Outbreak of human malaria caused by Plasmodium simium in the Atlantic Forest in Rio de Janeiro: a molecular epidemiological investigation
Outbreak of human malaria caused by Plasmodium simium in the Atlantic Forest in Rio de Janeiro: a molecular epidemiological investigation
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DOI：
10.1016/s2214-109x(17)30333-9
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发表时间：
2017-10-01
影响因子：
34.3
通讯作者：
Daniel-Ribeiro, Claudio Tadeu
中科院分区：
文献类型：
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作者：
Brasil, Patricia;Zalis, Mariano Gustavo;Daniel-Ribeiro, Claudio Tadeu
50多年前，疟疾在巴西南部和东南部被消灭。然而，最近在巴西里约热内卢州大西洋森林地区报告了越来越多归因于间日疟原虫的本地病例。由于间日疟原虫样非人灵长类疟疾寄生虫种simplasmodium是局部地方性的，我们进行了分子流行病学调查，以确定是否发生人畜共患疟疾传播。方法采用显微镜和聚合酶链反应（PCR）对有疟疾体征或症状的患者以及当地吼猴的血液样本进行检测。样本来自有前往或居住在巴西里约热内卢大西洋森林地区的个人，但不包括有疟疾预防、输血或组织或器官移植，或在前一年去过已知的疟疾流行地区的人。此外，我们开发了一种基于寄生虫线粒体基因组测序的分子检测方法来区分间日疟原虫和猴疟原虫，并将该检测方法应用于2015年和2016年爆发的33例间日疟原虫。结果2015- 2016年共报告本地疟疾病例49例。大多数患者为男性，平均年龄44岁（SD 14.6）， 82%居住在巴西里约热内卢州的城市地区，并曾因休闲或与工作有关的活动而访问大西洋森林。33例进行线粒体DNA测序。对28份样品成功地进行了分析，所有样品均显示为磷，表明该物种在该地区人畜共患传播。其中3例的全线粒体基因组测序显示，猴疟原虫与南美间日疟原虫的亲缘关系最为密切。该地区的疟疾暴发是由疟原虫引起的，以前被认为是猴子特有的疟疾寄生虫，与间日疟原虫有关，但不同于间日疟原虫，以前从未有确凿证据表明它会感染人类。这一明确的人畜共患传播证据，在此前唯一的人类感染磷的报告50年之后，导致这种寄生虫可能一直感染该地区的人，但由于缺乏分子分型技术，它一直被误诊为间日疟。需要对当地非人类灵长类动物和蚊子（按蚊）进行彻底筛查，以评估这一新认识的人畜共患疾病对巴西公共卫生和消除疟疾的威胁程度。版权(C)作者(s)。Elsevier Ltd.出版。这是一篇基于CC BY-NC-ND 4.0许可的开放获取文章。
Background Malaria was eliminated from southern and southeastern Brazil over 50 years ago. However, an increasing number of autochthonous episodes attributed to Plasmodium vivax have recently been reported from the Atlantic Forest region of Rio de Janeiro state. As the P vivax-like non-human primate malaria parasite species Plasmodium simium is locally enzootic, we performed a molecular epidemiological investigation to determine whether zoonotic malaria transmission is occurring.Methods We examined blood samples from patients presenting with signs or symptoms suggestive of malaria as well as from local howler monkeys by microscopy and PCR. Samples were included from individuals if they had a history of travel to or resided in areas within the Rio de Janeiro Atlantic Forest, but not if they had malaria prophylaxis, blood transfusion or tissue or organ transplantation, or had travelled to known malaria endemic areas in the preceding year. Additionally, we developed a molecular assay based on sequencing of the parasite mitochondrial genome to distinguish between P vivax and P simium, and applied this assay to 33 cases from outbreaks that occurred in 2015, and 2016.Findings A total of 49 autochthonous malaria cases were reported in 2015-16. Most patients were male, with a mean age of 44 years (SD 14.6), and 82% lived in urban areas of Rio de Janeiro state and had visited the Atlantic Forest for leisure or work-related activities. 33 cases were used for mitochondrial DNA sequencing. The assay was successfully performed for 28 samples, and all were shown to be P simium, indicative of zoonotic transmission of this species to human beings in this region. Sequencing of the whole mitochondrial genome of three of these cases showed that P simium is most closely related to P vivax parasites from South America. The malaria outbreaks in this region were caused by P simium, previously considered to be a monkey-specific malaria parasite, related to but distinct from P vivax, and which has never conclusively been shown to infect people before.Interpretation This unequivocal demonstration of zoonotic transmission, 50 years after the only previous report of P simium in people, leads to the possibility that this parasite has always infected people in this region, but that it has been consistently misdiagnosed as P vivax because of an absence of molecular typing techniques. Thorough screening of local non-human primates and mosquitoes (Anopheline) is required to evaluate the extent of this newly recognised zoonotic threat to public health and malaria elimination in Brazil. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.