将当地疟疾分子监测纳入比奥科岛定期疟疾指标调查:城市社区与低密度感染之间的高度关联。

IF 3 3区 医学 Q3 INFECTIOUS DISEASES
Thomas C Stabler, Salome Hosch, Elizabeth Nyakarungu, Johanna Nouria Giger, Monserrat Kobe Elonga, Rosalia Nzang Bibang, Victoria Mangue Ndong, Ilda Elobe Mometolo, Alejandro Lopelo Bolopa, Rosa Maria Oko Bedoung, Jose Raso Bijeri, Esperanza Willy Roka, Ana Gertrudis Nguema, Victoria Palacios Ichinda, Salvador Bakale, Cristina Nka Esokolete, Matilde Riloha Rivas, David S Galick, Wonder Philip Phiri, Carlos A Guerra, Guillermo A García, Luca Montemartini, Tobias Schindler, Joana C Silva, Claudia Daubenberger
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引用次数: 0

摘要

背景:有效的疟疾控制需要准确识别疟原虫感染,以适当调整干预措施。快速诊断测试(rdt)是实现这一目的的关键工具,因为它们体积小,功能易于使用。这些检测通常针对恶性疟原虫富组氨酸蛋白2 (HRP2)抗原。然而,一些恶性疟原虫的hrp2和hrp3基因缺失,这可能导致基于hrp2的rdt诊断为假阴性。此外,rdt的检测限为每微升100个寄生虫,不足以确定维持疟疾传播的低密度感染。本研究探索了利用来自赤道几内亚Bioko岛疟疾指标调查(MIS)的样本,利用一种新的基于墨盒的PCR检测方法plasmoopod整合分子监测,以加强对低密度感染的检测,并为有针对性的疟疾控制策略提供信息。方法:采用rdt联合DiaxxoPCR装置进行分子监测。DiaxxoPCR设备使用预填充的药筒系统,称为PlasmoPod,用于基于疟疾的检测,该检测采用靶向18S rDNA/rRNA的qPCR检测。2023 MIS样品从干血斑(DBS)中提取,qPCR在PlasmoPod上运行一式两份。利用qPCR方法将MIS的流行病学数据与分子数据以及MIS变量与疟疾感染之间的关联进行合并,并测量低密度感染。结果:分子监测的整合揭示了规避rdt诊断的低密度感染的比例。值得注意的是,城市社区的个人和报告最近发烧的人更有可能感染低密度、无症状的疟疾。研究结果表明,城市居民虽然在RDT和qPCR中与疟疾感染的相关性低于农村居民,但可能是传播宿主。低密度感染与最近报告发烧的个体之间的关系可能反映了最近的抗疟疾治疗或自然清除,因此在他们的血液中有挥之不去的寄生虫。结论:该研究突出了基于hrp2的rdt在检测低密度感染方面的局限性,并强调了PlasmoPod等分子工具在疟疾监测中的潜力。通过确定难以捉摸的传播宿主和追踪寄生虫输入,分子监测可以在实现消除疟疾方面发挥关键作用。研究结果提倡在疟疾项目中更广泛地实施分子诊断,特别是在低传播地区,以加强对隐藏感染库的检测和定位。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Integrating local malaria molecular monitoring into regular malaria indicator surveys on Bioko Island: high association between urban communities and low-density infections.

Background: Effective malaria control requires accurate identification of Plasmodium infections to tailor interventions appropriately. Rapid diagnostic tests (RDTs) are crucial tools for this purpose due to their small size and ease-of-use functionality. These tests typically target the Plasmodium falciparum histidine-rich protein 2 (HRP2) antigen. However, some strains of P. falciparum have deletions in the hrp2 and hrp3 genes, which may result in a false negative diagnosis using HRP2-based RDTs. Additionally, RDTs have a detection limit of 100 parasites per microlitre, insufficient for identifying low-density infections that sustain malaria transmission. This study explores integrating molecular monitoring using a novel cartridge-based PCR test, PlasmoPod, using samples from a malaria indicator survey (MIS) on Bioko Island, Equatorial Guinea to enhance detection of low-density infections and inform targeted malaria control strategies.

Methods: The study utilized a combination of RDTs and the DiaxxoPCR device for molecular monitoring. The device DiaxxoPCR uses a prefilled cartridge system, termed PlasmoPod for a malaria-based assay that employs a qPCR assay targeting 18S rDNA/rRNA. Samples from the 2023 MIS were extracted from dried blood spots (DBS), qPCR run in duplicate on the PlasmoPod. Epidemiological data from the MIS were merged with molecular data and the association between MIS variables to malaria infection by qPCR, and low-density infections were measured.

Results: The integration of molecular monitoring revealed a proportion of low-density infections that circumvented RDTs diagnosis. Notably, individuals in urban communities and those reporting recent fever were more likely to harbour low-density, asymptomatic malaria infections. Findings suggest that urban residents, although less associated to malaria infection than rural residents by both RDT and qPCR, may be serving as a transmission reservoir. The relationship between low-density infections and individuals who recently reported fever may reflect recent anti-malarial treatment or natural clearance, and thus have lingering parasites in their blood.

Conclusion: The study highlights the limitations of HRP2-based RDTs in detecting low density infections and underscores the potential of molecular tools like PlasmoPod in malaria surveillance. By identifying elusive transmission reservoirs and tracking parasite importation, molecular monitoring can play a crucial role in achieving malaria elimination. The findings advocate for the broader implementation of molecular diagnostics in malaria programs, especially in areas with low transmission, to enhance the detection and targeting of hidden reservoirs of infection.

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来源期刊
Malaria Journal
Malaria Journal 医学-寄生虫学
CiteScore
5.10
自引率
23.30%
发文量
334
审稿时长
2-4 weeks
期刊介绍: Malaria Journal is aimed at the scientific community interested in malaria in its broadest sense. It is the only journal that publishes exclusively articles on malaria and, as such, it aims to bring together knowledge from the different specialities involved in this very broad discipline, from the bench to the bedside and to the field.
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