Malaria over-diagnosis in Cameroon:diagnostic accuracy of Fluorescence and Staining Technologies(FAST)Malaria Stain and LED microscopy versus Giemsa and bright field microscopy validated by polymerase chain reaction  

作　　者：Sean M.Parsel Steven A.Gustafson Edward Friedlander Alexander A.Shnyra Aderosoye J.Adegbulu Ying Liu Nicole M.Parrish Syed A.Jamal Eve Lofthus Leo Ayuk Charles Awasom Carolyn J.Henry Carole P.McArthur 

机构地区：[1]Department of Pathology,Kansas City University of Medicine and Biosciences,1750 Independence Ave,Kansas,MO 64106,USA [2]Department of Pharmacology and Microbiology,Kansas City University of Medicine and Biosciences,1750 Independence Ave,Kansas,MO 64106,USA [3]Royal Veterinary College,4 Royal College St,London NW10TU,UK [4]Department of Biostatistics and Epidemiology,East Tennessee State University,P.O.Box 70259,Johnson,TN 37614,USA [5]Department of Pathology,Division of Microbiology,Johns Hopkins Medical Institute,Meyer B1-193,600 North Wolfe Street,Baltimore,MD 21287,USA [6]Rockhurst University,1100 Rockhurst Rd,Kansas,MO 64110,USA [7]University of Missouri-Kansas City,School of Dentistry,650 E 25th Street,Kansas,MO 64108,USA [8]Cameroon Ministry of Health Regional Hospital,Bamenda,Cameroon [9]Department of Veterinary Medicine and Surgery,University of Missouri,900 East Campus Drive,Columbia,MO 65211,USA [10]Department of Otolaryngology,Tulane University School of Medicine,1430 Tulane Ave,New Orleans,LA 70115,USA

出　　处：《Infectious Diseases of Poverty》2017年第1期274-282,共9页贫困所致传染病（英文）

基　　金：Support for this study was via a grant to SG from Kansas City University of Medicine and Biosciences and support for the stain and LED microscopes was to CM from QBC Diagnostics and the University of Missouri-Kansas City;Additional funding for supplies was provided from QBC and additional support for education and training of personnel in Cameroon was a gift to CM from the Shumaker Foundation,Kansas City.

摘　　要：Background:Malaria is a major world health issue and its continued burden is due,in part,to difficulties in the diagnosis of the illness.The World Health Organization recommends confirmatory testing using microscopy-based techniques or rapid diagnostic tests(RDT)for all cases of suspected malaria.In regions where Plasmodium species are indigenous,there are multiple etiologies of fever leading to misdiagnoses,especially in populations where HIV is prevalent and children.To determine the frequency of malaria infection in febrile patients over an 8-month period at the Regional Hospital in Bamenda,Cameroon,we evaluated the clinical efficacy of the Flourescence and Staining Technology(FAST)Malaria stain and ParaLens AdvanceTM microscopy system(FM)and compared it with conventional bright field microscopy and Giemsa stain(GS).Methods:Peripheral blood samples from 522 patients with a clinical diagnosis of“suspected malaria”were evaluated using GS and FM methods.A nested PCR assay was the gold standard to compare the two methods.PCR positivity,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were determined.Results:Four hundred ninety nine samples were included in the final analysis.Of these,30 were positive via PCR(6.01%)with a mean PPV of 19.62%and 27.99%for GS and FM,respectively.The mean NPV was 95.01%and 95.28%for GS and FM,respectively.Sensitivity was 26.67%in both groups and specificity was 92.78%and 96.21%for GS and FM,respectively.An increased level of diagnostic discrepancy was observed between technicians based upon skill level using GS,which was not seen with FM.Conclusions:The frequency of malarial infections confirmed via PCR among patients presenting with fever and other symptoms of malaria was dramatically lower than that anticipated based upon physicians’clinical suspicions.A correlation between technician skill and accuracy of malaria diagnosis using GS was observed that was less pronounced using FM.Additionally,FM increased the specificity and improved the P

关 键 词：MALARIA Fluorescent microscopy GIEMSA Diagnostic accuracy 

分 类 号：R53[医药卫生—内科学]