Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana.
Korle Bu Polyclinic Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana.
PLoS One. 2024 Feb 9;19(2):e0298088. doi: 10.1371/journal.pone.0298088. eCollection 2024.
Malaria is a common and severe public health problem in Ghana and largely responsible for febrile symptoms presented at health facilities in the country. Other infectious diseases, including COVID-19, may mimic malaria due to their shared non-specific symptoms such as fever and headache thus leading to misdiagnosis. This study therefore investigated COVID-19 among patients presenting with malaria-like symptoms at Korle-Bu Polyclinic, Accra, Ghana.
This study enrolled 300 patients presenting with malaria-like symptoms aged ≥18yrs. After consent was obtained from study patients, two to three millilitres of whole blood, nasopharyngeal and oropharyngeal swab samples, were collected for screening of Plasmodium falciparum using malaria rapid diagnostic test, microscopy and nested PCR, and SARS-CoV-2 using SARS-CoV-2 antigen test and Real-time PCR, respectively. The plasma and whole blood were also used for COVID-19 antibody testing and full blood counts using hematological analyser. SARS-CoV-2 whole genome sequencing was performed using MinIon sequencing.
The prevalence of malaria by microscopy, RDT and nested PCR were 2.3%, 2.3% and 2.7% respectively. The detection of SARS-CoV-2 by COVID-19 Rapid Antigen Test and Real-time PCR were 8.7% and 20% respectively. The Delta variant was reported in 23 of 25 SARS-CoV-2 positives with CT values below 30. Headache was the most common symptom presented by study participants (95%). Comorbidities reported were hypertension, asthma and diabetes. One hundred and thirteen (37.8%) of the study participants had prior exposure to SARS CoV-2 and (34/51) 66.7% of Astrazeneca vaccinated patients had no IgG antibody.
It may be difficult to use clinical characteristics to distinguish between patients with COVID-19 having malaria-like symptoms. Detection of IgM using RDTs may be useful in predicting CT values for SARS-CoV-2 real-time PCR and therefore transmission.
疟疾是加纳常见且严重的公共卫生问题，也是导致该国卫生机构出现发热症状的主要原因。由于发热和头痛等非特异性症状，其他传染病，包括 COVID-19，可能与疟疾相似，从而导致误诊。因此，本研究调查了加纳科勒布综合医院（Korle-Bu Polyclinic）出现疟疾样症状的患者中 COVID-19 的情况。
本研究纳入了 300 名年龄≥18 岁的出现疟疾样症状的患者。在获得研究患者的同意后，采集 2 至 3 毫升全血、鼻咽和口咽拭子样本，分别采用疟疾快速诊断检测、显微镜检查和巢式 PCR 检测疟原虫，采用 SARS-CoV-2 抗原检测和实时 PCR 检测 SARS-CoV-2。同时，采用血液分析仪对血浆和全血进行 COVID-19 抗体检测和全血细胞计数。采用 MinIon 测序进行 SARS-CoV-2 全基因组测序。
显微镜检查、RDT 和巢式 PCR 检测的疟疾患病率分别为 2.3%、2.3%和 2.7%。COVID-19 快速抗原检测和实时 PCR 检测的 SARS-CoV-2 检出率分别为 8.7%和 20%。报告了 25 例 SARS-CoV-2 阳性病例中的 23 例（CT 值<30）为 Delta 变异株。头痛是研究参与者最常见的症状（95%）。报告的合并症有高血压、哮喘和糖尿病。113 名（37.8%）研究参与者之前曾接触过 SARS-CoV-2，（34/51）66.7%接种阿斯利康疫苗的患者没有 IgG 抗体。
可能难以使用临床特征区分出现疟疾样症状的 COVID-19 患者。使用 RDT 检测 IgM 可能有助于预测 SARS-CoV-2 实时 PCR 的 CT 值，从而预测传播情况。
