Abstract
ABSTRACT.Plasmodium falciparum and Plasmodium vivax are co-endemic in Ethiopia. This study investigated whether mixed infections were missed by microscopy from a 2017 therapeutic efficacy study at two health facilities in Ethiopia. All patients (N = 304) were initially classified as having single-species P. falciparum (n = 148 samples) or P. vivax infections (n = 156). Dried blood spots were tested for Plasmodium antigens by bead-based multiplex assay for pan-Plasmodium aldolase, pan-Plasmodium lactate dehydrogenase, P. vivax lactate dehydrogenase, and histidine-rich protein 2. Of 304 blood samples, 13 (4.3%) contained both P. falciparum and P. vivax antigens and were analyzed by polymerase chain reaction for species-specific DNA. Of these 13 samples, five were confirmed by polymerase chain reaction for P. falciparum/P. vivax co-infection. One sample, initially classified as P. vivax by microscopy, was found to only have Plasmodium ovale DNA. Plasmodium falciparum/P. vivax mixed infections can be missed by microscopy even in the context of a therapeutic efficacy study with multiple trained readers.
Highlights
Persons may become infected with multiple malaria parasites simultaneously.[6]
This study investigated whether mixed infections were missed by microscopy from a 2017 therapeutic efficacy study at two health facilities in Ethiopia
rapid diagnostic test (RDT) detecting histidine-rich protein 2 (HRP2) and/or pan-Plasmodium lactate dehydrogenase antigens are unable to distinguish between a P. falciparum and P. falciparum/P. vivax mixed infection.[7]
Summary
Persons may become infected with multiple malaria parasites simultaneously.[6]. mixed infections are likely underreported because they are often difficult to detect by microscopy and unable to be detected by many RDTs.[4,7] Ayalew et al.[4] reported that only about 45% of microscopists from Ethiopian hospitals and health centers accurately identified a P. falciparum/P. vivax mixed infection. Of 304 blood samples, 13 (4.3%) contained both P. falciparum and P. vivax antigens and were analyzed by polymerase chain reaction for species-specific DNA.
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