Activation of minority-variant Plasmodium vivax hypnozoites following artesunate + amodiaquine treatment in a 23-year old man with relapsing malaria in Antananarivo, Madagascar

Malaria Journal

Case Report

Jonathan J Juliano¹  Jessica T Lin¹  Christopher Golden²  Milijaona Randrianarivelojosia³  Voahangy Andrianaranjaka³ 

[1] Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA;Harvard University Center for the Environment, Cambridge, MA, USA;Madagascar Health and Environmental Research (MAHERY), Maroantsetra, Madagascar;Institut Pasteur de Madagascar, Antananarivo 101, BP 1274, Madagascar;

关键词: Malaria;    Artesunate;    Vivax Malaria;    Vivax Infection;    Primaquine;   

DOI  :  10.1186/1475-2875-12-177

 received in 2013-02-04, accepted in 2013-05-27,  发布年份 2013

来源: Springer

【 摘 要 】

In endemic areas, Plasmodium vivax relapses are difficult to distinguish from new infections. Genotyping of patients who experience relapse after returning to a malaria-free area can be used to explore the nature of hypnozoite activation and relapse. This paper describes a person who developed P. vivax malaria for the first time after travelling to Boriziny in the malaria endemic coastal area of Madagascar, then suffered two P. vivax relapses 11 weeks and 21 weeks later despite remaining in Antananarivo in the malaria-free central highlands area. He was treated with the combination artesunate + amodiaquine according to the national malaria policy in Madagascar. Genotyping by PCR-RFLP at pvmsp-3α as well as pvmsp1 heteroduplex tracking assay (HTA) showed the same dominant genotype at each relapse. Multiple recurring minority variants were also detected at each relapse, highlighting the propensity for multiple hypnozoite clones to activate simultaneously to cause relapse.

【 授权许可】

Unknown   
© Andrianaranjaka et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.