Abstract
Background Plasmodium falciparum transmission depends on mature gametocytes that can be ingested by mosquitoes taking a blood meal on human skin. Although gametocyte skin sequestration has long been hypothesized as important contributor to efficient malaria transmission, this has never been formally tested.MethodsIn naturally infected gametocyte carriers from Burkina Faso, we assessed infectivity to mosquitoes by direct skin feeding and membrane feeding. We directly quantified male and female gametocytes and asexual parasites in finger-prick and venous blood samples, skin biopsy samples, and in of mosquitoes that fed on venous blood or directly on skin. Gametocytes were visualized in skin tissue with confocal microscopy.ResultsAlthough more mosquitoes became infected when feeding directly on skin then when feeding on venous blood (odds ratio, 2.01; 95% confidence interval, 1.21–3.33; P = .007), concentrations of gametocytes were not higher in the subdermal skin vasculature than in other blood compartments; only sparse gametocytes were observed in skin tissue.DiscussionOur data strongly suggest that there is no significant skin sequestration of P. falciparum gametocytes. Gametocyte densities in peripheral blood are thus informative for predicting onward transmission potential to mosquitoes and can be used to target and monitor malaria elimination initiatives.
Highlights
Gnificant reductions in malaria burden in recent decades have stimulated malaria elimination initiatives [1], which may require approaches that reduce malaria transmission [2]
We report on 2 independent studies in naturally infected gametocyte carriers from Burkina Faso, in which we quantified mature P. falciparum gametocytes in skin tissue, blood samples, and mosquito blood meals in association with onward transmission to Anopheles mosquitoes
Total gametocyte density, quantified in venous blood by Pfs25 and Pfmget quantitative reverse-transcription polymerase chain reaction (qRT-PCR) [26], was positively associated with the proportion of mosquitoes that became infected after direct skin feeding (ρ = 0.415; P = .02) or membrane feeding (ρ = 0.596; P < .001) (Figure 1A)
Summary
Plasmodium falciparum transmission depends on mature gametocytes that can be ingested by mosquitoes taking a blood meal on human skin. Gametocyte skin sequestration has long been hypothesized as important contributor to efficient malaria transmission, this has never been formally tested
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