Rapid diagnostic tests for malaria at sites of varying transmission intensity in Uganda
Rapid diagnostic tests for malaria at sites of varying transmission intensity in Uganda
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DOI：
10.1086/526502
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发表时间：
2008-02-15
影响因子：
6.4
通讯作者：
Dorsey, Grant
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文献类型：
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作者：
Hopkins, Heidi;Bebell, Lisa;Dorsey, Grant
背景资料。在非洲，发烧经常被推定为疟疾，导致误诊和过度使用抗疟疾药物。疟疾的快速诊断试验(RDT)可能会改善发烧管理。我们对乌干达不同疟疾传播强度的7000名患者进行了基于富含组氨酸蛋白2(HRP2)的RDT和基于疟原虫乳酸脱氢酶(PLDH)的RDT的专家显微镜和PCR校正显微镜的比较。当考虑所有部位时，基于HRP2的检测与显微镜相比的敏感性为97%，经PCR校正的敏感性为98%；基于pLDH的检测的敏感性与显微镜相比为88%，经PCR校正的敏感性为77%。与显微镜相比，基于HRP2的检测的特异度为71%，经PCR校正的特异度为88%；与显微镜相比，基于pLDH的测试的特异度为92%，经PCR校正的特异度为98%。基于恶性疟原虫聚合酶链式反应校正的镜检，除传播率最低的部位外，基于HRP2的检测的阳性预测值(PPV)都很高(93%)；基于pLDH的检测和专家显微镜对所有部位的阳性预测值(PPV)都很高(98%)。基于HRP2的检测的阴性预测值(NPV)一直很高(97%)；相反，随着传播强度的增加，基于pLDH的检测的NPV显著下降(从98%降至66%)，而专家显微镜的NPV显著下降(99%至54%)，原因是亚专利寄生虫病的漏检率增加。基于较高的PPV和NPV，基于HRP2的RDT很可能是非洲疟疾传播率中高的地区的最佳诊断选择。
Background. In Africa, fever is often treated presumptively as malaria, resulting in misdiagnosis and the overuse of antimalarial drugs. Rapid diagnostic tests (RDTs) for malaria may allow improved fever management.Methods. We compared RDTs based on histidine-rich protein 2 (HRP2) and RDTs based on Plasmodium lactate dehydrogenase (pLDH) with expert microscopy and PCR-corrected microscopy for 7000 patients at sites of varying malaria transmission intensity across Uganda.Results. When all sites were considered, the sensitivity of the HRP2-based test was 97% when compared with microscopy and 98% when corrected by PCR; the sensitivity of the pLDH-based test was 88% when compared with microscopy and 77% when corrected by PCR. The specificity of the HRP2-based test was 71% when compared with microscopy and 88% when corrected by PCR; the specificity of the pLDH-based test was 92% when compared with microscopy and >98% when corrected by PCR. Based on Plasmodium falciparum PCR-corrected microscopy, the positive predictive value (PPV) of the HRP2-based test was high (93%) at all but the site with the lowest transmission rate; the pLDH-based test and expert microscopy offered excellent PPVs (98%) for all sites. The negative predictive value (NPV) of the HRP2-based test was consistently high (>97%); in contrast, the NPV for the pLDH-based test dropped significantly (from 98% to 66%) as transmission intensity increased, and the NPV for expert microscopy decreased significantly (99% to 54%) because of increasing failure to detect subpatent parasitemia.Conclusions. Based on the high PPV and NPV, HRP2-based RDTs are likely to be the best diagnostic choice for areas with medium-to-high malaria transmission rates in Africa.