。流行病学特征和疟疾三联征（发热、寒战和头痛）可以预测疟疾患者的识别，有助于及早诊断和对疟疾患者进行及时治疗。
