Abstract
In the south and southeast regions of Brazil, cases of malaria occur outside the endemic Amazon region near the Atlantic Forest in some coastal states, where Plasmodium vivax is the recognized parasite. Characteristics of cases and vectors, especially Anopheles (Kerteszia) cruzii, raise the hypothesis of a zoonosis with simians as reservoirs. The present review aims to report on investigations of the disease over a 23-year period. Two main sources have provided epidemiological data: the behavior of Anopheles vectors and the genetic and immunological aspects of Plasmodium spp. obtained from humans, Alouatta simians, and Anopheles spp. mosquitoes. Anopheles (K.) cruzii is the most captured species in the forest canopy and is the recognized vector. The similarity between P. vivax and Plasmodium simium and that between Plasmodium malariae and Plasmodium brasilianum shared between simian and human hosts and the involvement of the same vector in the transmission to both hosts suggest interspecies transfer of the parasites. Finally, recent evidence points to the presence of Plasmodium falciparum in a silent cycle, detected only by molecular methods in asymptomatic individuals and An. (K.) cruzii. In the context of malaria elimination, it is paramount to assemble data about transmission in such non-endemic low-incidence areas.
Highlights
Plasmodium vivax, Plasmodium falciparum, and Plasmodium malariae are the most common etiologic agents of human malaria in the Americas
Efforts to control malaria until the 1960s were focused in urban areas, and these measures left behind the dense Atlantic Forest (Figure 1) that was neglected by health authorities
The hypothesis that wild monkeys in the Atlantic Forest play an important role in The existence of monkeys infected with P. brasilianum and P. simium, similar to the huthe areas of residual malaria transmission has been suggested for many decades [27,28,29,30,31,32]
Summary
Plasmodium vivax, Plasmodium falciparum, and Plasmodium malariae are the most common etiologic agents of human malaria in the Americas. Brazil registered 194,271 cases in 2018 [1], placing the country in second place in a list of malaria frequency in these regions [1]. Cases of P. vivax infection are the most common, and the Amazonian region is the most affected area in the country, with 99% of occurrences. Endemic areas are relatively frequent in the rural communities located in the coast of southeastern. Endemic areas are relatively frequent in the rural comm the coast of southeastern Brazil, and P. vivax is the parasite respo. P. vivax is the parasite responsible for human infections. P. falciparum infections, albeit in a lower proportion [2,3,5,6]
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