Abstract
In endemic areas, Plasmodium vivax relapses are difficult to distinguish from new infections. Genotyping of patients who experience relapse after returning to a malaria-free area can be used to explore the nature of hypnozoite activation and relapse. This paper describes a person who developed P. vivax malaria for the first time after travelling to Boriziny in the malaria endemic coastal area of Madagascar, then suffered two P. vivax relapses 11 weeks and 21 weeks later despite remaining in Antananarivo in the malaria-free central highlands area. He was treated with the combination artesunate + amodiaquine according to the national malaria policy in Madagascar. Genotyping by PCR-RFLP at pvmsp-3α as well as pvmsp1 heteroduplex tracking assay (HTA) showed the same dominant genotype at each relapse. Multiple recurring minority variants were also detected at each relapse, highlighting the propensity for multiple hypnozoite clones to activate simultaneously to cause relapse.
Highlights
In Madagascar, the combination of artesunate + amodiaquine (ASAQ) is recommended since December 2005 as the first-line treatment for uncomplicated and nonsevere malaria, regardless of the parasite species involved
In this report is described a case where sequential P. vivax malaria relapses in a patient living in Antananarivo, a malaria-free urban area, following ASAQ treatment comprised multiple minority-variant parasites, suggesting simultaneous reactivation of multiple hypnozoite clones
Concluding remarks The case reported involves P. vivax malaria imported from the coastal area to the central highland area in Madagascar
Summary
Activation of minority-variant Plasmodium vivax hypnozoites following artesunate + amodiaquine treatment in a 23-year old man with relapsing malaria in Antananarivo, Madagascar. Voahangy Andrianaranjaka, Jessica T Lin, Christopher Golden, Jonathan J Juliano and Milijaona Randrianarivelojosia1*
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call