湖北省输入性卵形疟的实验室检测能力分析

Analysis of laboratory detection capabilities for imported Plasmodium ovale in Hubei Province

分析评估湖北省2种输入性基因型卵形疟原虫的实验室检测分型能力。收集2015—2018年全省输入性疟疾病例的血样,湖北省疟疾诊断参比实验室采用显微镜镜检法和巢式PCR检测进行复核分型。以巢式PCR复核卵形疟原虫阳性结果为准,与显微镜镜检和快速诊断检测(RDT)结果进行比较。2015—2018年,湖北省共复核确诊疟疾病例494例,湖北省疟疾参比实验室使用巢式PCR复核,共检测出卵形疟原虫感染76例(15.38%),其中经典亚种(卵形疟原虫柯氏亚种)50例(65.79%),变异亚种(卵形疟原虫沃氏亚种)26例(34.21%)。对于卵形疟原虫柯氏亚种,省级镜检检出48例卵形疟,符合率为96.00%,RDT的符合率为64.00%;对于卵形疟原虫沃氏亚种,省级镜检检出23例为卵形疟,符合率为88.46%,RDT的符合率为80.77%。市级疾病预防控制中心镜检检出37例卵形疟,符合率仅为48.68%。97.36%(74/76)的输入性卵形疟病例来自非洲国家。提示需加强对市级疾病预防控制机构的镜检培训,提高针对卵形疟原虫的鉴定能力;持续推广镜检与RDT相结合的方式,对输入性卵形疟病例进行诊断。

To assess the laboratory capabilities in two genetic types of imported Plasmodium ovale in Hubei Province.Blood samples were collected from imported malaria cases in the province during 2015—2018.All cases were rechecked and genotyped by the Hubei Provincial Diagnostic Reference Laboratory(Hubei DRL)using microscopy and nested polymerase chain reaction(nested PCR).The detection accuracy of imported P.ovale by microscopy and malaria rapid diagnostic test(RDT)were compared with the nested PCR,which was used as positive reference.During 2015—2018,a total of 494 malaria cases were confirmed in Hubei Province,of them 76 cases(15.38%)were identified of P.ovale infection by nested PCR,including 50(65.79%)P.ovale curtisi,a subspecies,and 26(34.21%)P.ovale wallikeri,a mutated subspecies.In examining the P.ovale curtisi,the Hubei DRL detected 48 cases by microscopy with a coincidence rate of microscopy and RDT was 96.00%and 64.00%,respectively.In examining the P.ovale wallikeri,the Hubei DRL detected 23 cases by microscopy with coincidence rate of microscopy and RDT was 88.46%and 80.77%,respectively.The microscopic examination in the city-level Center for Disease Control and Prevention(CDC)detected 37 cases of P.ovale,with an accuracy of only 48.68%.Overall,97.36%(74/76)of the P.ovale cases were from Africa.The results suggested that microscope operation training should be strengthened in city-level CDCs to improve the identification capability for P.ovale identification,and that the combined use of microscopy and RDT should be promoted for diagnosis of imported P.ovale malaria cases.