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Ding H, Dong Y, Deng Y, Xu Y, Liu Y, Wu J, Chen M, Zhang C, Liu L, Lin Y. Molecular surveillance of chloroquine resistance in Plasmodium vivax isolates from malaria cases in Yunnan Province of China using pvcrt-o gene polymorphisms. Malar J 2023; 22:338. [PMID: 37940956 PMCID: PMC10631137 DOI: 10.1186/s12936-023-04776-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The efficacy of chloroquine treatment for vivax malaria has been rarely evaluated due to a lack of an appropriate testing method. The objective of this study was to conduct molecular monitoring of chloroquine resistance in Plasmodium vivax strains from vivax malaria patients in Yunnan Province, focusing on the analysis of polymorphism in the P. vivax chloroquine resistance transporter protein orthologous gene (pvcrt-o). METHODS In accordance with the principles of a cohort study, blood samples were collected from malaria cases diagnosed with a P. vivax mono-infection in Yunnan Province from 2020 to 2022. Segmental PCR was used to amplify the whole pvcrt-o gene in the blood samples and their products were subsequently sequenced. The sequencing data were arranged to obtain the full coding DNA sequence (CDS) as well as the gene's promoter region sequences. The CDSs were aligned with the reference sequence (XM_001613407.1) of the P. vivax SalI isolate to identify the mutant loci. RESULTS From a total of 375 blood samples taken from vivax malaria cases, 272 both whole gene CDSs (1272-1275 bp) and promoter DNA sequences (707 bp) of pvcrt-o gene were obtained. Among the whole CDSs, there were 7 single nucleotide polymorphic sites in which c.7 A>G was the minor allele frequency (MAF) site with 4.4% (12/272) detection rate. The mutation detection rate showed a significant decrease from 9.8% (10/102) in 2020 to 1.1% (1/92) in 2021 and 1.3% (1/78) in 2022, indicating statistical significance (χ2 = 11.256, P < 0.05). Among the identified 12 haplotypes, the majority of which were wild type (75.7%; 206/272). These four mutant haplotypes (Hap_3, Hap_5, Hap_9, and Hap_10) were classified as "K10 insertion type" and accounted for 12.1% (33/272). The detection rate of Hap_3 increased from 1.0% (1/102) in 2020 to 13.0% (12/92) in 2021 and 14.1% (11/78) in 2022, indicating statistical significance. A total of 23.8% (65/272) of the samples exhibited 14 bp (bp) deletions in the promoter region, occurring most frequently in the wild type haplotype (Hap_1) samples at a rate of 28.6% (59/206). CONCLUSIONS In recent years in Yunnan Province, a notable proportion of vivax malaria patients are infected by P. vivax strains with a "K10 insertion" and partial sequence deletions in the promoter region of the pvcrt-o gene, necessitating vigilance.
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Affiliation(s)
- Hongyun Ding
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, China
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Yunnan Institute of Parasitic Diseases Control, Pu'er, 665000, China
| | - Ying Dong
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Yunnan Institute of Parasitic Diseases Control, Pu'er, 665000, China.
| | - Yan Deng
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Yunnan Institute of Parasitic Diseases Control, Pu'er, 665000, China
| | - Yanchun Xu
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Yunnan Institute of Parasitic Diseases Control, Pu'er, 665000, China
| | - Yan Liu
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Yunnan Institute of Parasitic Diseases Control, Pu'er, 665000, China
| | - Jing Wu
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Yunnan Institute of Parasitic Diseases Control, Pu'er, 665000, China
| | - Mengni Chen
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Yunnan Institute of Parasitic Diseases Control, Pu'er, 665000, China
| | - Canglin Zhang
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Yunnan International Joint Laboratory of Tropical Infectious Diseases, Yunnan Institute of Parasitic Diseases Control, Pu'er, 665000, China
| | - Li Liu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, China.
| | - Yingkun Lin
- Center for Disease Control and Prevention, Dehong, 678499, China.
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Höher G, Rodrigues MMDO, Waskow G, Agnes G, Von Burg PV, Onsten T, Fiegenbaum M, Almeida S. Identification of ACKR1 variants associated with altered Duffy phenotype expression in blood donors from southern Brazil. Transfus Apher Sci 2020; 59:102768. [PMID: 32276863 DOI: 10.1016/j.transci.2020.102768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 11/18/2022]
Abstract
The atypical chemokine receptor 1 gene (ACKR1) is responsible for the clinically significant Duffy blood group. The main antigens of this system, Fya and Fyb, can be related to a null or weak expression of the DARC protein. In the present work, we aimed to identify ACKR1 gene variants in blood donors from southern Brazil based on discrepancies between their serological and molecular typing results. Then, we analyzed the association of these variants with the expression of the Duffy phenotype. The Fy antigen types were determined via hemagglutination and real-time PCR (c.125 G > A, c.265C > T and c.-67T > C SNPs) tests in a sample composed of 382 regular repetitive voluntary blood donors to the Blood Bank of Hospital de Clínicas de Porto Alegre. An inconclusive correlation between phenotype-genotype analyses was found in 11 (2.88 %) donors, and the entire ACKR1 gene was sequenced in these samples. Our investigation found 11 genetic variants, four of which (c.-541C > T, c.21 + 150C > T, c.22-58A > G, and c.298 G > A SNPs) seem to have putative functional effects on the structure and expression of DARC undertaken for in silico analysis (SIFT, PolyPhen-2 and RegulomeDB). Molecular events can result in apparent discrepancies between red cell genotypes and phenotypes. Our findings provided insight into the molecular background of FY antigens to improve technical approaches for red cell genotyping.
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Affiliation(s)
- Gabriela Höher
- Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
| | | | - Gabriela Waskow
- Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
| | - Grasiela Agnes
- Laboratório de Biologia Molecular, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
| | - Pâmela Victoria Von Burg
- Laboratório de Biologia Molecular, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
| | - Tor Onsten
- Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, Brazil
| | - Marilu Fiegenbaum
- Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
| | - Silvana Almeida
- Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil.
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Silva SR, Almeida ACG, da Silva GAV, Ramasawmy R, Lopes SCP, Siqueira AM, Costa GL, Sousa TN, Vieira JLF, Lacerda MVG, Monteiro WM, de Melo GC. Chloroquine resistance is associated to multi-copy pvcrt-o gene in Plasmodium vivax malaria in the Brazilian Amazon. Malar J 2018; 17:267. [PMID: 30012145 PMCID: PMC6048775 DOI: 10.1186/s12936-018-2411-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/09/2018] [Indexed: 01/08/2023] Open
Abstract
Background The resistance of Plasmodium vivax to chloroquine has become an obstacle to control strategies based on the use of anti-malarials. The current study investigated the association between P. vivax CQ-resistance in vivo with copy number variation and mutations in the promoter region in pvcrt-o and pvmdr1 genes. Methods The study included patients with P. vivax that received supervised treatment with chloroquine and primaquine. Recurrences were actively recorded during this period. Results Among the 60 patients with P. vivax, 25 were CQ-resistant and 35 CQ-susceptible. A frequency of 7.1% of multi-copy pvcrt-o was observed in CQ-susceptible samples and 7.7% in CQ-resistant at D0 (P > 0.05) and 33.3% in CQ-resistant at DR (P < 0.05). For pvmdr1, 10.7% of the CQ-susceptible samples presented multiple copies compared to 11.1% in CQ-resistant at D0 and 0.0% in CQ-resistant at DR (P > 0.05). A deletion of 19 bp was found in 11/23 (47.6%) of the patients with CQ-susceptible P. vivax and 3/10 (23.1%) of the samples with in CQRPv at D0. At day DR, 55.5% of the samples with CQRPv had the 19 bp deletion. For the pvmdr-1 gene, was no variation in the analysed gene compared to the P. vivax reference Sal-1. Conclusions This was the first study with 42-day clinical follow-up to evaluate the variation of the number of copies and polymorphisms in the promoter region of the pvcrt-o and pvmdr1 genes in relation to treatment outcomes. Significantly higher frequency of multi-copy pvcrt-o was found in CQRPv samples at DR compared to CQ-susceptible, indicating parasite selection of this genotype after CQ treatment and its association with CQ-resistance in vivo. Electronic supplementary material The online version of this article (10.1186/s12936-018-2411-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Siuhelem Rocha Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | - Anne Cristine Gomes Almeida
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | | | - Rajendranath Ramasawmy
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | - Stefanie Costa Pinto Lopes
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Instituto Leônidas & Maria Deane (ILMD), Fiocruz, Manaus, Amazonas, 69057-070, Brazil
| | - André Machado Siqueira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Instituto Nacional de Infectologia, Evandro Chagas, Fiocruz, Rio de Janeiro, 21040-360, Brazil
| | - Gabriel Luíz Costa
- Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Minas Gerais, 30190-002, Brazil
| | - Taís Nóbrega Sousa
- Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Minas Gerais, 30190-002, Brazil
| | | | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Instituto Leônidas & Maria Deane (ILMD), Fiocruz, Manaus, Amazonas, 69057-070, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | - Gisely Cardoso de Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil. .,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil.
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Davis MB, Walens A, Hire R, Mumin K, Brown AM, Ford D, Howerth EW, Monteil M. Distinct Transcript Isoforms of the Atypical Chemokine Receptor 1 (ACKR1)/Duffy Antigen Receptor for Chemokines (DARC) Gene Are Expressed in Lymphoblasts and Altered Isoform Levels Are Associated with Genetic Ancestry and the Duffy-Null Allele. PLoS One 2015; 10:e0140098. [PMID: 26473357 PMCID: PMC4608815 DOI: 10.1371/journal.pone.0140098] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022] Open
Abstract
The Atypical ChemoKine Receptor 1 (ACKR1) gene, better known as Duffy Antigen Receptor for Chemokines (DARC or Duffy), is responsible for the Duffy Blood Group and plays a major role in regulating the circulating homeostatic levels of pro-inflammatory chemokines. Previous studies have shown that one common variant, the Duffy Null (Fy-) allele that is specific to African Ancestry groups, completely removes expression of the gene on erythrocytes; however, these individuals retain endothelial expression. Additional alleles are associated with a myriad of clinical outcomes related to immune responses and inflammation. In addition to allele variants, there are two distinct transcript isoforms of DARC which are expressed from separate promoters, and very little is known about the distinct transcriptional regulation or the distinct functionality of these protein isoforms. Our objective was to determine if the African specific Fy- allele alters the expression pattern of DARC isoforms and therefore could potentially result in a unique signature of the gene products, commonly referred to as antigens. Our work is the first to establish that there is expression of DARC on lymphoblasts. Our data indicates that people of African ancestry have distinct relative levels of DARC isoforms expressed in these cells. We conclude that the expression of both isoforms in combination with alternate alleles yields multiple Duffy antigens in ancestry groups, depending upon the haplotypes across the gene. Importantly, we hypothesize that DARC isoform expression patterns will translate into ancestry-specific inflammatory responses that are correlated with the axis of pro-inflammatory chemokine levels and distinct isoform-specific interactions with these chemokines. Ultimately, this work will increase knowledge of biological mechanisms underlying disparate clinical outcomes of inflammatory-related diseases among ethnic and geographic ancestry groups.
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Affiliation(s)
- Melissa B. Davis
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
- Department of Molecular Biology and Biochemistry, Georgia Regents University–University of Georgia Medical Partnership, Athens, GA, United States of America
- * E-mail: (MD); (MM)
| | - Andrea Walens
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
| | - Rupali Hire
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
| | - Kauthar Mumin
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
| | - Andrea M. Brown
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
| | - DeJuana Ford
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States of America
| | - Elizabeth W. Howerth
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, United States of America
| | - Michele Monteil
- Department of Molecular Biology and Biochemistry, Georgia Regents University–University of Georgia Medical Partnership, Athens, GA, United States of America
- * E-mail: (MD); (MM)
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Sitali L, Chipeta J, Miller JM, Moonga HB, Kumar N, Moss WJ, Michelo C. Patterns of mixed Plasmodium species infections among children six years and under in selected malaria hyper-endemic communities of Zambia: population-based survey observations. BMC Infect Dis 2015; 15:204. [PMID: 25930101 PMCID: PMC4424549 DOI: 10.1186/s12879-015-0935-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although malaria is preventable and treatable, it still claims 660,000 lives every year globally with children under five years of age having the highest burden. In Zambia, malaria rapid diagnostic tests (RDTs) that only detect Plasmodium falciparum are the main confirmatory means for malaria diagnosis in most health facilities without microscopy services. As a consequence of this P. falciparum species diagnostic approach, non-falciparum malaria is not only under-diagnosed but entirely missed, thereby making the exact disease burden unknown. We thus investigated the prevalence of various Plasmodium spp. and associated burden of infection in selected communities in Zambia. METHODS Data from two malaria hyper-endemic provinces (Eastern and Luapula) of the 2012 National Malaria Indicator Survey (MIS), conducted between April and May 2012, were used. The MIS is a nationally representative, two-stage cluster survey conducted to coincide with the end of the malaria transmission season. Social, behavioural and background information were collected from households as part of the survey. Thick blood smears, RDTs and dried blood spots (DBS) were collected from children below six years of age. Slides were stained using Giemsa and examined by microscopy while polymerase chain reaction (PCR) was used to analyse the DBS for malaria Plasmodium spp. Multivariate logistic regression was employed to examine the association between background factors and malaria. RESULTS Overall, 873 children younger than six years of age were surveyed. The overall prevalence of Plasmodium spp. by PCR was 54.3% (95% CI 51-57.6%). Of the total Plasmodium isolates, 88% were P. falciparum, 10.6% were mixed infections and 1.4% were non-falciparum mono infections. Among the mixed infections, the majority were a combination of P. falciparum and P. malariae (6.5% of all mixed infections). Children two years and older (2-5 years) had three-fold higher risk of mixed malaria infections (aOR 2.8 CI 1.31-5.69) than children younger than two years of age. CONCLUSION The high prevalence of mixed Plasmodium spp. infections in this population stresses review of the current malaria RDT diagnostic approaches. The observed less incidence of mixed infections in children under two years of age compared to their older two-to-five-year-old counterparts is probably due to the protective maternal passive immunity, among other factors, in that age group.
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Affiliation(s)
- Lungowe Sitali
- Department of Biomedical Science, University of Zambia, School of Medicine, Lusaka, Zambia. .,Department of Paediatrics and Child Health, School of Medicine, Malaria Research Unit (SMUTH-MRU), Lusaka, Zambia. .,John Hopkins Malaria Research Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - James Chipeta
- Department of Paediatrics and Child Health, School of Medicine, Malaria Research Unit (SMUTH-MRU), Lusaka, Zambia. .,Department of Paediatrics and Child Health, University of Zambia, School of Medicine, Lusaka, Zambia.
| | - John M Miller
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Lusaka, Zambia.
| | - Hawela B Moonga
- Ministry of Health, National Malaria Control Centre, Lusaka, Zambia.
| | - Nirbhay Kumar
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.
| | - William J Moss
- John Hopkins Malaria Research Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Charles Michelo
- Department of Paediatrics and Child Health, School of Medicine, Malaria Research Unit (SMUTH-MRU), Lusaka, Zambia. .,Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia.
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Mendes C, Dias F, Figueiredo J, Mora VG, Cano J, de Sousa B, do Rosário VE, Benito A, Berzosa P, Arez AP. Duffy negative antigen is no longer a barrier to Plasmodium vivax--molecular evidences from the African West Coast (Angola and Equatorial Guinea). PLoS Negl Trop Dis 2011; 5:e1192. [PMID: 21713024 PMCID: PMC3119644 DOI: 10.1371/journal.pntd.0001192] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 04/17/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Plasmodium vivax shows a small prevalence in West and Central Africa due to the high prevalence of Duffy negative people. However, Duffy negative individuals infected with P. vivax have been reported in areas of high prevalence of Duffy positive people who may serve as supply of P. vivax strains able to invade Duffy negative erythrocytes. We investigated the presence of P. vivax in two West African countries, using blood samples and mosquitoes collected during two on-going studies. METHODOLOGY/FINDINGS Blood samples from a total of 995 individuals were collected in seven villages in Angola and Equatorial Guinea, and 820 Anopheles mosquitoes were collected in Equatorial Guinea. Identification of the Plasmodium species was achieved by nested PCR amplification of the small-subunit rRNA genes; P. vivax was further characterized by csp gene analysis. Positive P. vivax-human isolates were genotyped for the Duffy blood group through the analysis of the DARC gene. Fifteen Duffy-negative individuals, 8 from Equatorial Guinea (out of 97) and 7 from Angola (out of 898), were infected with two different strains of P. vivax (VK210 and VK247). CONCLUSIONS In this study we demonstrated that P. vivax infections were found both in humans and mosquitoes, which means that active transmission is occurring. Given the high prevalence of infection in mosquitoes, we may speculate that this hypnozoite-forming species at liver may not be detected by the peripheral blood samples analysis. Also, this is the first report of Duffy negative individuals infected with two different strains of P. vivax (VK247 and classic strains) in Angola and Equatorial Guinea. This finding reinforces the idea that this parasite is able to use receptors other than Duffy to invade erythrocytes, which may have an enormous impact in P. vivax current distribution.
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Affiliation(s)
- Cristina Mendes
- Centro de Malária e Outras Doenças Tropicais, Unidade de Parasitologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Fernanda Dias
- Centro de Malária e Outras Doenças Tropicais, Unidade de Parasitologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
| | - Joana Figueiredo
- Centro de Malária e Outras Doenças Tropicais, Unidade de Parasitologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Jorge Cano
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
| | - Bruno de Sousa
- Centro de Malária e Outras Doenças Tropicais, Unidade de Saúde Internacional, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Virgílio E. do Rosário
- Centro de Malária e Outras Doenças Tropicais, Unidade de Parasitologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Agustin Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Berzosa
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Paula Arez
- Centro de Malária e Outras Doenças Tropicais, Unidade de Parasitologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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