Abstract
Background Plasmodium ovale curtisi and wallikeri are perceived as relapsing malarial parasites. Contrary to Plasmodium vivax, direct evidence for this hypothesis is scarce. The aim of this prospective study was to characterize the reappearance patterns of ovale parasites.Methods P. ovale spp. infected patients were treated with artemether-lumefantrine and followed biweekly for up to 1 year for the detection of reappearing parasitemia. Molecular analysis of reappearing isolates was performed to identify homologous isolates by genotyping and to define cases of relapse following predefined criteria.ResultsAt inclusion, 26 participants were positive for P. ovale curtisi and/or P. ovale wallikeri. The median duration of follow-up was 35 weeks. Reappearance of the same P. ovale species was observed in 46% of participants; 61% of P. ovale curtisi and 19% of P. ovale wallikeri infection-free intervals were estimated to end with reappearance by week 32. Based on the predefined criteria, 23% of participants were identified with 1 or 2 relapses, all induced by P. ovale curtisi.ConclusionThese findings are in line with the currently accepted relapse theory inasmuch as the reappearance of P. ovale curtisi strains following initial blood clearance was conclusively demonstrated. Interestingly, no relapse of P. ovale wallikeri was observed.
Highlights
Plasmodium ovale curtisi and wallikeri are perceived as relapsing malarial parasites
Between October 2014 and October 2016, 34 patients with polymerase chain reaction (PCR) corrected P. ovale spp. infections were included, and 537 samples were analyzed by ultrasensitive real-time quantitative PCR (qPCR)
Thirteen participants presented with a qPCR diagnosed P. ovale curtisi infection at baseline, 9 were positive for P. ovale wallikeri, and 4 were positive for both
Summary
The aim of this study was to investigate the incidence patterns of ovale reappearance focusing on the molecular characterization of potential relapses and considering the difference between the sympatric species P. ovale wallikeri and P. ovale curtisi
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