1
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Escobar DF, Lucchi NW, Abdallah R, Valenzuela MT, Udhayakumar V, Jercic MI, Chenet SM. Molecular and epidemiological characterization of imported malaria cases in Chile. Malar J 2020; 19:289. [PMID: 32792011 PMCID: PMC7427082 DOI: 10.1186/s12936-020-03353-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Background Chile is one of the South American countries certified as malaria-free since 1945. However, the recent increase of imported malaria cases and the presence of the vector Anopheles pseudopunctipennis in previously endemic areas in Chile require an active malaria surveillance programme. Methods Specimens from 268 suspected malaria cases—all imported—collected between 2015 and 2018 at the Public Health Institute of Chile (ISP), were diagnosed by microscopy and positive cases were included for epidemiological analysis. A photo-induced electron transfer fluorogenic primer real-time PCR (PET-PCR) was used to confirm the presence of malaria parasites in available blood samples. Sanger sequencing of drug resistance molecular markers (pfk13, pfcrt and pfmdr1) and microsatellite (MS) analysis were performed in confirmed Plasmodium falciparum samples and results were related to origin of infection. Results Out of the 268 suspected cases, 65 were Plasmodium spp. positive by microscopy. A total of 63% of the malaria patients were male and 37% were female; 43/65 of the patients acquired infections in South American endemic countries. Species confirmation of available blood samples by PET-PCR revealed that 15 samples were positive for P. falciparum, 27 for Plasmodium vivax and 4 were mixed infections. The P. falciparum samples sequenced contained four mutant pfcrt genotypes (CVMNT, CVMET, CVIET and SVMNT) and three mutant pfmdr1 genotypes (Y184F/S1034C/N1042D/D1246Y, Y184F/N1042D/D1246Y and Y184F). MS analysis confirmed that all P. falciparum samples presented different haplotypes according to the suspected country of origin. Four patients with P. vivax infection returned to the health facilities due to relapses. Conclusion The timely detection of polymorphisms associated with drug resistance will contribute to understanding if current drug policies in the country are appropriate for treatment of imported malaria cases and provide information about the most frequent resistant genotypes entering Chile.
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Affiliation(s)
- Daniel F Escobar
- Sección de Parasitología, Instituto de Salud Pública de Chile, Santiago, Región Metropolitana, Chile
| | - Naomi W Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rispah Abdallah
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - María Isabel Jercic
- Sección de Parasitología, Instituto de Salud Pública de Chile, Santiago, Región Metropolitana, Chile
| | - Stella M Chenet
- Sección de Parasitología, Instituto de Salud Pública de Chile, Santiago, Región Metropolitana, Chile. .,Instituto de Investigación en Ganadería y Biotecnología, Universidad Nacional Toribio Rodríguez de Mendoza, Amazonas, Peru. .,Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza, Amazonas, Peru.
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2
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Cowell AN, Valdivia HO, Bishop DK, Winzeler EA. Exploration of Plasmodium vivax transmission dynamics and recurrent infections in the Peruvian Amazon using whole genome sequencing. Genome Med 2018; 10:52. [PMID: 29973248 PMCID: PMC6032790 DOI: 10.1186/s13073-018-0563-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/25/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Plasmodium vivax poses a significant challenge to malaria elimination due to its ability to cause relapsed infections from reactivation of dormant liver parasites called hypnozoites. We analyzed 69 P. vivax whole genome sequences obtained from subjects residing in three different villages along the Peruvian Amazon. This included 23 paired P. vivax samples from subjects who experienced recurrent P. vivax parasitemia following observed treatment with chloroquine and primaquine. METHODS Genomic DNA was extracted from whole blood samples collected from subjects. P. vivax DNA was enriched using selective whole genome amplification and whole genome sequencing. We used single nucleotide polymorphisms (SNPs) from the core P. vivax genome to determine characteristics of the parasite population using discriminant analysis of principal components, maximum likelihood estimation of individual ancestries, and phylogenetic analysis. We estimated the relatedness of the paired samples by calculating the number of segregating sites and using a hidden Markov model approach to estimate identity by descent. RESULTS We present a comprehensive dataset of population genetics of Plasmodium vivax in the Peruvian Amazonian. We define the parasite population structure in this region and demonstrate a novel method for distinguishing homologous relapses from reinfections or heterologous relapses with improved accuracy. The parasite population in this area was quite diverse with an estimated five subpopulations and evidence of a highly heterogeneous ancestry of some of the isolates, similar to previous analyses of P. vivax in this region. Pairwise comparison of recurrent infections determined that there were 12 homologous relapses and 3 likely heterologous relapses with highly related parasites. To the best of our knowledge, this is the first large-scale study to evaluate recurrent P. vivax infections using whole genome sequencing. CONCLUSIONS Whole genome sequencing is a high-resolution tool that can identify P. vivax homologous relapses with increased sensitivity, while also providing data about drug resistance and parasite population genetics. This information is important for evaluating the efficacy of known and novel antirelapse medications in endemic areas and thus advancing the campaign to eliminate malaria.
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Affiliation(s)
- Annie N Cowell
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - Hugo O Valdivia
- U.S. Naval Medical Research No. 6, Venezuela Ave, Block 36, Bellavista, Callao, Peru
| | - Danett K Bishop
- U.S. Naval Medical Research No. 6, Venezuela Ave, Block 36, Bellavista, Callao, Peru
| | - Elizabeth A Winzeler
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, UC San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
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3
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Malaria Epidemiology at the Clone Level. Trends Parasitol 2017; 33:974-985. [PMID: 28966050 DOI: 10.1016/j.pt.2017.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/14/2017] [Accepted: 08/30/2017] [Indexed: 01/08/2023]
Abstract
Genotyping to distinguish between parasite clones is nowadays a standard in many molecular epidemiological studies of malaria. It has become crucial in drug trials and to follow individual clones in epidemiological studies, and to understand how drug resistance emerges and spreads. Here, we review the applications of the increasingly available genotyping tools and whole-genome sequencing data, and argue for a better integration of population genetics findings into malaria-control strategies.
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4
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Rosas-Aguirre A, Gamboa D, Manrique P, Conn JE, Moreno M, Lescano AG, Sanchez JF, Rodriguez H, Silva H, Llanos-Cuentas A, Vinetz JM. Epidemiology of Plasmodium vivax Malaria in Peru. Am J Trop Med Hyg 2016; 95:133-144. [PMID: 27799639 PMCID: PMC5201219 DOI: 10.4269/ajtmh.16-0268] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/29/2016] [Indexed: 01/01/2023] Open
Abstract
Malaria in Peru, dominated by Plasmodium vivax, remains a public health problem. The 1990s saw newly epidemic malaria emerge, primarily in the Loreto Department in the Amazon region, including areas near to Iquitos, the capital city, but sporadic malaria transmission also occurred in the 1990s–2000s in both north-coastal Peru and the gold mining regions of southeastern Peru. Although a Global Fund-supported intervention (PAMAFRO, 2005–2010) was temporally associated with a decrease of malaria transmission, from 2012 to the present, both P. vivax and Plasmodium falciparum malaria cases have rapidly increased. The Peruvian Ministry of Health continues to provide artemesinin-based combination therapy for microscopy-confirmed cases of P. falciparum and chloroquine–primaquine for P. vivax. Malaria transmission continues in remote areas nonetheless, where the mobility of humans and parasites facilitates continued reintroduction outside of ongoing surveillance activities, which is critical to address for future malaria control and elimination efforts. Ongoing P. vivax research gaps in Peru include the following: identification of asymptomatic parasitemics, quantification of the contribution of patent and subpatent parasitemics to mosquito transmission, diagnosis of nonparasitemic hypnozoite carriers, and implementation of surveillance for potential emergence of chloroquine- and 8-aminoquinoline-resistant P. vivax. Clinical trials of tafenoquine in Peru have been promising, and glucose-6-phosphate dehydrogenase deficiency in the region has not been observed to be a limitation to its use. Larger-scale challenges for P. vivax (and malaria in general) in Peru include logistical difficulties in accessing remote riverine populations, consequences of government policy and poverty trends, and obtaining international funding for malaria control and elimination.
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Affiliation(s)
- Angel Rosas-Aguirre
- Research Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.,Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Dionicia Gamboa
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Paulo Manrique
- Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jan E Conn
- Wadsworth Center, New York State Department of Health, Albany, New York.,Department of Biomedical Sciences, School of Public Health, University at Albany (State University of New York), Albany, New York
| | - Marta Moreno
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, California
| | - Andres G Lescano
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan F Sanchez
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hugo Rodriguez
- Dirección Regional de Salud Loreto, Ministerio de Salud, Iquitos, Peru
| | - Hermann Silva
- Dirección Regional de Salud Loreto, Ministerio de Salud, Iquitos, Peru
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joseph M Vinetz
- Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru.,Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru.,Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, California
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5
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Negreiros S, Farias S, Viana GMR, Okoth SA, Chenet SM, de Souza TMH, Marchesini P, Udhayakumar V, Povoa MM, Santelli ACFES, de Oliveira AM. Efficacy of Chloroquine and Primaquine for the Treatment of Uncomplicated Plasmodium vivax Malaria in Cruzeiro do Sul, Brazil. Am J Trop Med Hyg 2016; 95:1061-1068. [PMID: 27549633 DOI: 10.4269/ajtmh.16-0075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/12/2016] [Indexed: 11/07/2022] Open
Abstract
We evaluated the efficacy of chloroquine and primaquine on uncomplicated Plasmodium vivax malaria in Cruzeiro do Sul, Brazil, in 2014. Patients ≥ 5 years of age with either fever or history of fever, and laboratory-confirmed P. vivax monoinfection received chloroquine (total dose = 25 mg/kg) and primaquine (total dose = 3.5 mg/kg), and were followed up for 168 days (24 weeks). We used microsatellite genotyping to differentiate recurrent infections caused by heterologous parasites from those caused by homologous ones. No new P. vivax episode occurred by Day 28 among 119 enrolled patients, leading to Day 28, with adequate clinical and parasitological response (ACPR) of 100% (95% confidence interval [CI] = 96.7-100%). Twenty-eight P. vivax episodes occurred by Day 168, with uncorrected ACPR of 69.9% (95% CI = 59.5-79.0%). Fifteen of these episodes were caused by either homologous haplotypes or haplotypes that could not be determined. Excluding the 13 recurrent episodes caused by heterologous parasites, Day 168 microsatellite-corrected ACPR was estimated at 81.2% (95% CI = 71.0-89.1%). Chloroquine and primaquine remain efficacious to treat acute uncomplicated P. vivax infection, but moderate recurrence rates were observed within 24 weeks of follow-up.
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Affiliation(s)
| | | | | | - Sheila Akinyi Okoth
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.,Atlanta Research and Education Foundation, Decatur, Georgia
| | - Stella M Chenet
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Paola Marchesini
- National Malaria Control Program, Brazilian Ministry of Health, Brasilia, Brazil
| | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Alexandre Macedo de Oliveira
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
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6
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Prospective Study of Plasmodium vivax Malaria Recurrence after Radical Treatment with a Chloroquine-Primaquine Standard Regimen in Turbo, Colombia. Antimicrob Agents Chemother 2016; 60:4610-9. [PMID: 27185794 DOI: 10.1128/aac.00186-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/09/2016] [Indexed: 01/15/2023] Open
Abstract
Plasmodium vivax recurrences help maintain malaria transmission. They are caused by recrudescence, reinfection, or relapse, which are not easily differentiated. A longitudinal observational study took place in Turbo municipality, Colombia. Participants with uncomplicated P. vivax infection received supervised treatment concomitantly with 25 mg/kg chloroquine and 0.25 mg/kg/day primaquine for 14 days. Incidence of recurrence was assessed over 180 days. Samples were genotyped, and origins of recurrences were established. A total of 134 participants were enrolled between February 2012 and July 2013, and 87 were followed for 180 days, during which 29 recurrences were detected. The cumulative incidence of first recurrence was 24.1% (21/87) (95% confidence interval [CI], 14.6 to 33.7%), and 86% (18/21) of these events occurred between days 51 and 110. High genetic diversity of P. vivax strains was found, and 12.5% (16/128) of the infections were polyclonal. Among detected recurrences, 93.1% (27/29) of strains were genotyped as genetically identical to the strain from the previous infection episode, and 65.5% (19/29) of infections were classified as relapses. Our results indicate that there is a high incidence of P. vivax malaria recurrence after treatment in Turbo municipality, Colombia, and that a large majority of these episodes are likely relapses from the previous infection. We attribute this to the primaquine regimen currently used in Colombia, which may be insufficient to eliminate hypnozoites.
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7
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Das R, Dhiman RC, Savargaonkar D, Anvikar AR, Valecha N. Genotyping of Plasmodium vivax by minisatellite marker and its application in differentiating relapse and new infection. Malar J 2016; 15:115. [PMID: 26912225 PMCID: PMC4766672 DOI: 10.1186/s12936-016-1139-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 02/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plasmodium vivax malaria is a major public health problem in India. Control of vivax malaria is challenging due to various factors including relapse which increase the burden significantly. There is no well studied marker to differentiate relapse from reinfection. This creates hindrance in search for anti-relapse medicines. The genomic study of minisatellite can help in characterization of relapse and new infection of vivax malaria. METHODS Eighty-eight samples of P. vivax were collected from malaria clinic. All the 14 chromosomes of P. vivax were scanned for minisatellite marker by Tandem Repeat Finder software Version 4.07b. Minisatellite marker CH1T1M13779 from chromosome one was applied for genotyping in 88 samples of P. vivax including 2 recurrence cases. RESULTS Whole genome of P. vivax was scanned and found to have one hundred minisatellite markers. CH1T1M13779 minisatellite marker from chromosome-1 was used for amplification in 88 samples of P. vivax. Of 66 amplified samples, 14 alleles were found with varied allele frequency. The base size of 280 (13.63 %) 320 bp (13.63 %) and 300 bp (16.66 %) showed the predominant allele in the P. vivax population. Genotyping of two paired samples (day 0 and day relapse) could demonstrate the presence of relapse and reinfection. CONCLUSION The CH1T1M13779 can be potential minisatellite marker which can be used to differentiate between relapse and new infection of P. vivax strain.
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Affiliation(s)
- Ram Das
- National Institute of Malaria Research (ICMR), Sector-8, Dwarka, New Delhi, 110077, India.
| | - Ramesh C Dhiman
- National Institute of Malaria Research (ICMR), Sector-8, Dwarka, New Delhi, 110077, India.
| | - Deepali Savargaonkar
- National Institute of Malaria Research (ICMR), Sector-8, Dwarka, New Delhi, 110077, India.
| | - Anupkumar R Anvikar
- National Institute of Malaria Research (ICMR), Sector-8, Dwarka, New Delhi, 110077, India.
| | - Neena Valecha
- National Institute of Malaria Research (ICMR), Sector-8, Dwarka, New Delhi, 110077, India.
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8
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Delgado-Ratto C, Gamboa D, Soto-Calle VE, Van den Eede P, Torres E, Sánchez-Martínez L, Contreras-Mancilla J, Rosanas-Urgell A, Rodriguez Ferrucci H, Llanos-Cuentas A, Erhart A, Van geertruyden JP, D’Alessandro U. Population Genetics of Plasmodium vivax in the Peruvian Amazon. PLoS Negl Trop Dis 2016; 10:e0004376. [PMID: 26766548 PMCID: PMC4713096 DOI: 10.1371/journal.pntd.0004376] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 12/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background Characterizing the parasite dynamics and population structure provides useful information to understand the dynamic of transmission and to better target control interventions. Despite considerable efforts for its control, vivax malaria remains a major health problem in Peru. In this study, we have explored the population genetics of Plasmodium vivax isolates from Iquitos, the main city in the Peruvian Amazon, and 25 neighbouring peri-urban as well as rural villages along the Iquitos-Nauta Road. Methodology/ Results From April to December 2008, 292 P. vivax isolates were collected and successfully genotyped using 14 neutral microsatellites. Analysis of the molecular data revealed a similar proportion of monoclonal and polyclonal infections in urban areas, while in rural areas monoclonal infections were predominant (p = 0.002). Multiplicity of infection was higher in urban (MOI = 1.5–2) compared to rural areas (MOI = 1) (p = 0.003). The level of genetic diversity was similar in all areas (He = 0.66–0.76, p = 0.32) though genetic differentiation between areas was substantial (PHIPT = 0.17, p<0.0001). Principal coordinate analysis showed a marked differentiation between parasites from urban and rural areas. Linkage disequilibrium was detected in all the areas ( IAs = 0.08–0.49, for all p<0.0001). Gene flow among the areas was stablished through Bayesian analysis of migration models. Recent bottleneck events were detected in 4 areas and a recent parasite expansion in one of the isolated areas. In total, 87 unique haplotypes grouped in 2 or 3 genetic clusters described a sub-structured parasite population. Conclusion/Significance Our study shows a sub-structured parasite population with clonal propagation, with most of its components recently affected by bottleneck events. Iquitos city is the main source of parasite spreading for all the peripheral study areas. The routes of transmission and gene flow and the reduction of the parasite population described are important from the public health perspective as well for the formulation of future control policies. We present the population genetics of malaria vivax parasites in a large area of the Peruvian Amazon. Our results showed that the parasite population had a predominant clonal propagation, reproducing themselves with identically or closely related parasites; therefore, the same genetic characteristics are maintained in the offspring. The clonal propagation may favour the higher levels of genetic differentiation among the parasites from isolated areas compared to areas where human migration is common. The patterns of gene flow have been established, finding Iquitos city as a reservoir of parasite genetic variability. Moreover, a recent reduction of the parasite population was observed in areas where recent control activities were performed. This research provides a picture of the nature and dynamics of the parasite population which have a significant impact in the malaria epidemiology; therefore, this knowledge is crucial for the development of efficient control policies.
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Affiliation(s)
| | - Dionicia Gamboa
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Veronica E. Soto-Calle
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Peter Van den Eede
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eliana Torres
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Sánchez-Martínez
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Contreras-Mancilla
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Alejandro Llanos-Cuentas
- Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Annette Erhart
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Umberto D’Alessandro
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Medical Research Council Unit, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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9
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McFarland AP, Sanchez JF, Mercado A, Ventocilla JA, Cavalcanti S, Gonzalez S, Lescano AG. Repeated Plasmodium vivax malaria relapses in a Peruvian sailor. Malar J 2015; 14:478. [PMID: 26620122 PMCID: PMC4665899 DOI: 10.1186/s12936-015-0959-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/21/2015] [Indexed: 01/05/2023] Open
Abstract
Two Plasmodium vivax recurrences in a Peruvian sailor with weight above the 60 kg (cap for primaquine dosage) highlight the importance of adequate radical cure weight dosage for patient treatment and control efforts, particularly within the military.
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Affiliation(s)
- Adam P McFarland
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
| | - Juan F Sanchez
- Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Av. Venezuela Cdra. 36 S/N. Bellavista, Callao, 03, Peru.
| | - Alejandro Mercado
- Centro Medico Naval "Cirujano Mayor Santiago Tavara", Peruvian Navy, Callao, Peru.
| | - Julio A Ventocilla
- Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Av. Venezuela Cdra. 36 S/N. Bellavista, Callao, 03, Peru.
| | - Sofia Cavalcanti
- Centro Medico Naval "Cirujano Mayor Santiago Tavara", Peruvian Navy, Callao, Peru.
| | - Sofia Gonzalez
- Centro Medico Naval "Cirujano Mayor Santiago Tavara", Peruvian Navy, Callao, Peru.
| | - Andres G Lescano
- Department of Parasitology, U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Av. Venezuela Cdra. 36 S/N. Bellavista, Callao, 03, Peru. .,School of Public Health and Management, Universidad Peruana Cayetano Heredia (UPCH), Lima, Peru.
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10
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Flannery EL, Wang T, Akbari A, Corey VC, Gunawan F, Bright AT, Abraham M, Sanchez JF, Santolalla ML, Baldeviano GC, Edgel KA, Rosales LA, Lescano AG, Bafna V, Vinetz JM, Winzeler EA. Next-Generation Sequencing of Plasmodium vivax Patient Samples Shows Evidence of Direct Evolution in Drug-Resistance Genes. ACS Infect Dis 2015; 1:367-79. [PMID: 26719854 DOI: 10.1021/acsinfecdis.5b00049] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Understanding the mechanisms of drug resistance in Plasmodium vivax, the parasite that causes the most widespread form of human malaria, is complicated by the lack of a suitable long-term cell culture system for this parasite. In contrast to P. falciparum, which can be more readily manipulated in the laboratory, insights about parasite biology need to be inferred from human studies. Here we analyze the genomes of parasites within 10 human P. vivax infections from the Peruvian Amazon. Using next-generation sequencing we show that some P. vivax infections analyzed from the region are likely polyclonal. Despite their polyclonality we observe limited parasite genetic diversity by showing that three or fewer haplotypes comprise 94% of the examined genomes, suggesting the recent introduction of parasites into this geographic region. In contrast we find more than three haplotypes in putative drug-resistance genes, including the gene encoding dihydrofolate reductase-thymidylate synthase and the P. vivax multidrug resistance associated transporter, suggesting that resistance mutations have arisen independently. Additionally, several drug-resistance genes are located in genomic regions with evidence of increased copy number. Our data suggest that whole genome sequencing of malaria parasites from patients may provide more insight about the evolution of drug resistance than genetic linkage or association studies, especially in geographical regions with limited parasite genetic diversity.
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Affiliation(s)
| | | | | | | | | | | | | | - Juan F. Sanchez
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Avenida Venezuela Cuadra 36 S/N, Centro Médico
Naval, Lima Callao 02, Peru
| | - Meddly L. Santolalla
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Avenida Venezuela Cuadra 36 S/N, Centro Médico
Naval, Lima Callao 02, Peru
| | - G. Christian Baldeviano
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Avenida Venezuela Cuadra 36 S/N, Centro Médico
Naval, Lima Callao 02, Peru
| | - Kimberly A. Edgel
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Avenida Venezuela Cuadra 36 S/N, Centro Médico
Naval, Lima Callao 02, Peru
| | - Luis A. Rosales
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Avenida Venezuela Cuadra 36 S/N, Centro Médico
Naval, Lima Callao 02, Peru
| | - Andrés G. Lescano
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Avenida Venezuela Cuadra 36 S/N, Centro Médico
Naval, Lima Callao 02, Peru
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Adekunle AI, Pinkevych M, McGready R, Luxemburger C, White LJ, Nosten F, Cromer D, Davenport MP. Modeling the dynamics of Plasmodium vivax infection and hypnozoite reactivation in vivo. PLoS Negl Trop Dis 2015; 9:e0003595. [PMID: 25780913 PMCID: PMC4364305 DOI: 10.1371/journal.pntd.0003595] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/05/2015] [Indexed: 12/23/2022] Open
Abstract
The dynamics of Plasmodium vivax infection is characterized by reactivation of hypnozoites at varying time intervals. The relative contribution of new P. vivax infection and reactivation of dormant liver stage hypnozoites to initiation of blood stage infection is unclear. In this study, we investigate the contribution of new inoculations of P. vivax sporozoites to primary infection versus reactivation of hypnozoites by modeling the dynamics of P. vivax infection in Thailand in patients receiving treatment for either blood stage infection alone (chloroquine), or the blood and liver stages of infection (chloroquine + primaquine). In addition, we also analysed rates of infection in a study in Papua New Guinea (PNG) where patients were treated with either artesunate, or artesunate + primaquine. Our results show that up to 96% of the P. vivax infection is due to hypnozoite reactivation in individuals living in endemic areas in Thailand. Similar analysis revealed the around 70% of infections in the PNG cohort were due to hypnozoite reactivation. We show how the age of the cohort, primaquine drug failure, and seasonality may affect estimates of the ratio of primary P. vivax infection to hypnozoite reactivation. Modeling of P. vivax primary infection and hypnozoite reactivation provides important insights into infection dynamics, and suggests that 90–96% of blood stage infections arise from hypnozoite reactivation. Major differences in infection kinetics between Thailand and PNG suggest the likelihood of drug failure in PNG. Plasmodium vivax is one of two major parasite species causing human disease. This parasite can lie dormant in the liver as a hypnozoite, before later reactivating to cause blood-stage infection. Treatment to eliminate the dormant hypnozoite stage relies mostly on a single drug—primaquine. Understanding the rate of primary infection versus hypnozoite reactivation is important to understanding primaquine efficacy and drug resistance, as well as the development of new drugs targeting hypnozoites. Here we use mathematical modeling to analyse data from two clinical cohorts and show that up to 96% of infections may be caused by hypnozoite reactivation. We also use modeling to understand the impact of drug resistance, seasonal infection and subject age.
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Affiliation(s)
- Adeshina I. Adekunle
- Centre for Vascular Research, UNSW Australia, Sydney, New South Wales, Australia
| | - Mykola Pinkevych
- Centre for Vascular Research, UNSW Australia, Sydney, New South Wales, Australia
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Christine Luxemburger
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Lisa J. White
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Deborah Cromer
- Centre for Vascular Research, UNSW Australia, Sydney, New South Wales, Australia
| | - Miles P. Davenport
- Centre for Vascular Research, UNSW Australia, Sydney, New South Wales, Australia
- * E-mail:
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Durand S, Cabezas C, Lescano AG, Galvez M, Gutierrez S, Arrospide N, Alvarez C, Santolalla ML, Bacon DJ, Graf PCF. Efficacy of three different regimens of primaquine for the prevention of relapses of Plasmodium vivax malaria in the Amazon Basin of Peru. Am J Trop Med Hyg 2014; 91:18-26. [PMID: 24752682 DOI: 10.4269/ajtmh.13-0053] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We evaluated the efficacy of three primaquine (PQ) regimes to prevent relapses with Plasmodium vivax through an open-label randomized trial in Loreto, Peru. Vivax monoinfections were treated with chloroquine for 3 days and PQ in three different regimes: 0.5 mg/kg per day for 5 days (150 mg total), 0.5 mg/kg per day for 7 days (210 mg total), or 0.25 mg/kg per day for 14 days (210 mg total). Biweekly fever assessments and bimonthly thick smears were taken for 210 days. Recurrences after 35 days were considered relapses. One hundred eighty cases were enrolled in each group; 90% of cases completed follow-up. There were no group-related differences in age, sex, or parasitemia. Relapse rates were similar in the 7- and 14-day regimes (16/156 = 10.3% and 22/162 = 13.6%, P = 0.361) and higher in the 5-day group (48/169 = 28.4%, P < 0.001 and P = 0.001, respectively). The 7-day PQ regimen used in Peru is as efficacious as the recommended 14-day regimen and superior to 5 treatment days.
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Affiliation(s)
- Salomón Durand
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California
| | - Cesar Cabezas
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California
| | - Andres G Lescano
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California
| | - Mariela Galvez
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California
| | - Sonia Gutierrez
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California
| | - Nancy Arrospide
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California
| | - Carlos Alvarez
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California
| | - Meddly L Santolalla
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California
| | - David J Bacon
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California
| | - Paul C F Graf
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Instituto Nacional de Salud, Lima, Peru; Universidad Nacional Mayor de San Marcos, Lima, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru; Direccion Regional de Salud Loreto, Iquitos, Peru; US Naval Medical Center San Diego, San Diego, California
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