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首页> 外文期刊>Annals of tropical medicine and parasitology >Malaria diagnosis and treatment under the strategy of the integrated management of childhood illness (IMCI): relevance of laboratory support from the rapid immunochromatographic tests of ICT Malaria P.f/P.v and OptiMal.
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Malaria diagnosis and treatment under the strategy of the integrated management of childhood illness (IMCI): relevance of laboratory support from the rapid immunochromatographic tests of ICT Malaria P.f/P.v and OptiMal.

机译：儿童疾病综合管理（IMCI）策略下的疟疾诊断和治疗：ICT疟疾P.f / P.v和OptiMal的快速​​免疫色谱测试对实验室支持的意义。

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The algorithm developed for the integrated management of childhood illness (IMCI) provides guidelines for the treatment of paediatric malaria. In areas where malaria is endemic, for example, the IMCI strategy may indicate that children who present with fever, a recent history of fever and/or pallor should receive antimalarial chemotherapy. In many holo-endemic areas, it is unclear whether laboratory tests to confirm that such signs are the result of malaria would be very relevant or useful. Children from a holo-endemic region of Tanzania were therefore checked for malarial parasites by microscopy and by using two rapid immunochromatographic tests (RIT) for the diagnosis of malaria (ICT Malaria P.f/P.v and OptiMal. At the time they were tested, each of these children had been targeted for antimalarial treatment (following the IMCI strategy) because of fever and/or pallor. Only 70% of the 395 children classified to receive antimalarial drugs by the IMCI algorithm had malarial parasitaemias (68.4% had Plasmodium falciparum trophozoites, 1.3% only P. falciparum gametocytes, 0.3% P. ovale and 0.3% P. malariae). As indicators of P. falciparum trophozoites in the peripheral blood, fever had a sensitivity of 93.0% and a specificity of 15.5% whereas pallor had a sensitivity of 72.2% and a specificity of 50.8%. The RIT both had very high corresponding sensitivities (of 100.0% for the ICT and 94.0% for OptiMal) but the specificity of the ICT (74.0%) was significantly lower than that for OptiMal (100.0%). Fever and pallor were significantly associated with the P. falciparum asexual parasitaemias that equalled or exceeded the threshold intensity (2000/microl) that has the optimum sensitivity and specificity for the definition of a malarial episode. Diagnostic likelihood ratios (DLR) showed that a positive result in the OptiMal test (DLR = infinity) was a better indication of malaria than a positive result in the ICT (DLR = 3.85). In fact, OptiMal had diagnostic reliability (0.93) which approached that of an ideal test and, since it only detects live parasites, OptiMal is superior to the ICT in monitoring therapeutic responses. Although the RIT may seem attractive for use in primary health facilities because relatively inexperienced staff can perform them, the high cost of these tests is prohibitive. In holo-endemic areas, use of RIT or microscopical examination of bloodsmears may only be relevant when malaria needs to be excluded as a cause of illness (e.g. prior to treatment with toxic or expensive drugs, or during malaria epidemics). Wherever the effective drugs for the first-line treatment of malaria are cheap (e.g. chloroquine and Fansidar), treatment based on clinical diagnosis alone should prove cost-saving in health facilities without microscopy.
机译：为儿童疾病综合管理（IMCI）开发的算法为小儿疟疾的治疗提供了指南。例如，在疟疾流行地区，IMCI策略可能表明出现发热，近期有发热和/或苍白史的儿童应接受抗疟药化疗。在许多全流行地区，尚不清楚实验室测试以确认此类迹象是疟疾的结果是否非常相关或有用。因此，对来自坦桑尼亚全流行地区的儿童进行了显微镜检查，并使用两种快速免疫色谱测试（RIT）来诊断疟疾（ICT疟疾Pf / Pv和OptiMal），以检查是否有疟疾寄生虫。这些孩子因发烧和/或苍白而被定为抗疟疾治疗的对象（遵循IMCI策略）。按IMCI算法分类为接受抗疟药的395名儿童中，只有70％患有疟疾寄生虫血症（68.4％的恶性疟原虫滋养体为1.3）仅恶性疟原虫配子细胞，卵圆形疟原虫0.3％和疟疾疟原虫0.3％的百分比）作为外周血恶性疟原虫滋养体的指标，发烧的敏感性为93.0％，特异性为15.5％，而苍白的敏感性RIT的敏感性为72.2％，特异性为50.8％，RIT的敏感性都很高（ICT的敏感性为100.0％，OptiMal的敏感性为94.0％），但ICT的特异性（74.0％）明显低于ICT。 OptiMal（100.0％）。发烧和苍白与恶性疟原虫无性寄生虫病显着相关，其等于或超过阈值强度（2000 /微升），具有确定疟疾发作的最佳敏感性和特异性。诊断似然比（DLR）显示，与ICT的阳性结果（DLR = 3.85）相比，OptiMal测试的阳性结果（DLR =无穷大）更能说明疟疾。实际上，OptiMal的诊断可靠性（0.93）接近理想测试的可靠性，并且由于它只能检测到活的寄生虫，因此在监测治疗反应方面，它优于ICT。尽管RIT似乎可以在初级卫生保健机构中使用，因为相对缺乏经验的人员可以执行RIT，但是这些测试的高昂费用令人望而却步。在全流行地区，只有在需要将疟疾排除为疾病原因时（例如在使用有毒或昂贵的药物治疗之前或在疟疾流行期间），才可能需要使用RIT或对涂片进行显微镜检查。只要一线治疗疟疾的有效药物便宜（例如氯喹和Fansidar），仅凭临床诊断就可以在无需显微镜的情况下节省医疗机构的成本。

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