Current strategies to avoid misdiagnosis of malaria
Current strategies to avoid misdiagnosis of malaria
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DOI：
10.1046/j.1469-0691.2003.00640.x
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发表时间：
2003-06-01
影响因子：
14.2
通讯作者：
H채nscheid, T
中科院分区：
文献类型：
--
作者：
H채nscheid, T
疟疾仍然是最重要的寄生虫病，每年有数以万计的病例输入非流行国家。然而，任何一家机构都可能只看到极少数病例--这可能是为什么实验室和临床误诊可能并不少见的原因。在实验室，考虑到大量实验室工作人员提供随叫随到的服务，往往没有专家的帮助，以及难以发现低水平寄生虫血症病例，不熟悉显微镜诊断可能是主要原因。因此，应为工作人员提供持续的微观培训，以保持熟练程度。免疫层析快速检测试验(RDT)的补充使用可能是有用的，特别是在待命时间，尽管为了确保正确的解释，它们的固有局限性必须众所周知。基于聚合酶链式反应的诊断仍然不适合常规使用，因为它的周转时间长，成本高，而且在正常工作时间以外无法获得，尽管它在某些情况下可能会有帮助。一旦警觉的临床医生考虑了疟疾的可能性，并且怀疑仍然很高，就可以通过重复涂片或RDT来排除疟疾。然而，没有临床怀疑的情况可能并不少见，并可能产生更严重的后果。根据当地发现的疟疾病例数量，实验室工作人员在决定对可疑样本进行未经请求的疟疾诊断测试时应具有较低的门槛，特别是在其他实验室测试异常的情况下(例如，血小板减少症、非典型淋巴细胞的存在或乳酸脱氢酶升高)。在全自动血细胞计数过程中检测白细胞内血吸虫是避免误诊临床上未被怀疑的疟疾的一种很有前途的新方法。
Malaria remains the most important parasitic disease, and tens of thousands of cases are imported into non-endemic countries annually. However, any single institution may see only a very few cases-this is probably the reason why laboratory and clinical misdiagnosis may not be uncommon. In the laboratory, unfamiliarity with microscopic diagnosis may be the main reason, considering the large number of laboratory staff who provide on-call services, often without expert help at hand, as well as the difficulty in detecting cases with low-level parasitemia. Staff should therefore be provided with continuing microscopic training to maintain proficiency. The complementary use of immunochromatographic rapid detection tests (RDTs) may be useful, especially during on-call hours, although, in order to ensure correct interpretation, their inherent limitations have to be well known. Diagnosis based on the polymerase chain reaction is still unsuitable for routine use, due to its long turnaround time, its cost, and its unavailability outside regular hours, although it may be helpful in selected cases. Once the alert clinician has considered the possibility of malaria, and suspicion continues to be high, malaria can be excluded by repeat smears or RDTs. However, the absence of clinical suspicion may not be infrequent, and may have more serious consequences. Depending on the local number of malaria cases seen, laboratory staff should have a low threshold for the decision to perform unsolicited malaria diagnostic tests on suspicious samples, especially if other laboratory tests are abnormal (e.g. thrombocytopenia, presence of atypical lymphocytes, or raised lactate dehydrogenase). The detection of intraleukocytic hemozoin during automated full blood counts is a promising new way to avoid misdiagnosis of clinically unsuspected malaria.