论文标题
在存在多种物种的情况下进行疟疾治疗评估的模型
A model for malaria treatment evaluation in the presence of multiple species
论文作者
论文摘要
疟原虫(P.)恶性疟原虫和疟原虫是疟疾的两个最常见原因。虽然大多数死亡和严重的发病率是由于恶性疟原虫造成的,但维瓦克斯假单胞菌构成了在非洲以外消除疟疾的更大挑战,因为它能够形成潜在的肝脏寄生虫(催眠症),这可能会导致一个个别患者内部发作。在恶性疟原虫和维瓦克斯菌是共同流行的地区,个体可以同时携带这两种物种的寄生虫。这些混合感染以多种方式使动态复杂化。混合感染的治疗将同时影响两种物种,恶性疟原虫可以掩盖对体内假单胞菌的检测,并且已经假设清除恶性疟原虫可能会触发休眠的腹腔疟原虫的复发。当仅针对血液阶段的寄生虫治疗混合感染时,患者面临着由于腹腔疟原虫催眠剂而引起的复发感染的风险。 我们提出了一个随机数学模型,该模型捕获了恶性疟原虫和维瓦克斯疟原虫之间的相互作用,并结合了标准的精神分裂症治疗(靶向血液阶段的寄生虫)和自由基治疗(另外针对肝脏寄生虫)。我们应用该模型来评估自由基治疗对混合和疟原虫感染的不同治疗覆盖范围的含义,以及对恶性疟原虫,维瓦克斯疟原虫和混合感染的所谓“统一的自由基治疗”策略。我们发现,通过G6PD筛查,统一的激进治疗策略导致疟疾病例和死亡的总体发生率大大降低。我们执行单向灵敏度分析,以突出重要的模型参数。
Plasmodium (P.) falciparum and P. vivax are the two most common causes of malaria. While the majority of deaths and severe morbidity are due to P. falciparum, P. vivax poses a greater challenge to eliminating malaria outside of Africa due to its ability to form latent liver stage parasites (hypnozoites), which can cause relapsing episodes within an individual patient. In areas where P. falciparum and P. vivax are co-endemic, individuals can carry parasites of both species simultaneously. These mixed infections complicate dynamics in several ways; treatment of mixed infections will simultaneously affect both species, P. falciparum can mask the detection of P. vivax, and it has been hypothesised that clearing P. falciparum may trigger a relapse of dormant P. vivax. When mixed infections are treated for only blood-stage parasites, patients are at risk of relapse infections due to P. vivax hypnozoites. We present a stochastic mathematical model that captures interactions between P. falciparum and P. vivax, and incorporates both standard schizontocidal treatment (which targets blood-stage parasites) and radical treatment (which additionally targets liver-stage parasites). We apply this model to assess the implications of different treatment coverage of radical cure for mixed and P. vivax infections and a so-called "unified radical cure" treatment strategy for P. falciparum, P. vivax and mixed infections. We find that a unified radical cure strategy, with G6PD screening, leads to a substantially lower incidence of malaria cases and deaths overall. We perform a one-way sensitivity analysis to highlight important model parameters.