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

<h4>Background</h4>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 regim...

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Autores principales:	Peter Van den Eede, Veronica E Soto-Calle, Christopher Delgado, Dionicia Gamboa, Tanilu Grande, Hugo Rodriguez, Alejandro Llanos-Cuentas, Jozef Anné, Umberto D'Alessandro, Annette Erhart
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/147c3a91884d4ffcbe7c33ffdf4e859c
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spelling	oai:doaj.org-article:147c3a91884d4ffcbe7c33ffdf4e859c2021-11-18T06:59:39ZPlasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study.1932-620310.1371/journal.pone.0016257https://doaj.org/article/147c3a91884d4ffcbe7c33ffdf4e859c2011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21297986/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methodology</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.Peter Van den EedeVeronica E Soto-CalleChristopher DelgadoDionicia GamboaTanilu GrandeHugo RodriguezAlejandro Llanos-CuentasJozef AnnéUmberto D'AlessandroAnnette ErhartPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 1, p e16257 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Peter Van den Eede Veronica E Soto-Calle Christopher Delgado Dionicia Gamboa Tanilu Grande Hugo Rodriguez Alejandro Llanos-Cuentas Jozef Anné Umberto D'Alessandro Annette Erhart Plasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study.
description	<h4>Background</h4>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.<h4>Methodology</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
format	article
author	Peter Van den Eede Veronica E Soto-Calle Christopher Delgado Dionicia Gamboa Tanilu Grande Hugo Rodriguez Alejandro Llanos-Cuentas Jozef Anné Umberto D'Alessandro Annette Erhart
author_facet	Peter Van den Eede Veronica E Soto-Calle Christopher Delgado Dionicia Gamboa Tanilu Grande Hugo Rodriguez Alejandro Llanos-Cuentas Jozef Anné Umberto D'Alessandro Annette Erhart
author_sort	Peter Van den Eede
title	Plasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study.
title_short	Plasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study.
title_full	Plasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study.
title_fullStr	Plasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study.
title_full_unstemmed	Plasmodium vivax sub-patent infections after radical treatment are common in Peruvian patients: results of a 1-year prospective cohort study.
title_sort	plasmodium vivax sub-patent infections after radical treatment are common in peruvian patients: results of a 1-year prospective cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/147c3a91884d4ffcbe7c33ffdf4e859c
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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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