Toward elimination

随着许多疟疾控制计划朝着消除方向发展，更勤奋的监视和监测计划成为消除计划的重点。正在考虑消除剩下的少数寄生虫的策略（MDA）策略。但是，不管其感染状况如何，对大量人群的治疗都可能是昂贵的，在疾病负担低 - 可以承受当地人口的抵抗力。为了克服这一点，正在考虑大众屏幕和治疗程序（MSAT）程序。该策略的主要缺点是，当前使用的现场诊断（即显微镜和RDTS）不足以检测寄生虫非常低的感染。因此，疟疾诊断的大多数重点都转向开发敏感的工具，以检测这种低水平感染，通常是在无症状的个体中，更适合现场使用。

ISNTD D3会议， 伦敦

Having recently attended the International Society for NTDs (ISNTD) meeting at the Wellcome Trust Centre in London, I am optimistic about the prospects of future diagnostics. I was truly amazed at the level of innovation showcased at the meeting, especially as a PhD student just entering this field.

During the meeting, there was heavy emphasis put on the importance of integrating new diagnostics into an “E-health system”. That is, incorporating in-built data-transmission technologies that are desirable for real time surveillance, QC monitoring and for optimising supply chain management. In terms of improving clinical practice or patient outcomes however, a recent Cochrane review found没有证据表明使用电子健康信息（EHI）有任何作用on these. Despite this, these systems are still useful for non-clinical projects, e.g in the validation of new tools, and so theInternational Diagnostics Centre (IDC)“致力于利用这些技术进步来改善NTD的诊断”。

ISNTD的座右铭是“通过合作伙伴关系的进步”，很明显，尽管与不同的群体合作，因此开发了更有效的产品。这样的合作导致了开发的几个开放平台诊断，包括Trulab Uno dx, which includes assays for MTb, malaria, chikungunya and many more viruses. Open-platforms allow multiple detection targets from different pathogens, or from the host, to be selected and run on the same machine. Still, these are platforms that require lab space, trained staff and power- rendering them only suitable for reference laboratories. Much effort has been put into the transfer of these sensitive molecular tests from the lab to the field. One of the biggest advances toward this has been the use of isothermic reactions, which eliminate the need for costly and heavy thermocyclers. Such technologies, includingLAMP和纳尔菲亚，采取了进一步的一步，不再需要读取设备，例如荧光读取器或光谱仪。此外，正在将非侵入性诊断方法作为理想。

疟疾呼吸

去年显示，可以通过气相色谱 - 质谱法（GC-MS）检测到独特的挥发性有机化合物（VOC）感染疟疾的患者的呼吸。The level of VOC detected appeared to correlate with the patient’s parasitaemia even at very low levels, which suggests a sensitive method for diagnosis of clinical and asymptomatic malaria. With funding from the Bill & Melinda Gates foundation, the Commonwealth Scientific and Industrial Research Organisation (CSIR, QIMR Berghofer Medical Research Institute) together with the Australian National University, developed a breathalyser-like product that is currently being validated in field trials in Malawi, Bangladesh, Malaysia and Sudan. Volunteers will provide a breath sample as they undergo the normal testing and treatment. Volatiles in the breath are stabilised by reagents in the specimen tubes and then transported to the Canberra or St. Louis for chemical and statistical analysis. If an alternative platform to GC-MS can be developed to analyse the samples, this non-invasive, cheap technique could eliminate the need for skilled technicians and reduce the cost for such a test.

嗅探狗

达勒姆大学和伦敦卫生学院和热带医学学院已获得了巨大的挑战和探索资助，以探索雇用的可能性嗅探犬检测患者的疟疾。The project is based on the principle whereby感染疟疾的个体对喂食蚊子更具吸引力, presumably though sensing chemo-attractants released by the host. Since dogs are extremely sensitive to smell, it is thought that might also be able to detect the volatiles produced by infected indiviuals. The use of sniffer dog has most recently been approved by the NHS to detect certain types of cancer. The project will involve collecting urine and sweat from 400 children as part of a collaboration with MRC unit in the Gambia and the UK charity Medical Detection Dogs. Dogs will be trained to distinguish between sweat from uninfected and infected children. Using dogs would eliminate the need for skilled technicians. They are mobile, cheap to keep, and diagnosis would be almost immediate.

超越理想诊断

去年，我回顾了一些most innovative diagnostics of 2014和most recentlyAnja Choon reviewed a new urine test for malaria。显微镜和RDT仍然是黄金标准，可能会持续一段时间，那么将这些创新带入现场的主要障碍是什么？在ISNTD D3会议的结束会议上，来自Medecines Frontrees（MSF）的Laurence Flevaud博士探讨了在偏远设置中面临的一些挑战，即使是配备了最佳诊断。她强调了向最终用户交付产品/试剂的巨大后勤问题，需要毫不妥协的目标产品配置文件，以生产出功能性的现场工具，并最终需要开发科学家与熟悉的本地非政府组织紧密合作在实施期间以后可能会出现问题的文化，后勤和政治障碍。她的压倒信息是从偏移量中纳入或至少考虑产品的实施策略，以防止出现完美良好的诊断工具，以缓慢而昂贵的“诊断墓地”旅行。关于这一点，有趣的是考虑如何发生疟疾狗的部署和扩大。