未治疗的低疟原虫血症感染后疟疾风险：肯尼亚西部高传播地区队列研究 4 年结果。

Risk of Malaria Following Untreated Subpatent Plasmodium falciparum Infections: Results Over 4 Years From a Cohort in a High-Transmission Area in Western Kenya.

机构信息

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.

Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA.

出版信息

J Infect Dis. 2024 Apr 12;229(4):969-978. doi: 10.1093/infdis/jiad398.

DOI:10.1093/infdis/jiad398

PMID:37713614

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11011184/

Abstract

BACKGROUND

People with suspected malaria may harbor Plasmodium falciparum undetected by rapid diagnostic test (RDT). The impact of these subpatent infections on the risk of developing clinical malaria is not fully understood.

METHODS

We analyzed subpatent P. falciparum infections using a longitudinal cohort in a high-transmission site in Kenya. Weighted Kaplan-Meier models estimated the risk difference (RD) for clinical malaria during the 60 days following a symptomatic subpatent infection. Stratum-specific estimates by age and transmission season assessed modification.

RESULTS

Over 54 months, we observed 1128 symptomatic RDT-negative suspected malaria episodes, of which 400 (35.5%) harbored subpatent P. falciparum. Overall, the 60-day risk of developing clinical malaria was low following all episodes (8.6% [95% confidence interval, 6.7%-10.4%]). In the low-transmission season, the risk of clinical malaria was slightly higher in those with subpatent infection, whereas the opposite was true in the high-transmission season (low-transmission season RD, 2.3% [95% confidence interval, .4%-4.2%]; high-transmission season RD, -4.8% [-9.5% to -.05%]).

CONCLUSIONS

The risk of developing clinical malaria among people with undetected subpatent infections is low. A slightly elevated risk in the low-transmission season may merit alternate management, but RDTs identify clinically relevant infections in the high-transmission season.

摘要

背景

快速诊断检测（RDT）可能无法检测到疑似疟疾患者的潜伏性疟原虫感染。这些亚临床感染对发生临床疟疾的风险的影响尚不完全清楚。

方法

我们使用肯尼亚一个高传播地区的纵向队列来分析潜伏性疟原虫感染。加权 Kaplan-Meier 模型估计了在出现有症状的亚临床感染后 60 天内临床疟疾的风险差异（RD）。按年龄和传播季节分层的特定估计值评估了修饰作用。

结果

在 54 个月期间，我们观察到 1128 例有症状的 RDT 阴性疑似疟疾发作，其中 400 例（35.5%）存在潜伏性疟原虫感染。总体而言，所有发作后 60 天内发生临床疟疾的风险都很低（8.6%[95%置信区间，6.7%-10.4%]）。在低传播季节，亚临床感染患者发生临床疟疾的风险略高，而在高传播季节则相反（低传播季节 RD，2.3%[95%置信区间，0.4%-4.2%]；高传播季节 RD，-4.8%[-9.5%至-.05%]）。