Summary of discordant results between rapid diagnosis tests, microscopy, and polymerase chain reaction for detecting Plasmodium mixed infection: a systematic review and meta-analysis
Summary of discordant results between rapid diagnosis tests, microscopy, and polymerase chain reaction for detecting Plasmodium mixed infection: a systematic review and meta-analysis
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DOI：
10.1038/s41598-020-69647-y
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发表时间：
2020-07-29
影响因子：
4.6
通讯作者：
Masangkay, Frederick Ramirez
中科院分区：
文献类型：
--
作者：
Kotepui, Manas;Kotepui, Kwuntida Uthaisar;Masangkay, Frederick Ramirez
疟疾快速诊断试验（RDTs）被广泛用于在无法使用显微镜的疟疾流行区检测疑似疟疾感染的患者中的疟原虫。然而，很少有人知道RDT在检测疟原虫混合感染的性能。本研究的目的是评估RDT和显微镜/聚合酶链反应（PCR）检测疟原虫混合感染的不一致结果。对PubMed（MEDLINE）、Web of Science和Scopus数据库进行了系统性综述，以确定报告RDT检测疟原虫混合感染性能的相关研究。根据不同的RDT类型对研究进行分组，包括RDT 2型（pf-HRP 2/pan-aldolase）、RDT 3型（pf-HRP 2/pan-pLDH）、RDT 4型（Pf-LDH/pan-pLDH）、RDT 5型（Pf/Pv-pLDH）和RDT 6型（pf-HRP 2/Pv-pLDH），以进行亚组分析。在森林图中直观总结的每个分析组中不同比例的估计值显示了比值比（OR）和95%置信区间（CI）。使用RevMan（版本5.3;科克伦社区）绘制图。本研究纳入了28项研究。总体而言，荟萃分析显示，RDT检测疟原虫混合感染的比例显著高于显微镜检查（p=0.0007，OR=3.33，95% CI 1.66-6.68）。亚组分析表明，只有靶向Pf-specific histidine protein 2（HRP 2）/泛特异性乳酸脱氢酶（LDH）的RDT才能检测到比显微镜检查显着更高比例的疟原虫混合感染（p=0.004，OR=8.46，95%CI 2.75-26.1）。RDT和PCR方法之间的亚组分析表明，靶向Pf-specific HRP 2/Pv-specific LDH的RDT可以检测到比PCR方法显著更低比例的疟原虫混合感染（p=0.0005，OR=0.42，95%CI 0.26-0.68）。这是第一项总结RDTs和显微镜/PCR检测疟原虫混合感染结果不一致的研究。以Pf-HRP 2/pan-pLDH为靶点的疟疾RDTs检测疟原虫混合感染的比例高于显微镜法，而以Pf-HRP 2/PV特异性LDH为靶点的疟疾RDTs检测疟原虫混合感染的比例低于PCR法。本研究的结果将支持RDT的选择和仔细解释，以更好地诊断疟原虫混合种属感染，并在地方性和非地方性环境中对疟疾患者进行适当治疗。
Malaria rapid diagnostic tests (RDTs) are widely used to detect malaria parasites among patients who suspected malaria infections in malaria-endemic areas where microscopy is unavailable. Nevertheless, little is known about the performance of RDTs in detecting Plasmodium mixed infections. The present study aimed to evaluate the discordant results between RDTs and microscopy/polymerase chain reaction (PCR) in detecting Plasmodium mixed infections. The PubMed (MEDLINE), Web of Science, and Scopus databases were systematically reviewed to identify related studies that reported the performance of RDTs in detecting Plasmodium mixed infections. Studies were grouped according to the different RDT types including RDT type 2 (pf-HRP2/pan-aldolase), RDT type 3 (pf-HRP2/pan-pLDH), RDT type 4 (Pf-LDH/pan-pLDH), RDT type 5 (Pf/Pv-pLDH), and RDT type 6 (pf-HRP2/Pv-pLDH) for subgroup analysis. The estimates of the different proportions in each analysis group that were visually summarized in a forest plot showed the odds ratio (OR) and 95% confidence interval (CI). Plots were drawn using RevMan (version 5.3; Cochrane Community). Twenty-eight studies were included in the present study. Overall, the meta-analysis showed that RDTs could detect a significantly higher proportion of Plasmodium mixed infections than microscopy (p=0.0007, OR=3.33, 95% CI 1.66-6.68). Subgroup analysis demonstrated that only RDTs targeting Pf-specific histidine-rich protein 2 (HRP2)/pan-specific lactate dehydrogenase (LDH) could detect a significantly higher proportion of Plasmodium mixed infections than microscopy (p=0.004, OR=8.46, 95% CI 2.75-26.1). The subgroup analysis between RDTs and PCR methods demonstrated that RDTs targeting Pf-specific HRP2/Pv-specific LDH could detect a significantly lower proportion of Plasmodium mixed infections than PCR methods (p=0.0005, OR=0.42, 95% CI 0.26-0.68). This is the first study to summarize the discordant results between RDTs and microscopy/PCR in detecting Plasmodium mixed infections. Malaria RDTs targeting Pf-HRP2/pan-pLDH could detect a higher proportion of Plasmodium mixed infections than microscopy, while RDTs targeting Pf-HRP2/Pv-specific LDH could detect a lower proportion of Plasmodium mixed infections than PCR methods. The results of this study will support the selection and careful interpretations of RDTs for a better diagnosis of Plasmodium mixed-species infections and appropriate treatment of malaria patients in endemic and non-endemic settings.