CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES >
Analysis of the causes of misdiagnosis of seven imported malaria cases in Shanghai from 2020 to 2021
Received date: 2022-06-10
Revised date: 2022-10-11
Online published: 2023-02-27
Supported by
Shanghai Scientific and Technological Innovation Action Plan(20DZ2200300);Fifth Round Three-Year Action Plan on Key Subject of Shanghai Public Health System Construction(GWV-10.1-XK13)
Objective Comprehensive analysis of laboratory test results of the samples from imported malaria cases to determine the causes of misdiagnosis, to provide reference for reducing the occurrence of misdiagnosis. Methods A total of 112 samples of imported malaria cases reported by each district centers for disease control and prevention (CDCs) from 2020 to 2021 were collected, including blood smears, anticoagulated blood, and Plasmodium genomic DNA extracted by district CDCs (district CDC group). The samples were rechecked by the municipal malaria reference laboratories through microscopic examination, genomic DNA extraction (municipal CDC group) and multiplex PCR assay, respectively. Among the samples of microscopic positives, where as real time quantitative PCR (qPCR) negatives reported by the district CDC, additional qPCR was conducted to plot amplification curves, determine the cycle threshold (Ct) values and compare the concentration and purity of DNA between the two groups. Results Microscopic examination was performed for 112 samples and nuclear acid detection were performed for 110 samples by the district CDCs. 108 were positive samples of Plasmodium and 4 were negative samples. The microscopic concordance rate was 93.8% (105/112), as reviewed by the municipal CDC. Among them, the positive concordance rate was 94.1% (96/102) and the negative concordance rate was 9/10. A total of seven imported malaria cases were screened for misdiagnosis. Three samples had qualitative identification mistakes by the district CDCs (two P. falciparum cases were misdiagnosed as negative, and one negative case was misdiagnosed as P. falciparum). Four samples have species identification mistakes, one sample was P. malariae misdiagnosed as P. ovale, one sample was P. malariae misdiagnosed as undefined, and two samples were P. ovale misdiagnosed as P. vivax. The concordance rate of nucleic acid detection was 96.4% (106/110), as reviewed by the municipal CDC, with a positive concordance rate of 96.2% (102/106) and a negative concordance rate of 4/4. In seven misdiagnosed cases, there were no amplifications of multiplex PCR the district CDC group, and normal amplifications in the municipal CDC group. The qPCR detections were amplified normally in both district and municipal CDC groups, and the corresponding samples in the municipal CDC group had lower Ct values and the amplification curve entered the exponential growth phase earlier. The DNA concentrations in the district CDC group were all greater than those in municipal CDC group, while municipal CDC group had higher DNA purity. Conclusion Relevant district CDCs need to improve their microscopic examination capability for Plasmodium, and use appropriate DNA extraction kits and qPCR kits for Plasmodium nucleic acid detection.
ZHANG Yaoguang , JIANG Li , WANG Zhenyu , ZHU Min , ZHU Qian , MA Xiaojiang , YU Qing , Chen Jian . Analysis of the causes of misdiagnosis of seven imported malaria cases in Shanghai from 2020 to 2021[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2023 , 41(1) : 68 -74 . DOI: 10.12140/j.issn.1000-7423.2023.01.010
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