Challenges in diagnosing paediatric malaria in Dar es Salaam, Tanzania

Malaria Journal

Research

Nina Langeland¹  Bjørn Blomberg²  Gro EA Strøm³  Maulidi Fataki⁴  Christel G Haanshuus⁵ 

[1] Department of Clinical Science, University of Bergen, Bergen, Norway;Department of Clinical Science, University of Bergen, Bergen, Norway;National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway;Department of Clinical Science, University of Bergen, Bergen, Norway;National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway;Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;Muhimbili National Hospital, Dar es Salaam, Tanzania;National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway;

关键词: Malaria;    Diagnostics;    Polymerase chain reaction;    Blood microscopy;    Rapid diagnostic test;    Tanzania;    Paediatrics;    Fever;   

DOI  :  10.1186/1475-2875-12-228

 received in 2013-03-27, accepted in 2013-06-28,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundMalaria is a major cause of paediatric morbidity and mortality. As no clinical features clearly differentiate malaria from other febrile illnesses, and malaria diagnosis is challenged by often lacking laboratory equipment and expertise, overdiagnosis and overtreatment is common.MethodsChildren admitted with fever at the general paediatric wards at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania from January to June 2009 were recruited consecutively and prospectively. Demographic and clinical features were registered. Routine thick blood smear microscopy at MNH was compared to results of subsequent thin blood smear microscopy, and rapid diagnostics tests (RDTs). Genus-specific PCR of Plasmodium mitochondrial DNA was performed on DNA extracted from whole blood and species-specific PCR was done on positive samples.ResultsAmong 304 included children, 62.6% had received anti-malarials during the last four weeks prior to admission and 65.1% during the hospital stay. Routine thick blood smears, research blood smears, PCR and RDT detected malaria in 13.2%, 6.6%, 25.0% and 13.5%, respectively. Positive routine microscopy was confirmed in only 43% (17/40), 45% (18/40) and 53% (21/40), by research microscopy, RDTs and PCR, respectively. Eighteen percent (56/304) had positive PCR but negative research microscopy. Reported low parasitaemia on routine microscopy was associated with negative research blood slide and PCR. RDT-positive cases were associated with signs of severe malaria. Palmar pallor, low haemoglobin and low platelet count were significantly associated with positive PCR, research microscopy and RDT.ConclusionsThe true morbidity attributable to malaria in the study population remains uncertain due to the discrepancies in results among the diagnostic methods. The current routine microscopy appears to result in overdiagnosis of malaria and, consequently, overuse of anti-malarials. Conversely, children with a false positive malaria diagnosis may die because they do not receive treatment for the true cause of their illness. RDTs appear to have the potential to improve routine diagnostics, but the clinical implication of the many RDT-negative, PCR-positive samples needs to be elucidated.

【 授权许可】

CC BY   
© Strøm et al.; licensee BioMed Central Ltd. 2013