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Plasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study

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dc.contributor.author Van den Eede, P.
dc.contributor.author Soto-Calle, V. E.
dc.contributor.author Delgado, C.
dc.contributor.author Gamboa, D.
dc.contributor.author Grande, T.
dc.contributor.author Rodriguez, H.
dc.contributor.author Llanos-Cuentas, A.
dc.contributor.author Anné, J.
dc.contributor.author D'Alessandro, U.
dc.contributor.author Erhart, A.
dc.date.accessioned 2011-02-22T15:09:07Z
dc.date.available 2011-02-22T15:09:07Z
dc.date.issued 2011
dc.identifier.issn 1932-6203
dc.identifier.doi http://dx.doi.org/10.1371/journal.pone.0016257
dc.identifier.other ITG-P1B
dc.identifier.other ITG-P9A
dc.identifier.other ITG-PLA
dc.identifier.other PARAS
dc.identifier.other U-MALAR
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other Abstract
dc.identifier.other UPD31
dc.identifier.other FTA
dc.identifier.uri http://hdl.handle.net/10390/6481
dc.description.abstract BACKGROUND: There is an increasing body of literature reporting treatment failure of the currently recommended radical treatment of Plasmodium vivax infections. As P. vivax is the main malaria species outside the African continent, emerging tolerance to its radical treatment regime could have major consequences in countries like Peru, where 80% of malaria cases are due to P. vivax. Here we describe the results of a 1-year longitudinal follow up of 51 confirmed P. vivax patients living around Iquitos, Peruvian Amazon, and treated according to the Peruvian national guidelines. METHODOLOGY: Each month a blood sample for microscopy and later genotyping was systematically collected. Recent exposure to infection was estimated by detecting antibodies against the P. vivax circumsporozoite protein (CSP) and all PCR confirmed P. vivax infections were genotyped with 16 polymorphic microsatellites. RESULTS: During a 1-year period, 84 recurrent infections, 22 positive also by microscopy, were identified, with a median survival time to first recurrent infection of 203 days. Most of them (71%) were asymptomatic; in 13 patients the infection persisted undetected by microscopy for several consecutive months. The genotype of mostly recurrent infections differed from that at day 0 while fewer differences were seen between the recurrent infections. The average expected heterozygosity was 0.56. There was strong linkage disequilibrium (I(A) (s) = 0.29, p<1.10(-4)) that remained also when analyzing only the unique haplotypes, suggesting common inbreeding. CONCLUSION: In Peru, the P. vivax recurrent infections were common and displayed a high turnover of parasite genotypes compared to day 0. Plasmodium vivax patients, even when treated according to the national guidelines, may still represent an important parasite reservoir that can maintain transmission. Any elimination effort should consider such a hidden reservoir. en
dc.language English en
dc.subject Protozoal diseases en
dc.subject Malaria en
dc.subject Plasmodium vivax en
dc.subject Evaluation en
dc.subject Follow-up en
dc.subject Case studies en
dc.subject Treatment en
dc.subject National policies en
dc.subject Guidelines en
dc.subject Detection en
dc.subject Genotyping en
dc.subject Asymptomatic infections en
dc.subject Microscopy en
dc.subject Exposure en
dc.subject Treatment failure en
dc.subject Reservoirs en
dc.subject Peru en
dc.subject America, Latin en
dc.title Plasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study en
dc.citation.issue 1 en
dc.citation.jtitle PLoS ONE en
dc.citation.volume 6 en
dc.citation.pages e16257 en
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/21297986
dc.citation.jabbreviation PLoS ONE en


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