PET-PCR 揭示了洪都拉斯 Moskitia 的低寄生虫血症和亚微观疟疾感染。

PET-PCR reveals low parasitaemia and submicroscopic malarial infections in Honduran Moskitia.

机构信息

Microbiology Research Institute, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras.

Hospital de Puerto Lempira, Secretaría de Salud de Honduras, Gracias a Dios, Honduras.

出版信息

Malar J. 2023 Mar 28;22(1):110. doi: 10.1186/s12936-023-04538-x.

DOI:10.1186/s12936-023-04538-x

PMID:36978056

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10053754/

Abstract

BACKGROUND

Malaria remains a main parasitic disease of humans. Although the largest number of cases is reported in the African region, there are still endemic foci in the Americas. Central America reported 36,000 malaria cases in 2020, which represents 5.5% of cases in the Americas and 0.015% of cases globally. Most malaria infections in Central America are reported in La Moskitia, shared by Honduras and Nicaragua. In the Honduran Moskitia, less than 800 cases were registered in 2020, considering it an area of low endemicity. In low endemicity settings, the number of submicroscopic and asymptomatic infections tends to increase, leaving many cases undetected and untreated. These reservoirs challenge national malaria elimination programmes. This study aimed to assess the diagnostic performance of Light Microscopy (LM), a nested PCR test and a photoinduced electron transfer polymerase chain reaction (PET-PCR) in a population of febrile patients from La Moskitia.

METHODS

A total of 309 febrile participants were recruited using a passive surveillance approach at the Puerto Lempira hospital. Blood samples were analysed by LM, nested PCR, and PET-PCR. Diagnostic performance including sensitivity, specificity, negative and positive predictive values, kappa index, accuracy, and ROC analysis was evaluated. The parasitaemia of the positive samples was quantified by both LM and PET-PCR.

RESULTS

The overall prevalence of malaria was 19.1% by LM, 27.8% by nPCR, and 31.1% by PET-PCR. The sensitivity of LM was 67.4% compared to nPCR, and the sensitivity of LM and nPCR was 59.6% and 80.8%, respectively, compared to PET-PCR. LM showed a kappa index of 0.67, with a moderate level of agreement. Forty positive cases by PET-PCR were not detected by LM.

CONCLUSIONS

This study demonstrated that LM is unable to detect parasitaemia at low levels and that there is a high degree of submicroscopic infections in the Honduran Moskitia.

摘要

背景

疟疾仍然是人类的主要寄生虫病。尽管报告的病例数量最多的是在非洲地区，但美洲仍存在地方性流行。中美洲在 2020 年报告了 36000 例疟疾病例，占美洲病例的 5.5%，占全球病例的 0.015%。中美洲的大多数疟疾感染报告发生在洪都拉斯和尼加拉瓜共有地区的拉莫斯基蒂亚。在洪都拉斯的莫斯基蒂亚，2020 年仅登记了不到 800 例病例，认为该地区属于低度流行地区。在低度流行地区，亚临床和无症状感染的数量往往会增加，导致许多病例未被发现和治疗。这些感染源对国家消除疟疾规划构成挑战。本研究旨在评估在拉莫斯基蒂亚发热患者人群中，使用光镜（LM）、巢式 PCR 检测和光诱导电子转移聚合酶链反应（PET-PCR）的诊断性能。

方法

采用被动监测方法，在波托西瓦尔医院共招募了 309 名发热参与者。通过 LM、巢式 PCR 和 PET-PCR 分析血样。评估了敏感性、特异性、阴性和阳性预测值、kappa 指数、准确性和 ROC 分析等诊断性能。通过 LM 和 PET-PCR 对阳性样本的寄生虫血症进行定量。

结果

通过 LM 检测，疟疾的总流行率为 19.1%，通过 nPCR 检测为 27.8%，通过 PET-PCR 检测为 31.1%。与 nPCR 相比，LM 的敏感性为 67.4%，与 PET-PCR 相比，LM 和 nPCR 的敏感性分别为 59.6%和 80.8%。LM 的 kappa 指数为 0.67，具有中等程度的一致性。PET-PCR 检测的 40 例阳性病例未被 LM 检测到。