4.4 Article

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

Journal

MALARIA JOURNAL
Volume 12, Issue -, Pages -

Publisher

BMC
DOI: 10.1186/1475-2875-12-177

Keywords

-

Funding

  1. Institut Pasteur de Madagascar [MDG-910-G19-M]
  2. University of North Carolina, USA from the National Institutes of Health [AI089819]
  3. National Institutes of Health [5T32AI0715132]
  4. North Carolina Clinical and Translational Science Award [UL1RR025747]
  5. Directorate For Geosciences [1115057] Funding Source: National Science Foundation

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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-3 alpha 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.

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