Estimation of Plasmodium falciparum Transmission Intensity in Lilongwe, Malawi, by Microscopy, Rapid Diagnostic Testing, and Nucleic Acid Detection
Estimation of Plasmodium falciparum Transmission Intensity in Lilongwe, Malawi, by Microscopy, Rapid Diagnostic Testing, and Nucleic Acid Detection
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DOI：
10.4269/ajtmh.16-0156
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发表时间：
2016-08-01
影响因子：
3.3
通讯作者：
Juliano, Jonathan J.
中科院分区：
文献类型：
--
作者：
Parr, Jonathan B.;Belson, Connor;Juliano, Jonathan J.
对疟疾传播强度的估计通常依赖于显微镜检查或快速诊断检测。然而，这些方法不如核酸扩增技术敏感，可能低估寄生虫的流行。我们比较了显微镜，RDT和聚合酶链反应（PCR）诊断恶性疟原虫寄生虫血症的MTI研究的一部分，800名儿童和成人在马拉维利隆圭进行。PCR检测寄生虫血症的病例数多于镜检或RDT。年龄小于5岁预测单独PCR检测到的寄生虫血症（调整的比值比= 1.61，95%置信区间= 1.09-2.38，Wald P = 0.02）。此外，我们确定了一个恶性疟原虫假阴性RDT结果，由于怀疑缺失组氨酸蛋白2（hrp 2）基因，并使用一种新的，超灵敏的PCR检测方法来检测传统的PCR错过了低水平的寄生虫血症。应考虑在未来的传播研究中使用分子方法作为RDT或显微镜的补充。
Estimates of malaria transmission intensity (MTI) typically rely upon microscopy or rapid diagnostic testing (RDT). However, these methods are less sensitive than nucleic acid amplification techniques and may underestimate parasite prevalence. We compared microscopy, RDT, and polymerase chain reaction (PCR) for the diagnosis of Plasmodium falciparum parasitemia as part of an MTI study of 800 children and adults conducted in Lilongwe, Malawi. PCR detected more cases of parasitemia than microscopy or RDT. Age less than 5 years predicted parasitemia detected by PCR alone (adjusted odds ratio = 1.61, 95% confidence interval = 1.09-2.38, Wald P = 0.02). In addition, we identified one P falciparum parasite with a false-negative RDT result due to a suspected deletion of the histidinerich protein 2 (hrp2) gene and used a novel, ultrasensitive PCR assay to detect low-level parasitemia missed by traditional PCR. Molecular methods should be considered for use in future transmission studies as a supplement to RDT or microscopy.