Ngaba Neguemadji Ngardig, Khan Imteyaz A, Hange Namrata, Lourdes Ligsay Pormento Maria Kezia, Reddy Somagutta Manoj Kumar, Kumar Ajay, Abdelkerim Youssouf, Djindimadje Alarangue, Jahan Samia
CHU Bon Samaritain de Walia, N'Djamena, P.O. Box 456, Chad.
Rugers Robert Wood Johnson Medical School, Clinical Academic Building (CAB), 125 Paterson St, New Brunswick, NJ 08901, USA.
J Trop Med. 2022 Apr 23;2022:5883173. doi: 10.1155/2022/5883173. eCollection 2022.
Malaria is an endemic disease in sub-Saharan Africa. In clinical practice, the main concern is the overdiagnosis of malaria leading to inappropriate drug prescription without laboratory confirmation.
This study aimed to evaluate clinical examination reliability compared with translational laboratory methods of malaria diagnosis.
The study was conducted in Goundi Hospital among hospitalized patients over a seven-month period. Patients were interviewed, and malaria tests done included the Giemsa-stained thick and thin blood smears. Diagnostic accuracy was analysed by calculating sensitivity, specificity, and predictive values.
Among 1,874 participants, 674 (35.96%) patients had positive Giemsa-stained thick blood films. The rate of positivity is higher for patients under 5 years of age. The parasite densities were between 160 and 84.000 parasites/L. The threshold pyrogen of the parasitic density was around 10.000 parasites/L for patients between 0 and 11 months of age, between 1 and 4 years of age, and between 5 and 14 years of age. This threshold was lower for patients over 15 years of age. The study reported some issues in the findings: 60.88% (607/997) cases of fever without positivity of the blood thick smear and 40.13% (284/674) cases of positivity of the thick drop without fever. The positive predictive value of malaria was between 80 and 85% for patients under 5 years of age. This value is lower for patients between 5 and 14 years of age and patients over 15 years of age.
A presumptive diagnosis of malaria should be confirmed by the laboratory in all suspected cases in all possible scenarios. Every parasitemia should be followed by the calculation of parasitic density. However, for the children under 5 years of age in areas of high transmission, the presumptive diagnosis of malaria in certain circumstances could be considered.
疟疾是撒哈拉以南非洲的一种地方病。在临床实践中，主要担忧的是疟疾的过度诊断，导致在没有实验室确诊的情况下开出不恰当的药物处方。
本研究旨在评估与疟疾诊断的转化实验室方法相比，临床检查的可靠性。
该研究在贡迪医院对住院患者进行了为期七个月的调查。对患者进行了访谈，并进行了疟疾检测，包括吉姆萨染色的厚血膜和薄血膜。通过计算敏感性、特异性和预测值来分析诊断准确性。
在1874名参与者中，674名（35.96%）患者吉姆萨染色厚血膜呈阳性。5岁以下患者的阳性率更高。寄生虫密度在每升160至84000个寄生虫之间。对于0至11个月、1至4岁以及5至14岁的患者，寄生虫密度的发热阈值约为每升10000个寄生虫。15岁以上患者的该阈值较低。该研究报告了研究结果中的一些问题：60.88%（607/997）的发热病例血厚涂片未呈阳性，40.13%（284/674）的厚血滴阳性病例无发热。5岁以下患者疟疾的阳性预测值在80%至85%之间。5至14岁患者和15岁以上患者的该值较低。
在所有可能的情况下，所有疑似病例的疟疾初步诊断都应通过实验室确认。每次检测到寄生虫血症后都应计算寄生虫密度。然而，在高传播地区，对于5岁以下儿童，在某些情况下可以考虑疟疾的初步诊断。
