Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana.
Department of Child Health, University of Ghana Medical School, University of Ghana, Accra, Ghana.
Clin Infect Dis. 2022 Aug 31;75(3):435-441. doi: 10.1093/cid/ciab977.
Rapid diagnostic tests (RDTs) have been extensively evaluated and play an important role in malaria diagnosis. However, the accuracy of RDTs for malaria diagnosis in patients with sickle cell disease (SCD) is unknown.
We compared the performance of a histidine rich protein 2 (HRP-2)-based RDT (First Response) and a lactate dehydrogenase (LDH)-based RDT (Optimal) with routine microscopy as reference standard in 445 children with SCD and an acute febrile illness in Accra, Ghana.
The overall sensitivity, specificity, and positive and negative predictive values of the HRP-2-based RDTs were 100%, 95.7%, 73.8%, and 100%, respectively. Comparable values for the LDH-based RDTs were 91.7%, 99.5%, 95.7%, and 99.0%, respectively. A total of 423 results were true in both tests, 1 result was false in both tests, 16 results were false in the HRP-2 test only, and 5 were false in the LDH test only (McNemar test, P = .03). At follow-up, 73.7% (28/38), 52.6% (20/38), 48.6% (17/35), and 13.2% (5/38) of study participants were HRP-2 positive on days 14, 28, 35, and 42, respectively, compared with 0%, 2.6% (1/38), 2.9% (1/35), and 2.6% (1/38) for LDH.
The HRP2-based RDT fulfilled World Health Organization criteria for malaria diagnosis in patients with SCD and may provide diagnostic evidence for treatment to begin in cases in which treatment would otherwise have begun presumptively based on symptoms, whereas LDH-based RDTs may be more suitable as a confirmatory test in low-parasitemic subgroups, such as patients with SCD.
快速诊断检测（RDT）已得到广泛评估，并在疟疾诊断中发挥重要作用。然而，RDT 用于诊断镰状细胞病（SCD）患者疟疾的准确性尚不清楚。
我们比较了基于组氨酸丰富蛋白 2（HRP-2）的 RDT（First Response）和基于乳酸脱氢酶（LDH）的 RDT（Optimal）与常规显微镜检查作为参考标准在加纳阿克拉 445 名患有 SCD 和急性发热疾病的儿童中的表现。
HRP-2 基于 RDT 的总体敏感性、特异性、阳性和阴性预测值分别为 100%、95.7%、73.8%和 100%。LDH 基于 RDT 的相应值分别为 91.7%、99.5%、95.7%和 99.0%。两种检测方法共有 423 项结果均为真，两种检测方法均有 1 项结果为假，HRP-2 检测仅 16 项结果为假，LDH 检测仅 5 项结果为假（McNemar 检验，P=0.03）。在随访中，28/38（73.7%）、20/38（52.6%）、17/35（48.6%）和 5/38（13.2%）的研究参与者在第 14、28、35 和 42 天的 HRP-2 检测结果为阳性，而 LDH 的相应结果为 0%、1/38（2.6%）、1/35（2.9%）和 1/38（2.6%）。
基于 HRP2 的 RDT 符合世界卫生组织对 SCD 患者疟疾诊断的标准，并且可能为开始治疗提供诊断依据，否则根据症状开始治疗的情况下，而 LDH 基于 RDT 可能更适合作为低寄生虫血症亚组（如 SCD 患者）的确认试验。
