Changing patterns of Plasmodium blood-stage infections in the Wosera region of Papua New Guinea monitored by light microscopy and high throughput PCR diagnosis
Changing patterns of Plasmodium blood-stage infections in the Wosera region of Papua New Guinea monitored by light microscopy and high throughput PCR diagnosis
复制标题
DOI：
10.4269/ajtmh.2006.75.588
复制
发表时间：
2006-10-01
影响因子：
3.3
通讯作者：
Zimmerman, Peter A.
中科院分区：
文献类型：
--
作者：
Kasehagen, Laurin J.;Mueller, Ivo;Zimmerman, Peter A.
在巴布亚新几内亚（PNG），疟疾的复杂模式通常包括恶性疟原虫、间日疟原虫、三日疟原虫和卵形疟原虫的单一和混合感染。在这里，我们通过四个横断面调查（2001年8月至2003年6月），评估最近的流行病学特征的疟原虫血液阶段感染在沃塞拉地区。鉴于以前的研究在这里进行依赖于血液涂片/光学显微镜（LM）诊断疟原虫属感染，我们介绍了一种新开发的，后聚合酶链反应（PCR），半定量，连接酶检测反应-荧光微球测定（LDR-FMA）。两种方法对> 1，100份样本的直接比较显示，对恶性疟原虫（PF）、间日疟原虫（PV）和三日疟原虫（PM）进行的分析中，诊断一致率> 80%。LDR-FMA的更高灵敏度占诊断之间不一致性的75%。基于LM，发现与20世纪90年代初的调查相比，血液阶段PF、PV和PM感染的患病率显著降低。此外，感染的年龄分布发生了重大变化，PV成为4岁以下儿童中最常见的寄生虫。与先前的研究一致，在基于PCR的LDR-FMA分析的样本中，所有疟原虫属感染的患病率均显著增加。这种增加在PM、PO和混合感染以及青少年（10-19岁）和成人年龄组中最为明显，这表明LM可能导致较少见疟原虫种的患病率报告不足、感染复杂性以及感染向年轻年龄组的倾斜分布。这项研究表明，LDR-FMA诊断在大型流行病学研究或疟疾控制干预措施中的应用是可行的，并可能有助于对疟疾流行病学的新见解。
In Papua New Guinea (PNG), complex patterns of malaria commonly include single and mixed infections of Plasmodium falciparum, P. vivax, P. malariae, and P. ovale. Here, we assess recent epidemiologic characteristics of Plasmodium blood-stage infections in the Wosera region through four cross-sectional surveys (August 2001 to June 2003). Whereas previous studies performed here have relied on blood smear/light microscopy (LM) for diagnosing Plasmodium species infections, we introduce a newly developed, post-polymerase chain reaction (PCR), semi-quantitative, ligase detection reaction-fluorescent microsphere assay (LDR-FMA). A direct comparison of the two methods for > 1,100 samples showed that diagnosis was concordant for > 80% of the analyses performed for P. falciparum (PF), P. vivax (PV), and P. malariae (PM). Greater sensitivity of the LDR-FMA accounted for 75% of the discordance between diagnoses. Based on LM, the prevalence of blood-stage PF, PV, and PM infections was found to be markedly reduced compared with an early 1990s survey. In addition, there were significant shifts in age distribution of infections, with PV becoming the most common parasite in children < 4 years of age. Consistent with previous studies, prevalence of all Plasmodium species infections increased significantly in samples analyzed by the PCR-based LDR-FMA. This increase was most pronounced for PM, PO, and mixed infections and in adolescent (10-19 years) and adult age groups, suggesting that LM may lead to under-reported prevalence of less common Plasmodium species, infection complexity, and a skewed distribution of infections towards younger age groups. This study shows that the application of LDR-FMA diagnosis in large epidemiologic studies or malaria control interventions is feasible and may contribute novel insights regarding the epidemiology of malaria.