Comparison of conventional and non-invasive diagnostic tools for detecting Plasmodium falciparum infection in southwestern Cameroon: a cross-sectional study.

IF 4.8 1区 医学 Q1 INFECTIOUS DISEASES
Tobias O Apinjoh, Veronica N Ntasin, Phil Collins C Tataw, Vincent N Ntui, Dieudonne L Njimoh, Fidelis Cho-Ngwa, Eric A Achidi
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引用次数: 2

Abstract

Background: Malaria remains a significant health challenge in sub-Saharan Africa, with early diagnosis critical to reducing its morbidity and mortality. Despite the increasing Plasmodium spp. diagnostic capabilities, access to testing is limited in some cases by the almost absolute requirement for blood from potentially infected subjects as the only sample source for all conventional methods. A rapid test on non-invasive specimen with comparable performance to microscopy for the screening or diagnosis of all participants is invaluable. This study sought to compare conventional and non-invasive diagnostic tools for detecting Plasmodium falciparum.

Methods: This was a cross-sectional study, carried out between March and August 2019 to evaluate and compare the diagnostic performance of a PfHRP2/pLDH-based malaria rapid diagnostic test (mRDT) on patients' blood, saliva and urine relative to conventional light microscopy and nested PCR at outpatient clinics in the Buea and Tiko health districts of Southwestern Cameroon. The significance of differences in proportions was explored using the Pearson's χ2 test whereas differences in group means were assessed using analyses of variance.

Results: A total of 359 individuals of both sexes, aged 1-92 years, were enrolled into the study. Of the 301 individuals tested by light microscopy and mRDTs on blood, saliva and urine, 84 (27.9%), 81 (26.9%), 87 (28.9%) and 107 (35.5%) respectively were positive. However, only 34.3%, 90.5%, 91.4%, 83.9% and 65.4% febrile, light microscopy and mRDT positives on blood, saliva and urine respectively had P. falciparum infection as confirmed by PCR. The sensitivity and specificity of presumptive diagnosis, light microscopy and mRDT on blood, saliva and urine were 86.9% and 19.7%, 77.8% and 96.1%, 75.8% and 96.6%, 74.5% and 93.1%, and 70.7% and 81.8%, respectively. The agreement between mRDT on saliva (k = 0.696) and microscopy (k = 0.766) compared to PCR was good.

Conclusion: The study highlighted the low performance of presumptive diagnosis, reinforcing the need for parasitological tests prior to antimalarial therapy. The higher PfHRP2/pLDH mRDT parasite detection rates and sensitivity in saliva compared to urine suggests that the former is a practical adjunct to or alternative worth optimising for the routine diagnosis of malaria. Flow chart for diagnosis of P. falciparum infection by light microscopy, rapid diagnostic tests and nested PCR.

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Abstract Image

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喀麦隆西南部检测恶性疟原虫感染的常规和非侵入性诊断工具的比较:一项横断面研究。
背景:疟疾仍然是撒哈拉以南非洲的一个重大卫生挑战,早期诊断对于降低其发病率和死亡率至关重要。尽管疟原虫的诊断能力不断提高,但在某些情况下,由于几乎绝对要求潜在感染者的血液作为所有常规方法的唯一样本来源,因此获得检测的机会受到限制。对所有参与者进行筛查或诊断的非侵入性标本的快速测试具有与显微镜相当的性能是非常宝贵的。本研究旨在比较常规和非侵入性检测恶性疟原虫的诊断工具。方法:这是一项横断面研究,于2019年3月至8月期间开展,旨在评估和比较基于PfHRP2/ pldh的疟疾快速诊断测试(mRDT)在喀麦隆西南部Buea和Tiko卫生区的门诊诊所对患者血液、唾液和尿液的诊断性能,与传统光学显微镜和巢式PCR相比。采用Pearson χ2检验探讨比例差异的显著性,采用方差分析评估组均值差异。结果:共有359名年龄在1-92岁的男女被纳入研究。在301例血液、唾液和尿液的光镜和mrdt检测中,分别有84例(27.9%)、81例(26.9%)、87例(28.9%)和107例(35.5%)呈阳性。而经PCR证实,发热、光镜、唾液和尿液mRDT阳性分别为34.3%、90.5%、91.4%、83.9%和65.4%的人感染恶性疟原虫。血液、唾液和尿液的推定诊断、光镜检查和mRDT检查的敏感性和特异性分别为86.9%和19.7%、77.8%和96.1%、75.8%和96.6%、74.5%和93.1%、70.7%和81.8%。与PCR相比,唾液mRDT (k = 0.696)与镜检(k = 0.766)吻合较好。结论:该研究强调了推定诊断的低绩效,强调了在抗疟治疗之前进行寄生虫学检查的必要性。与尿液相比,唾液中PfHRP2/pLDH mRDT寄生虫的检出率和敏感性更高,这表明前者是一种实用的辅助手段或值得优化的替代方法,可用于疟疾的常规诊断。恶性疟原虫感染的光镜、快速诊断试验和巢式PCR诊断流程图。
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来源期刊
Infectious Diseases of Poverty
Infectious Diseases of Poverty Medicine-Public Health, Environmental and Occupational Health
CiteScore
16.70
自引率
1.20%
发文量
368
审稿时长
13 weeks
期刊介绍: Infectious Diseases of Poverty is a peer-reviewed, open access journal that focuses on essential public health questions related to infectious diseases of poverty. It covers a wide range of topics and methods, including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies, and their application. The journal also explores the impact of transdisciplinary or multisectoral approaches on health systems, ecohealth, environmental management, and innovative technologies. It aims to provide a platform for the exchange of research and ideas that can contribute to the improvement of public health in resource-limited settings. In summary, Infectious Diseases of Poverty aims to address the urgent challenges posed by infectious diseases in impoverished populations. By publishing high-quality research in various areas, the journal seeks to advance our understanding of these diseases and contribute to the development of effective strategies for prevention, diagnosis, and treatment.
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