Accuracy of a rapid diagnostic test on the diagnosis of malaria infection and of malaria - attributable fever during low and high transmission season in Burkina Faso
Accuracy of a rapid diagnostic test on the diagnosis of malaria infection and of malaria - attributable fever during low and high transmission season in Burkina Faso
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DOI：
10.1186/1475-2875-9-192
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发表时间：
2010-07-07
期刊：
影响因子：
3
通讯作者：
Van den Ende, Jef
中科院分区：
文献类型：
--
作者：
Bisoffi, Zeno;Sirima, Sodiomon B.;Van den Ende, Jef
背景：疟疾管理政策目前建议只有在实验室确认后才能进行治疗。在无法使用显微镜的情况下，快速诊断测试（RDTs）是通常的替代方法。目前仍缺乏关于基于测试的儿童策略安全性的结论性证据。此外，还没有正式尝试估计RDT对疟疾引起的发热的准确性。本研究的目的是在估计的准确性RDT的诊断疟疾感染和疟疾引起的发热，在布基纳法索的一个地区，具有典型的季节性疟疾传播pattern.Methods：横断面研究。受试者：在研究期间咨询的年龄> 6个月的所有患者。诊断疟疾感染的金标准是显微镜检查。疟疾引起发热的金标准是通过比较发热与非发热受试者的寄生虫密度估计的疟疾引起发热的数量。排除标准：结果：在旱季，186/852例发热患者（22%）和213/1,382例无发热患者（15%）有恶性疟原虫感染。在雨季，这一比例分别为841/1，317（64%）和623/1，669（37%）。发热归因于疟疾的比例分别为11%和69%。旱季RDT阳性113/ 400例（28.3%），雨季RDT阳性443/650例（68.2%）。在旱季，RDT对疟疾感染的敏感性和特异性分别为86%和90%。在雨季，它们分别为94%和78%。在旱季，RDT诊断疟疾发热的敏感性和特异性分别为94%和75%，阳性预测值（PPV）为9%，阴性预测值（NPV）为99.8%。在雨季，疟疾引起的发热的检测灵敏度为97%，特异性为55%。PPV范围从成人的38%到82%的婴儿，而NPV范围从84%的婴儿到超过99%for adult.Conclusions：在旱季RDT有一个低的阳性预测值，但一个非常高的阴性预测值疟疾引起的发热。在雨季，阴性检测可以安全地排除成人疟疾，但不能排除儿童疟疾。
Background: Malaria management policies currently recommend that the treatment should only be administered after laboratory confirmation. Where microscopy is not available, rapid diagnostic tests (RDTs) are the usual alternative. Conclusive evidence is still lacking on the safety of a test-based strategy for children. Moreover, no formal attempt has been made to estimate RDTs accuracy on malaria-attributable fever. This study aims at estimating the accuracy of a RDT for the diagnosis of both malaria infection and malaria-attributable fever, in a region of Burkina Faso with a typically seasonal malaria transmission pattern.Methods: Cross-sectional study. Subjects: all patients aged > 6 months consulting during the study periods. Gold standard for the diagnosis of malaria infection was microscopy. Gold standard for malaria-attributable fever was the number of fevers attributable to malaria, estimated by comparing parasite densities of febrile versus non-febrile subjects. Exclusion criteria: severe clinical condition needing urgent care.Results: In the dry season, 186/852 patients with fever (22%) and 213/1,382 patients without fever (15%) had a Plasmodium falciparum infection. In the rainy season, this proportion was 841/1,317 (64%) and 623/1,669 (37%), respectively. The attributable fraction of fever to malaria was 11% and 69%, respectively. The RDT was positive in 113/ 400 (28.3%) fever cases in the dry season, and in 443/650 (68.2%) in the rainy season. In the dry season, the RDT sensitivity and specificity for malaria infection were 86% and 90% respectively. In the rainy season they were 94% and 78% respectively. In the dry season, the RDT sensitivity and specificity for malaria-attributable fever were 94% and 75%, the positive predictive value (PPV) was 9% and the negative predictive value (NPV) was 99.8%. In the rainy season the test sensitivity for malaria-attributable fever was 97% and specificity was 55%. The PPV ranged from 38% for adults to 82% for infants, while the NPV ranged from 84% for infants to over 99% for adults.Conclusions: In the dry season the RDT has a low positive predictive value, but a very high negative predictive value for malaria-attributable fever. In the rainy season the negative test safely excludes malaria in adults but not in children.