Abstract
BackgroundPlasmodium vivax is very rarely seen in West Africa, although specific detection methods are not widely applied in the region, and it is now considered to be absent from North Africa. However, this parasite species has recently been reported to account for most malaria cases in Nouakchott, the capital of Mauritania, which is a large country at the interface of sub-Saharan West Africa and the Maghreb region in northwest Africa.MethodsTo determine the distribution of malaria parasite species throughout Mauritania, malaria cases were sampled in 2012 and 2013 from health facilities in 12 different areas. These sampling sites were located in eight major administrative regions of the country, within different parts of the Sahara and Sahel zones. Blood spots from finger-prick samples of malaria cases were processed to identify parasite DNA by species-specific PCR.ResultsOut of 472 malaria cases examined, 163 (34.5 %) had P. vivax alone, 296 (62.7 %) Plasmodium falciparum alone, and 13 (2.8 %) had mixed P. falciparum and P. vivax infection. All cases were negative for Plasmodium malariae and Plasmodium ovale. The parasite species distribution showed a broad spectrum, P. vivax being detected at six of the different sites, in five of the country’s major administrative regions (Tiris Zemmour, Tagant, Brakna, Assaba, and the capital Nouakchott). Most cases in Nouakchott were due to P. vivax, although proportions vary significantly among different health facilities in the city. In the northern town of Zouérat, all cases were due to P. vivax, whereas almost all cases in the south of the country were due to P. falciparum. All P. vivax cases tested were Duffy blood group positive.ConclusionsIt is important that P. vivax is recognized to be a widespread cause of malaria in Mauritania, occurring in diverse regions. This should be noted by the World Health Organization, as it has significant implications for diagnosis, treatment and control of malaria in the northwestern part of Africa.
Highlights
Plasmodium vivax is very rarely seen in West Africa, specific detection methods are not widely applied in the region, and it is considered to be absent from North Africa
Most malaria cases in Africa are caused by Plasmodium falciparum [1], with a relatively small proportion attributable to Plasmodium malariae or Plasmodium ovale, while Plasmodium vivax is known to occur in only some areas of the continent [2, 3]
One factor contributing to this is that most inhabitants in Nouakchott are ethnically identified as white Maures, who are generally positive for the Duffy antigen erythrocyte receptor for P. vivax, which is rare among other West African ethnic groups living mostly in the south of the country [16]
Summary
Plasmodium vivax is very rarely seen in West Africa, specific detection methods are not widely applied in the region, and it is considered to be absent from North Africa This parasite species has recently been reported to account for most malaria cases in Nouakchott, the capital of Mauritania, which is a large country at the interface of sub-Saharan West Africa and the Maghreb region in northwest Africa. Recent reports indicate that P. vivax is more commonly seen than P. falciparum in patients with malaria in Nouakchott [9,10,11,12] This represents an apparently unique epidemiological situation, as P. vivax has been very rarely or never seen at most other sites in West Africa [2, 3, 13,14,15]. A second factor is that local breeding of the mosquito vector Anopheles arabiensis has been facilitated by surface water environments, created by loosely regulated urbanization over recent decades in an area that was originally desert [12]
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