Abstract

Negative Duffy expression on the surface of human red blood cells was believed to be a barrier for Plasmodium vivax infection in most Africans. However, P. vivax has been demonstrated to infect Duffy-negative individuals in several Central and East African countries. In this study, we investigated the distribution of Duffy blood group phenotypes with regard to P. vivax infection and parasitemia in Sudan. Out of 992 microscopic-positive malaria samples, 190 were identified as P. vivax positive infections. Among them, 186 were P. vivax mono-infections and 4 were mixed P. vivax and Plasmodium falciparum infections. A subset of 77 samples was estimated with parasitemia by quantitative real-time PCR. Duffy codons were sequenced from the 190 P. vivax positive samples. We found that the Duffy Fy(a-b+) phenotype was the most prevalent, accounting for 67.9% of all P. vivax infections, while homozygous Duffy-negative Fy(a-b-) accounted for 17.9% of the P. vivax infections. The prevalence of infection in Fy(a-b+) and Fy(a+b-)were significantly higher than Fy(a-b-) phenotypes (p = 0.01 and p < 0.01, respectively). A significantly low proportion of P. vivax infection was observed in Duffy negative individuals Fy(a-b-). This study highlights the prevalence of P. vivax in Duffy-negatives in Sudan and indicates low parasitemia among the Duffy-negative individuals.

Highlights

  • Malaria is a serious health problem, especially in developing countries

  • Plasmodium vivax is widely spread and it has been increasingly recognized as a cause of severe malaria and even death [1,2]

  • The prevalence of P. vivax was believed to be much lower in Africa, using a compiled database, a recent study has highlighted the widespread presence of P. vivax across all malaria-endemic regions of Africa [3]

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Summary

Introduction

Malaria is a serious health problem, especially in developing countries. According to the latest estimates from the World Health Organization, there were 214 million new cases and 435,000 deaths, mostly occurring in sub-Saharan Africa [1].The predominant malaria parasite species is Plasmodium falciparum. Plasmodium vivax is widely spread and it has been increasingly recognized as a cause of severe malaria and even death [1,2]. The prevalence of P. vivax was believed to be much lower in Africa, using a compiled database, a recent study has highlighted the widespread presence of P. vivax across all malaria-endemic regions of Africa [3]. Based on the WHO World Malaria Report 2018, malaria constitutes a major public health problem with 720,819 reported confirmed cases and 3885 deaths in Sudan [1].

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