Diagnostic Performance of Conventional and Ultrasensitive Rapid Diagnostic Tests for Malaria in Febrile Outpatients in Tanzania.
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16 avril 2019
- doi: 10.1093/infdis/jiy676
- issn: 0022-1899
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info:eu-repo/semantics/altIdentifier/doi/10.1093/infdis/jiy676
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info:eu-repo/semantics/altIdentifier/pmid/30476111
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info:eu-repo/semantics/altIdentifier/eissn/1537-6613
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info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_BF9ED9BE8E738
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Ague Chills and fever Intermittent fever Malarial feverCiter ce document
N.E. Hofmann et al., « Diagnostic Performance of Conventional and Ultrasensitive Rapid Diagnostic Tests for Malaria in Febrile Outpatients in Tanzania. », Serveur académique Lausannois, ID : 10.1093/infdis/jiy676
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Résumé
A novel ultrasensitive malaria rapid diagnostic test (us-RDT) has been developed for improved active Plasmodium falciparum infection detection. The usefulness of this us-RDT in clinical diagnosis and fever management has not been evaluated. Diagnostic performance of us-RDT was compared retrospectively to that of conventional RDT (co-RDT) in 3000 children and 515 adults presenting with fever to Tanzanian outpatient clinics. The parasite density was measured by an ultrasensitive qPCR (us-qPCR), and the HRP2 concentration was measured by an enzyme-linked immunosorbent assay. us-RDT identified few additional P. falciparum-positive patients as compared to co-RDT (276 vs 265 parasite-positive patients detected), with only a marginally greater sensitivity (75% vs 73%), using us-qPCR as the gold standard (357 parasite-positive patients detected). The specificity of both RDTs was >99%. Five of 11 additional patients testing positive by us-RDT had negative results by us-qPCR. The HRP2 concentration was above the limit of detection for co-RDT (>3653 pg of HRP2 per mL of blood) in almost all infections (99% [236 of 239]) with a parasite density >100 parasites per µL of blood. At parasite densities 793 pg/mL) and co-RDT in 29 (25%) and 24 (20%) of 118 patients, respectively. There is neither an advantage nor a risk of using us-RDT, rather than co-RDT, for clinical malaria diagnosis. In febrile patients, only a small proportion of infections are characterized by a parasite density or an HRP2 concentration in the range where use of us-RDT would confer a meaningful advantage over co-RDT.