Awosolu Oluwaseun Bunmi, Yahaya Zary Shariman, Farah Haziqah Meor Termizi, Olusi Titus Adeniyi
School of Biological Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia.
Vector Control Research Unit, Universiti Sains Malaysia, Minden, Penang 11800, Malaysia.
Pathogens. 2022 Nov 9;11(11):1312. doi: 10.3390/pathogens11111312.
Malaria remains a major public health challenge worldwide. In order to ensure a prompt and accurate malaria diagnosis, the World Health Organization recommended the confirmatory parasitological diagnosis of malaria by microscopy and malaria rapid diagnostic test (RDT) prior to antimalarial administration and treatment. This study was designed to evaluate the performance of nested polymerase chain reaction (nested PCR), light microscopy, and histidine-rich protein 2 rapid diagnostic test (PfHRP2 RDT) in the detection of falciparum malaria in Akure, Nigeria. A cross-sectional and hospital-based study involving 601 febrile volunteer participants was conducted in Akure, Nigeria. Approximately 2-3 mL venous blood samples were obtained from each study participant for parasitological confirmation by microscopy and PfHRP2-based malaria RDT. Thick and thin films were prepared and viewed under the light microscope for parasite detection, parasite density quantification, and species identification, respectively. Dry blood spot samples were prepared on 3MM Whatman filter paper for nested PCR. The overall prevalence of microscopy, PfHRP2 RDT, and nested PCR were 64.89% (390/601), 65.7% (395/601), and 67.39% (405/601), respectively. The estimates of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Youden's j index of microscopy and RDT were 96.30, 100.00, 100.00, 92.89, 97.50, 0.963, and 95.06, 94.90, 97.47, 90.29, 95.01, and 0.899, respectively. Malaria RDT recorded higher false negativity, compared microscopy (4.94% vs. 3.70%). A near perfect agreement was reported between microscopy and nested PCR, and between PfHRP2 RDT and nested PCR with Cohen's kappa (k) values of 0.94 and 0.88, respectively. This study revealed that PfHRP2 RDT and microscopy continues to remain sensitive and specific for falciparum malaria diagnosis in the study area.
疟疾仍然是全球主要的公共卫生挑战。为确保及时、准确地诊断疟疾，世界卫生组织建议在给予抗疟药物和治疗之前，通过显微镜检查和疟疾快速诊断检测（RDT）对疟疾进行寄生虫学确诊诊断。本研究旨在评估巢式聚合酶链反应（巢式PCR）、光学显微镜检查和富含组氨酸蛋白2快速诊断检测（PfHRP2 RDT）在尼日利亚阿库雷检测恶性疟原虫方面的性能。在尼日利亚阿库雷进行了一项基于医院的横断面研究，涉及601名发热志愿者参与者。从每位研究参与者采集约2 - 3 mL静脉血样本，通过显微镜检查和基于PfHRP2的疟疾RDT进行寄生虫学确诊。制备厚血膜和薄血膜，分别在光学显微镜下观察以检测寄生虫、定量寄生虫密度和鉴定虫种。在3MM Whatman滤纸上制备干血斑样本用于巢式PCR。显微镜检查、PfHRP2 RDT和巢式PCR的总体患病率分别为64.89%（390/601）、65.7%（395/601）和67.39%（405/601）。显微镜检查和RDT的敏感性、特异性、阳性预测值、阴性预测值、准确性和尤登指数估计值分别为96.30、100.00、100.00、92.89、97.50、0.963和95.06、94.90、97.47、90.29、95.01、0.899。与显微镜检查相比，疟疾RDT的假阴性率更高（4.94%对3.70%）。显微镜检查与巢式PCR之间以及PfHRP2 RDT与巢式PCR之间报告了近乎完美的一致性，科恩kappa（k）值分别为0.94和0.88。本研究表明，在研究地区，PfHRP2 RDT和显微镜检查对于恶性疟原虫诊断仍然保持敏感和特异。
