Abstract
In recent years, there has been a substantial increase of imported Plasmodium vivax incidence in Henan Province. As China is in a pre-elimination phase, the surveillance of imported malaria is essential, but there is no good way to distinguish imported cases from indigenous cases. This paper reports a case of a 39-year-old man who acquired P. vivax while staying in Indonesia for one month in 2013, and relapsed in Henan, China in 2014. This was diagnosed as vivax malaria based on rapid diagnostic test, Giemsa-stained peripheral blood smear and Plasmodium species-specific nested PCR. The genetic sequence for the circumsporozoite protein genes was analysed and the genetic variations were compared with a previously constructed database of Chinese isolates. The results from the circumsporozoite protein (CSP) gene sequence analysis centered on the repeat patterns showed that the imported cases had completely different sequences from any subtypes from Chinese isolates, but well matched with the countries travelled by the patient. The imported vivax cases were able to clearly distinguish from the indigenous vivax cases by detecting the CSP gene and were able to confim its origin by genotyping.
Highlights
Malaria is a parasitic infection caused by Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae and Plasmodium ovale
This study aimed at a case of imported P. vivax from Southeast Asia, who relapsed three months after leaving there, this case was diagnosed by light microscopy, rapid diagnostic test(RDT), nested PCR and sequence analysis
Considering his travel history and historical exposure to P. vivax, given the related examination of malaria, the result was positive. This case suggested it was necessary to obtain the epidemiological history when formulating a diagnosis and it highlighted the importance of considering more etiologies for febrile illnesses, which was especially important in the current era of globalization and increasing residential mobility [9]. This was the first report of a relapse P. vivax case from an endemic area in Henan Province
Summary
Malaria is a parasitic infection caused by Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae and Plasmodium ovale. In China, malaria seems to have been known for over 4,000 years and was identified as one of the top five parasitic diseases that affected seriously the socio-economic development after the establishment of the People’s Republic of China in 1949 [2]. In the early 1950s, a malaria epidemic spread in 1,829 counties, i.e., 70-80% of all counties in China [3]. In Henan Province, malaria has been a major health problem historically. Plasmodium vivax was endemic in the whole province, while P. falciparum was prevalent in the regions south of 33° latitude north. In the early 1970s, the morbidity reported was 16.9%, the number of the malaria cases was highest in the country [4]. Afterwards, the reported malaria cases have declined
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