用于排除输入性疟疾诊断的灯的价值：意大利米兰的一项回顾性观察研究

The value of lamp to rule out imported malaria diagnosis: a retrospective observational study in Milan, Italy.

作者信息

Giacomelli Andrea, Monti Maria Elena, Grande Romualdo, Oreni Letizia, Galimberti Laura, Ridolfo Anna Lisa, Bonazzetti Cecilia, Sabaini Federico, Cordier Laura, Zambelli Agostino, Rizzardini Giuliano, Galli Massimo, Antinori Spinello

机构信息

Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy.

Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, ASST Fatebenefratelli-Sacco, Milan, Italy.

出版信息

Infect Dis (Lond). 2022 Jun;54(6):410-417. doi: 10.1080/23744235.2021.2023754. Epub 2022 Jan 4.

DOI:10.1080/23744235.2021.2023754

PMID:34983306

Abstract

BACKGROUND

The diagnosis of malaria in returning travellers could be a challenge in non-endemic settings. We aimed to assess the performance of LAMP in comparison with standard conventional diagnostic methods using real-time-polymerase chain reaction (PCR) in case of discordant results.

METHODS

All travellers returning from malaria-endemic areas who presented to our Emergency Department (ED) from January 2017 to December 2020 with signs and symptoms suggestive for malaria were included. Blood microscopy was the reference diagnostic method applied at our laboratory with LAMP implemented as an additional method to aid in malaria diagnosis. PCR was employed only in case of between test's discordant results. Sensitivity and specificity of microscopy compared to LAMP were calculated with the confidence interval of 95%.

RESULTS

Four-hundred and eight patients (55.6% male, median age 42 years) were screened for malaria. The diagnosis was confirmed in 49 cases (12%): 44 cases (90%) caused by . Peripheral blood smear missed to identify three malaria cases, which tested positive with LAMP and PCR. One case of malaria caused by in a naive tourist, one case by in a semi-immune pregnant women and one case by in a previously treated semi-immune patient. All the discordant cases were characterized by a very low parasitaemia. Microscopy when compared to LAMP showed a sensitivity of 93.9% (95% confidence interval (CI) 83.1-98.7%) and a specificity of 100% (95% CI 98.9-100%).

CONCLUSIONS

In our non-endemic setting LAMP was able to identify malaria cases with low-level parasitaemia otherwise missed by blood microscopy.

摘要

背景

在非疟疾流行地区，对归国旅行者进行疟疾诊断可能具有挑战性。我们旨在评估环介导等温扩增技术（LAMP）与标准传统诊断方法（实时聚合酶链反应（PCR））在结果不一致情况下的性能。

方法

纳入2017年1月至2020年12月期间前往我们急诊科（ED）的所有来自疟疾流行地区且有疟疾疑似症状和体征的归国旅行者。血液显微镜检查是我们实验室采用的参考诊断方法，LAMP作为辅助疟疾诊断的额外方法实施。仅在检测结果不一致的情况下采用PCR。计算显微镜检查与LAMP相比的敏感性和特异性，并给出95%置信区间。

结果

对408例患者（男性占55.6%，中位年龄42岁）进行了疟疾筛查。确诊49例（12%）：44例（90%）由……引起。外周血涂片漏诊了3例疟疾，这3例经LAMP和PCR检测呈阳性。1例初发旅游者感染……导致的疟疾，1例半免疫孕妇感染……导致的疟疾，1例既往接受过治疗的半免疫患者感染……导致的疟疾。所有不一致的病例均表现为极低的寄生虫血症。显微镜检查与LAMP相比，敏感性为93.9%（95%置信区间（CI）83.1 - 98.7%），特异性为100%（95% CI 98.9 - 100%）。