背景:疟疾仍然是一种严重的寄生虫病,对公共健康构成重大威胁,阻碍撒哈拉以南非洲的经济发展。埃塞俄比亚,一个疟疾流行的国家,正面临着这种疾病的死灰复燃,发病率稳步上升。常规诊断方法,比如显微镜,由于低寄生虫密度而变得不太有效,特别是在达菲阴性的非洲人群中。制定综合控制策略,在该疾病流行的地区,生成有关间日疟原虫和恶性疟原虫感染的分布和临床发生的数据至关重要。这项研究评估了埃塞俄比亚发热患者的疟原虫感染和Duffy抗原基因型。
方法:在疟疾传播季节(4-10月),随机选择了300名在埃塞俄比亚西南部Jimma镇的四个医疗机构就诊的发热患者。收集了社会人口统计信息,对所有研究参与者进行显微镜检查.通过定量聚合酶链反应(qPCR)评估所有样品的疟原虫物种和寄生虫血症以及Duffy基因型。数据采用Fisher精确检验和kappa统计学分析。
结果:经qPCR检测,发热患者疟原虫感染率为16%(48/300),其中间日疟原虫19例(39.6%),25例(52.1%)为恶性疟原虫,和4(8.3%)混合(P。间日疟原虫和恶性疟原虫)感染。在48份qPCR阳性样本中,39(13%)镜检阴性。双变量Logistic回归分析结果表明,与农业相关的职业,复发和复发与疟原虫感染显著相关(P<0.001)。在300名发热患者中,85(28.3%)为达菲阴性,其中两个人患有间日疟原虫,六个人患有恶性疟原虫,其中一人混合感染。除了一名恶性疟原虫感染患者,Duffy阴性个体的疟原虫感染均为低寄生虫血症。
结论:本研究揭示了显微镜下疟疾感染的高流行率。由于低寄生虫血症,在Duffy阴性个体中未检测到间日疟原虫感染。在这项研究中,一种改进的分子诊断工具用于检测和表征疟原虫感染,目的是量化Duffy阴性个体间日疟原虫感染。先进的分子诊断技术,如多重实时PCR,环介导等温扩增(LAMP),和基于CRISPR的诊断方法。这些技术提供了更高的灵敏度,特异性,与所采用的方法相比,以及检测低寄生虫密度感染的能力。
BACKGROUND: Malaria remains a severe parasitic disease, posing a significant threat to public health and hindering economic development in sub-Saharan Africa. Ethiopia, a malaria endemic country, is facing a resurgence of the disease with a steadily rising incidence. Conventional diagnostic methods, such as microscopy, have become less effective due to low parasite density, particularly among Duffy-negative human populations in Africa. To develop comprehensive control strategies, it is crucial to generate data on the distribution and clinical occurrence of Plasmodium vivax and Plasmodium falciparum infections in regions where the disease is prevalent. This study assessed Plasmodium infections and Duffy antigen genotypes in febrile patients in Ethiopia.
METHODS: Three hundred febrile patients visiting four health facilities in Jimma town of southwestern Ethiopia were randomly selected during the malaria transmission season (Apr-Oct). Sociodemographic information was collected, and microscopic examination was performed for all study participants. Plasmodium species and parasitaemia as well as the Duffy genotype were assessed by quantitative polymerase chain reaction (qPCR) for all samples. Data were analysed using Fisher\'s exact test and kappa statistics.
RESULTS: The Plasmodium infection rate by qPCR was 16% (48/300) among febrile patients, of which 19 (39.6%) were P. vivax, 25 (52.1%) were P. falciparum, and 4 (8.3%) were mixed (P. vivax and P. falciparum) infections. Among the 48 qPCR-positive samples, 39 (13%) were negative by microscopy. The results of bivariate logistic regression analysis showed that agriculture-related occupation, relapse and recurrence were significantly associated with Plasmodium infection (P < 0.001). Of the 300 febrile patients, 85 (28.3%) were Duffy negative, of whom two had P. vivax, six had P. falciparum, and one had mixed infections. Except for one patient with P. falciparum infection, Plasmodium infections in Duffy-negative individuals were all submicroscopic with low parasitaemia.
CONCLUSIONS: The present study revealed a high prevalence of submicroscopic malaria infections. Plasmodium vivax infections in Duffy-negative individuals were not detected due to low parasitaemia. In this study, an improved molecular diagnostic tool was used to detect and characterize Plasmodium infections, with the goal of quantifying P. vivax infection in Duffy-negative individuals. Advanced molecular diagnostic techniques, such as multiplex real-time PCR, loop-mediated isothermal amplification (LAMP), and CRISPR-based diagnostic methods. These techniques offer increased sensitivity, specificity, and the ability to detect low-parasite-density infections compared to the employed methodologies.