背景:恶性疟原虫是撒哈拉以南非洲的主要疟疾物种,是严重疾病和死亡的主要原因。尽管如此,据报道,严重的疟疾和非恶性疟原虫感染导致的死亡,但发病率远低于恶性疟原虫感染。在流行病学研究中越来越多地使用分子检测技术,据报道,该地区非恶性疟原虫的流行率比以前认为的要高。本文回顾了有关乌干达非恶性疟疾流行及其严重疾病临床数据的文献。它旨在阐明在高度疟疾流行的国家中,单一非恶性疟疾感染对疟疾死亡率的影响程度,并概述其对疟疾病例管理的政策影响。
方法:通过PubMed和GoogleScholar寻求截至2024年3月的可用英语发表的同行评审文献。使用的关键词是严重疟疾,还有恶性疟原虫,疟原虫,间日疟原虫,P.Ovalespp.,混合感染和乌干达。审查共53条。文章采用分子诊断方法进行解释分析。
结果:文献报道了乌干达非恶性疟原虫感染的大量流行。疟疾疟原虫和卵疟原虫。分别是仅次于恶性疟原虫的第二和第三大流行疟疾物种。非恶性疟疾感染通常以混合感染而不是单一感染的形式发生。此外,分子诊断显示,最初报告的恶性疟原虫单一感染的21%是,事实上,混合感染。没有发现有关混合或非恶性疟原虫感染引起的严重疟疾流行或病死率的文章。
结论:关于混合和非恶性疟原虫物种对乌干达严重疟疾和死亡的影响存在严重的知识差距。关于患病率的有力证据,复发性寄生虫血症,混合和非恶性疟疾感染的严重临床表现对于疟疾病例管理的循证和有效决策至关重要。
BACKGROUND: Plasmodium falciparum is the dominant malaria species in the sub-Saharan Africa and the main cause of severe disease and death. Notwithstanding, severe malaria and death due to non-falciparum infections have been reported, but at much lower rates than P. falciparum infections. Following increasing use of molecular detection techniques in epidemiological studies, a higher prevalence of non-falciparum species has been reported in the region than previously thought. This article reviews the literature on the prevalence of non-falciparum malaria species in Uganda and the clinical figures of their severe diseases. It aims to elucidate the extent to which mono non-falciparum malaria infections in a highly malaria-endemic country contribute to malaria mortality and outline its policy implications on malaria case management.
METHODS: The available English-language published peer-reviewed literature up to March 2024 was sought via PubMed and Google Scholar. The keywords used were severe malaria, AND P. falciparum, P. malariae, P. vivax, P. ovale spp., mixed infections AND Uganda. The review encompassed 53 articles. Articles using molecular diagnosis methods were accounted for analysis.
RESULTS: The literature reported a substantial prevalence of non-falciparum infections in Uganda. Plasmodium malariae and Plasmodium ovale spp. were the second and third most prevalent reported malaria species respectively after P. falciparum as dominant species. Non-falciparum malaria infections often occur as mixed infections rather than mono-infections. Besides, molecular diagnostics revealed that 21% of initially reported mono-infections of P. falciparum were, in fact, mixed infections. No article was found on the prevalence of severe malaria or case fatality rate due to mixed or non-falciparum infections.
CONCLUSIONS: A critical knowledge gap exists regarding the impact of mixed and non-falciparum species on severe malaria and death in Uganda. Robust evidence on prevalence, recurrent parasitaemia, and severe clinical manifestations of mixed and non-falciparum malaria infections is crucial for evidence-based and effective policymaking regarding malaria case management.