Abstract
A recent paper in Malaria Journal reported the observation of unexpected prevalence rates of healthy individuals carrying Plasmodium falciparum (5.14%) or Plasmodium vivax (2.26%) DNA among blood donors from the main transfusion centre in the metropolitan São Paulo, a non-endemic area for malaria. The article has been challenged by a group of authors who argued that the percentages reported were higher than those found in blood banks of the endemic Amazon Region and also that that paper had not considered the literature on the classical dynamics of malaria transmission in the Atlantic Forest, which involves Anopheles (Kerteszia) cruzii and bromeliad malaria, due to P. vivax and Plasmodium malariae parasites, but not P. falciparum. The present commentary paper responds to this challenge and brings evidence and literature data supporting that the observed prevalence ratios may indicate a proportion of individuals that are exposed to Plasmodium transmission in permissive environments; that blood carrying parasite DNA may not be necessarily infective if used in transfusion; and that in the literature, there are examples supporting the circulation of P. falciparum in the area.
Highlights
The dynamics of malaria in the Brazilian Atlantic Forest seems to represent ideal, low transmission settings that involve patterns of evolution of Plasmodium parasites, its hosts and its vectors
The study by Maselli et al [1] points to the maintenance of P. falciparum in the Atlantic Forest in silent cycles that may involve non-human primates, humans and mosquito vectors with distinct biology and ecological features, beyond the classical Kerteszia/ bromeliad malaria transmission dynamics
In view of the results reported by Maselli et al [1] and the recent data quoted above, it seems evident that the dynamics of malaria in the Atlantic Forest is poorly known and needs further investigations, including studies relative to mosquito vectors and other determinants of the transmission, i.e., infectiveness and pathogenicity of the Plasmodium lineages that are circulating in the region, duration of infection in untreated individuals, duration of sporogony and gametocytogony, as discussed by Wernsdorfer [18]
Summary
The dynamics of malaria in the Brazilian Atlantic Forest seems to represent ideal, low transmission settings that involve patterns of evolution of Plasmodium parasites, its hosts and its vectors. The study by Maselli et al [1] points to the maintenance of P. falciparum in the Atlantic Forest in silent cycles that may involve non-human primates, humans and mosquito vectors with distinct biology and ecological features, beyond the classical Kerteszia/ bromeliad malaria transmission dynamics.
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