Analysis of inconsistence of Plasmodium detection in some malaria cases

doi:10.12140/j.issn.1000-7423.2019.04.017

Abstract

Abstract:

Microscopic examination, PCR and rapid diagnostic test (RDT) are three major methods commonly used for detecting Plasmodium and diagnosing malaria. During the re-check and confirmation of diagnosis of malaria cases in national and provincial malaria diagnosis laboratories, it is common to observe the inconsistence in the results of three detection methods for the same blood sample, even reversing the final diagnosis at the end in some cases. For this reason, the literature related to the sensitivity and specificity of the three detection methods was collected and analyzed combining with our practical experience in order to provide reference for better understanding and encountering the inconsistence for those who meet the similar situation.

Key words: Microscopic examination, Polymerase chain reaction, Malaria rapid diagnostic test, Case confirmation, Sensitivity

CLC Number:

R531.3

Mei LI, Zhi-gui XIA, Shui-sen ZHOU. Analysis of inconsistence of Plasmodium detection in some malaria cases[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2019, 37(4): 464-471.

Figures/Tables 3

References 56

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分类	治疗至RDT阴性时的天数/d
	50%的患者显示阴性		95%的患者显示阴性
	预测平均值	95%CI	预测平均值	95%CI
RDT类型
HRP2-RDT产品	15	5~32	36	21~61
HRP2+ pLDH-RDT 产品	7	2~20	24	11~43
pLDH-RDT产品	2	1~7	10	3~24
治疗方式
ACT	8	3~21	27	13~43
非ACT	4	2~14	19	8~34
年龄
成年人	4	1~15	19	6~36
儿童	11	3~25	31	14~49

序号	镜检	PCR	RDT	首要原因^a	解决方案	结果判断
1	+	+	-	②	/	阳性,虫种以PCR为准
2	+	-	+	低原虫血症时：⑧; 高原虫血症时：⑨	原虫血症较低时,镜检结果拍照待复核,选择更敏感的PCR扩增体系再测,或属引物扩增500 bp以上DNA序列并测序;原虫血症较高时,属引物扩增500 bp以上DNA序列并测序	阳性,虫种以镜检或测序结果为准
3	+	-	-	低原虫血症时：⑧; 高原虫血症时：⑨	原虫血症较低时,镜检结果拍照待复核,选择更敏感PCR扩增体系再测,或属引物扩增500 bp以上DNA序列并测序;原虫血症较高时,属引物扩增500 bp以上DNA序列并测序	阳性,虫种以PCR或测序结果为准
4	-	+	+	①	结合临床和服药史,或未/不服用抗疟药物追踪观察至少3~6 d	阳性,虫种以PCR结果为准
5	-	+	-	①②	结合临床和服药史,或未/不服用抗疟药物追踪观察3~6 d	阳性,虫种以PCR结果为准
6	-	-	+	①⑦	选择更敏感PCR扩增体系再测,或结合临床和服药史,或未/不服用抗疟药物前提下追踪观察至少8 d	再测阳性,以PCR结果为准;再测阴性,以临床或后续追踪结果为准