Accuracy of malaria diagnosis by clinical laboratories in Belgium
Accuracy of malaria diagnosis by clinical laboratories in Belgium
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DOI：
10.1186/s12936-019-2731-0
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发表时间：
2019-03-28
期刊：
影响因子：
3
通讯作者：
Jacobs, Jan
中科院分区：
文献类型：
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作者：
Loomans, Laura;Botella, Anali Conesa;Jacobs, Jan
背景比利时疟原虫参考实验室向临床实验室提供疟疾阳性或可疑样本的免费参考检测。方法将参考实验室（显微镜、快速诊断测试 (RDT) 和疟原虫物种特异性 PCR）的最终疟疾诊断与比利时周边实验室的最终诊断进行比较。对 2013 年至 2017 年间提交的所有样本的参考实验室报告进行了分析。评估标准包括疟疾的诊断、疟原虫种类鉴定（包括混合感染）以及恶性疟原虫的寄生虫密度以及有性和无性阶段的存在。结果总共纳入了 947 个非重复样本。参考测试确认提交的样本分别为96.3%（893/927）和90.0%（18/20）呈阳性和阴性，两次漏诊样本为卵形疟原虫和三日疟原虫。提交实验室在 95.1% (508/534) 的恶性疟原虫单一感染样本中正确鉴定出恶性疟原虫。他们在 62.9% (95/151) 的单个非恶性疟原虫样本中正确诊断出该物种，并在另外 26 个 (17.2%) 样本中报告了非恶性疟原虫；大多数错误发生在三日疟 (n=8/21, 38.1%) 和卵形疟 (n=14/51, 27.5%) 中。提交实验室诊断出 21 种混合疟原虫种类感染中只有一种；其中三例中，恶性疟原虫被忽视了。将单一感染和混合感染综合起来，恶性疟原虫的诊断率为 98.6% (546/554)。在可供比较的 471 个恶性疟原虫单一样本中，实验室正确报告了 87.5% (70/80) 样本中寄生虫密度高于 2%；他们错误地报告了另外 52 个 (8.9%) 样本中的寄生虫密度 >2%。实验室分别正确报告了 25.6% (11/43) 和 56.7% (17/30) 样本中的恶性疟原虫裂殖体和配子体。 结论 疟疾非流行环境中的诊断实验室对疟疾和恶性疟原虫提供了出色的诊断，对非恶性疟原虫感染进行了相当好的诊断，并对恶性疟原虫寄生虫密度进行了可接受的计算。
BackgroundThe Belgian Reference Laboratory for Plasmodium offers a free-of-charge reference testing of malaria-positive or doubtful samples to clinical laboratories.MethodsThe final malaria diagnosis from the Reference Laboratory (microscopy, rapid diagnostic tests (RDTs) and Plasmodium species-specific PCR) were compared with the final diagnosis from peripheral Belgian laboratories. The Reference Laboratory reports were analysed for all samples submitted between 2013 and 2017. Criteria assessed included the diagnosis of malaria, Plasmodium species identification including mixed infections, and in case of Plasmodium falciparum, the parasite density and the presence of sexual and asexual stages.ResultsA total of 947 non-duplicate samples were included. Reference testing confirmed 96.3% (893/927) and 90.0% (18/20) samples submitted as positive and negative, respectively, the two missed diagnoses were samples with Plasmodium ovale and Plasmodium malariae. Submitting laboratories had correctly identified P. falciparum in 95.1% (508/534) samples with P. falciparum single infection. They had correctly diagnosed the species in 62.9% (95/151) single non-falciparum samples and had reported non-falciparum' in another 26 (17.2%) samples; most errors occurred among P. malariae (n=8/21, 38.1%) and P. ovale (n=14/51, 27.5%). Only one of the 21 mixed Plasmodium species infections had been diagnosed as such by the submitting laboratories; in three of them, P. falciparum had been overlooked. Taken single and mixed infections together, P. falciparum was diagnosed in 98.6% (546/554) samples. Among 471 single P. falciparum samples available for comparison, laboratories had correctly reported parasite densities above 2% in 87.5% (70/80) samples; they had incorrectly reported parasite densities>2% in an extra 52 (8.9%) samples. Laboratories had correctly reported P. falciparum schizonts and gametocytes in 25.6% (11/43) and 56.7% (17/30) samples, respectively.ConclusionDiagnostic laboratories in a malaria non-endemic setting provided excellent diagnosis of malaria and P. falciparum, reasonably good diagnosis of non-falciparum infections and acceptable calculation of P. falciparum parasite density.