Prospective Clinical and Molecular Evaluation of Potential Plasmodium ovale curtisi and wallikeri Relapses in a High-transmission Setting
Prospective Clinical and Molecular Evaluation of Potential Plasmodium ovale curtisi and wallikeri Relapses in a High-transmission Setting
复制标题
DOI：
10.1093/cid/ciz131
复制
发表时间：
2019-12-15
影响因子：
11.8
通讯作者：
Ramhartert, Michael
中科院分区：
文献类型：
--
作者：
Groger, Miriam;Veletzky, Luzia;Ramhartert, Michael
背景卵形疟原虫和瓦氏疟原虫被认为是复发性疟疾寄生虫。与间日疟原虫相反，这一假说的直接证据很少。这项前瞻性研究的目的是描述卵圆形寄生虫的再现模式。卵形青霉感染的患者用蒿甲醚-苯芴醇治疗，并每两周随访一次，长达1年，以检测再次出现的寄生虫血症。对重现的分离株进行分子分析，通过基因分型鉴定同源分离株，并根据预定标准确定复发病例。入选时，26名受试者的卵形普氏杆菌和/或卵形普氏杆菌呈阳性。中位随访时间为35周。在46%的受试者中观察到相同的卵形疟原虫种属的重现;估计61%的卵形疟原虫curtisi和19%的卵形疟原虫wallikeri无感染间期在第32周前以重现结束。根据预先确定的标准，23%的参与者被确定为1或2次复发，所有复发均由卵圆弓形虫引起。这些发现与目前公认的复发理论一致，因为最终证明了初始血液清除后卵形普氏杆菌菌株的重现。有趣的是，没有观察到卵形瓦氏疟原虫的复发。
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.Results. At 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.Conclusion. These 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.