亚洲国家无症状疟疾的检测：诊断准确性的荟萃分析。

Detection of asymptomatic malaria in Asian countries: a meta-analysis of diagnostic accuracy.

机构信息

International Medical University, Kuala Lumpur, Malaysia.

James Cook University, College of Public Health, Medical and Veterinary Sciences, Douglas, QLD, Australia.

出版信息

Malar J. 2022 Feb 16;21(1):50. doi: 10.1186/s12936-022-04082-0.

BACKGROUND

Achieving malaria elimination requires the targeting of the human reservoir of infection, including those patients with asymptomatic infection. The objective was to synthesise evidence on the accuracy of the rapid-onsite diagnostic tests (RDTs) and microscopy for the detection of asymptomatic malaria as part of the surveillance activities in Asian countries.

METHODS

This was a meta-analysis of diagnostic test accuracy. Relevant studies that evaluated the diagnostic performance of RDTs and microscopy for detection of asymptomatic malaria were searched in health-related electronic databases. The methodological quality of the studies included was assessed using the QUADAS-2 tool.

RESULTS

Ten studies assessing RDT and/or microscopy were identified. The diagnostic accuracies in all these studies were verified by PCR. Overall, the pooled sensitivities of RDT, as well as microscopy for detection of any malaria parasites in asymptomatic participants, were low, while their pooled specificities were almost ideal. For the detection of Plasmodium falciparum, pooled sensitivity by RDT (59%, 95%CI:16-91%) or microscopy (55%, 95%CI: 25-82%) were almost comparable. For detection of Plasmodium vivax, pooled sensitivity of RDT (51%, 95% CI:7-94%) had also the comparable accuracy of microscopy (54%, 95%CI,11-92%). Of note are the wide range of sensitivity and specificity.

CONCLUSION

The findings of this meta-analysis suggest that RDTs and microscopy have limited sensitivity and are inappropriate for the detection of asymptomatic Plasmodium infections. Other methods including a combination of PCR-based strategies, Loop-Mediated Isothermal Amplification (LAMP) technique must be considered to target these infections, in order to achieve malaria elimination. However, more data is needed for the wide acceptance and feasibility of these approaches. Studies to explore the role of asymptomatic and sub-patent infections in the transmission of malaria are of critical importance and are recommended.

背景

实现疟疾消除需要针对人类感染源，包括无症状感染者。本研究旨在综合评估快速现场诊断检测（RDT）和显微镜检查用于检测亚洲国家监测活动中无症状疟疾的准确性。

方法

这是一项诊断测试准确性的荟萃分析。检索了与健康相关的电子数据库中评估 RDT 和显微镜检查用于检测无症状疟疾的诊断性能的相关研究。使用 QUADAS-2 工具评估纳入研究的方法学质量。

结果

共确定了 10 项评估 RDT 和/或显微镜检查的研究。所有这些研究的诊断准确性均通过 PCR 验证。总体而言，RDT 和显微镜检查在无症状参与者中检测任何疟原虫的综合敏感性较低，而特异性几乎理想。对于检测恶性疟原虫，RDT（59%，95%CI：16-91%）或显微镜（55%，95%CI：25-82%）的汇总敏感性几乎相当。对于检测间日疟原虫，RDT 的汇总敏感性（51%，95%CI：7-94%）也与显微镜（54%，95%CI，11-92%）的准确性相当。值得注意的是，敏感性和特异性的范围很广。

结论

本荟萃分析的结果表明，RDT 和显微镜检查的敏感性有限，不适合检测无症状的疟原虫感染。为了实现疟疾消除，必须考虑其他方法，包括基于 PCR 的策略组合、环介导等温扩增（LAMP）技术。然而，需要更多的数据来广泛接受和评估这些方法的可行性。探索无症状和亚临床感染在疟疾传播中的作用的研究至关重要，建议开展此类研究。