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- Title
Plasmodium falciparum Gametocyte Carriage Is Associated with Subsequent Plasmodium vivax Relapse after Treatment.
- Authors
Lin, Jessica T.; Bethell, Delia; Tyner, Stuart D.; Lon, Chanthap; Shah, Naman K.; Saunders, David L.; Sriwichai, Sabaithip; Khemawoot, Phisit; Kuntawunggin, Worachet; Smith, Bryan L.; Noedl, Harald; Schaecher, Kurt; Socheat, Duong; Youry Se; Meshnick, Steven R.; M.^Fukuda, Mark
- Abstract
Mixed P. falciparum/P. vivax infections are common in southeast Asia. When patients with P. falciparum malaria are treated and followed for several weeks, a significant proportion will develop P. vivax malaria. In a combined analysis of 243 patients recruited to two malaria treatment trials in western Cambodia, 20/43 (47%) of those with P. falciparum gametocytes on admission developed P. vivax malaria by Day 28 of follow-up. The presence of Pf gametocytes on an initial blood smear was associated with a 3.5-fold greater rate of vivax parasitemia post-treatment (IRR = 3.5, 95% CI 2.0-6.0, p,0.001). The increased rate of post-treatment P. vivax infection persisted when correlates of exposure and immunity such as a history of malaria, male gender, and age were controlled for (IRR = 3.0, 95% CI 1.9-4.7, p,0.001). Polymerase chain reaction (PCR) confirmed that only a low proportion of subjects (5/55 or 9.1%) who developed vivax during follow-up had detectable Pv parasites in the peripheral blood at baseline. Molecular detection of falciparum gametocytes by reverse transcriptase PCR in a subset of patients strengthened the observed association, while PCR detection of Pv parasitemia at follow-up was similar to microscopy results. These findings suggest that the majority of vivax infections arising after treatment of falciparum malaria originate from relapsing liver-stage parasites. In settings such as western Cambodia, the presence of both sexual and asexual forms of P. falciparum on blood smear at presentation with acute falciparum malaria serves as a marker for possible occult P. vivax coinfection and subsequent relapse. These patients may benefit from empiric treatment with an 8- aminoquinolone such as primaquine.
- Subjects
SOUTHEAST Asia; PLASMODIUM falciparum; PLASMODIUM vivax; DISEASE relapse; GERM cells; MALARIA; REVERSE transcriptase; PRIMAQUINE; MICROSCOPY
- Publication
PLoS ONE, 2011, Vol 6, Issue 4, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0018716