Performance of a highly sensitive rapid diagnostic test (HS-RDT) for detecting malaria in peripheral and placental blood samples from pregnant women in Colombia
Performance of a highly sensitive rapid diagnostic test (HS-RDT) for detecting malaria in peripheral and placental blood samples from pregnant women in Colombia
复制标题
DOI：
10.1371/journal.pone.0201769
复制
发表时间：
2018-08-02
期刊：
影响因子：
3.7
通讯作者：
Ding, Xavier
中科院分区：
文献类型：
--
作者：
Maria Vasquez, Ana;Catalina Medina, Ana;Ding, Xavier
背景怀孕对恶性疟原虫感染的诊断提出了特殊的挑战，因为寄生虫滞留在胎盘中，这意味着外周血循环水平较低。本研究的目的是评估一种新的高灵敏度快速诊断测试 (HS-RDT) 的性能，用于检测哥伦比亚孕妇的外周血和胎盘血样本中的疟疾。方法这是一项回顾性研究，使用从哥伦比亚疟疾流行地区孕妇采集的 737 份外周血和胎盘样本。进行了光学显微镜 (LM)、常规快速诊断测试（Pf/Pv RDT 和 Pf RDT）和 HS-RDT 测试。将LM、HS-RDT和RDT的诊断准确性终点与嵌套聚合酶链式反应（nPCR）作为参考测试进行比较。结果与nPCR相比，HS-RDT、Pf RDT、Pf/Pv RDT和LM检测外周样本感染的敏感性分别为85.7%（95% CI = 70.6-93.7）、82.8%（95% CI =分别为 67.391.9)、77.1% (95% CI = 61.0-87.9) 和 77.1% (95% CI = 61.0-87.9)。 HS-RDT 检测无症状女性疟疾的敏感性较高，其中 LM 和 Pf/Pv RDT 漏掉了 nPCR 检测到的一半感染，但差异并不显着。总体而言，所有测试的特异性均相似 (>99.0%)。在胎盘血液中，nPCR 测定的恶性疟原虫感染率为 2.8% (8/286)，HS-RDT 测定的感染率为 1%，传统 RDT（Pf RDT 和 Pf/Pv RDT）和 LM 测定的感染率为 0.7%。 HS-RDT 检测到外周血中胎盘感染，LM 和 Pf/Pv RDT 呈阴性，但阳性胎盘数量较低。 结论 与 ANC 就诊期间和分娩时常规使用的检测相比，HS-RDT 检测孕妇外周血和胎盘样本中恶性疟原虫感染的敏感性稍好。尽管需要进一步的研究来指导使用 HS-RDT 进行妊娠期疟疾病例管理的建议，但本研究表明该测试在低传播环境中诊断妊娠期疟疾的潜在价值。
BackgroundPregnancy poses specific challenges for the diagnosis of Plasmodium falciparum infection due to parasite sequestration in the placenta, which translates in low circulation levels in peripheral blood. The aim of this study is to assess the performance of a new highly sensitive rapid diagnostic test (HS-RDT) for the detection of malaria in peripheral and placental blood samples from pregnant women in Colombia.MethodsThis is a retrospective study using 737 peripheral and placental specimens collected from pregnant women in Colombian malaria-endemic regions. Light microscopy (LM), conventional rapid diagnostic tests (Pf/Pv RDT and Pf RDT), and HS-RDT testing were performed. Diagnostic accuracy endpoints of LM, HS-RDT and RDTs were compared with nested polymerase chain reaction (nPCR) as the reference test.ResultsIn comparison with nPCR, the sensitivity of HS-RDT, Pf RDT, Pf/Pv RDT and LM to detect infection in peripheral samples was 85.7% (95% CI = 70.6-93.7), 82.8% (95% CI = 67.391.9), 77.1 % (95% CI = 61.0-87.9) and 77.1 % (95% CI = 61.0-87.9) respectively. The sensitivity to detect malaria in asymptomatic women, was higher with HS-RDT, where LM and Pf/Pv RDT missed half of infections detected by nPCR, but differences were not significant. Overall, specificity was similar for all tests (>99.0%). In placental blood, the prevalence of infection by P. falciparum by nPCR was 2.8% (8/286), by HS-RDT was 1 % and by conventional RDTs (Pf RDT and Pf/Pv RDT) and LM was 0.7%. The HS-RDT detected placental infections in peripheral blood that were negative by LM and Pf/Pv RDT, however the number of positive placentas was low.ConclusionsThe sensitivity of HS-RDT to detect P. falciparum infections in peripheral and placental samples from pregnant women was slightly better compared to routinely used tests during ANC visits and at delivery. Although further studies are needed to guide recommendations on the use of the HS-RDT for malaria case management in pregnancy, this study shows the potential value of this test to diagnose malaria in pregnancy in low-transmission settings.