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Patiño LH, Castañeda S, Camargo M, Cao LY, Liggayu B, Paniz-Mondolfi A, Ramírez JD. Validation of real-time PCR assays for detecting Plasmodium and Babesia DNA species in blood samples. Acta Trop 2024; 258:107350. [PMID: 39134111 DOI: 10.1016/j.actatropica.2024.107350] [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: 06/05/2024] [Revised: 07/11/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024]
Abstract
Malaria and babesiosis are global health threats affecting humans, wildlife, and domestic animals, particularly in Africa, the Americas, and Europe. Malaria can lead to severe outcomes, while babesiosis usually resembles a mild illness but can be severe and fatal in individuals with weakened immune systems. Swift, accurate detection of these parasites is crucial for treatment and control. We evaluated a real-time PCR assay for diagnosing five Plasmodium and three Babesia species from blood samples, assessing its sensitivity, specificity, and analytical performance by analyzing 46 malaria-positive and 32 Babesia spp-positive samples diagnosed through microscopy. The limit of detection for Plasmodium species ranged from 30 to 0.0003 copies/µL. For mixed infections, it was 0.3 copies/µL for P. falciparum/P. vivax and 3 copies/µL for P. malariae/P. knowlesi. Babesia species had a detection limit of 0.2 copies/µL. No cross-reactivity was observed among 64 DNA samples from various microorganisms. The assay showed good sensitivity, detecting Plasmodium and Babesia species with 100 % accuracy overall, except for P. falciparum (97.7 %) and B. microti (12.5 %). The low sensitivity of detecting B. microti was attributed to limitations in microscopy for species identification. This technique heavily relies on the proficiency of the examiner, as species within the genus cannot be distinguished under a microscope. Additionally, Babesia can be confused with the early trophozoite stage (ring forms) of Plasmodium parasites. The findings support multiplex qPCR's diagnostic superiority over the gold standard, despite higher costs. It offers enhanced sensitivity, specificity, and detects mixed infections, crucial for effective monitoring and diagnosis of malaria and babesiosis in endemic regions with significant public health challenges.
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Affiliation(s)
- Luz Helena Patiño
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia; Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sergio Castañeda
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Milena Camargo
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Li Yong Cao
- Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Bernadette Liggayu
- Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alberto Paniz-Mondolfi
- Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia; Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Braima KA, Piera KA, Lubis IND, Noviyanti R, Rajahram GS, Kariodimedjo P, Nainggolan IRA, Permatasari R, Trianty L, Amalia R, Sakam SSB, Tan AF, William T, Westaway JAF, Lee P, Daim S, Surendra H, Christy N, Letizia AG, Peatey CL, Moideen MA, Barber BE, Sutherland CJ, Anstey NM, Grigg MJ. Improved limit of detection for zoonotic Plasmodium knowlesi and P. cynomolgi surveillance using reverse transcription for total nucleic acid preserved samples or dried blood spots. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.04.24305339. [PMID: 38633782 PMCID: PMC11023669 DOI: 10.1101/2024.04.04.24305339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Zoonotic P. knowlesi and P. cynomolgi symptomatic and asymptomatic infections occur across endemic areas of Southeast Asia. Most infections are low-parasitemia, with an unknown proportion below routine microscopy detection thresholds. Molecular surveillance tools optimizing the limit of detection (LOD) would allow more accurate estimates of zoonotic malaria prevalence. Methods An established ultra-sensitive Plasmodium genus quantitative-PCR (qPCR) assay targeting the 18S rRNA gene underwent LOD evaluation with and without reverse transcription (RT) for P. knowlesi, P. cynomolgi and P. vivax using total nucleic acid preserved (DNA/RNA Shield™) isolates and archived dried blood spots (DBS). LODs for selected P. knowlesi-specific assays, and reference P. vivax- and P. cynomolgi-specific assays were determined with RT. Assay specificities were assessed using clinical malaria samples and malaria-negative controls. Results The use of reverse transcription improved Plasmodium species detection by up to 10,000-fold (Plasmodium genus), 2759-fold (P. knowlesi), 1000-fold (P. vivax) and 10-fold (P. cynomolgi). The median LOD with RT for the Kamau et al. Plasmodium genus RT-qPCR assay was ≤0.0002 parasites/μL for P. knowlesi and 0.002 parasites/μL for both P. cynomolgi and P. vivax. The LODs with RT for P. knowlesi-specific PCRs were: Imwong et al. 18S rRNA (0.0007 parasites/μL); Divis et al. real-time 18S rRNA (0.0002 parasites/μL); Lubis et al. hemi-nested SICAvar (1.1 parasites/μL) and Lee et al. nested 18S rRNA (11 parasites/μL). The LOD for P. vivax- and P. cynomolgi-specific assays with RT were 0.02 and 0.20 parasites/μL respectively. For DBS P. knowlesi samples the median LOD for the Plasmodium genus qPCR with RT was 0.08, and without RT was 19.89 parasites/uL (249-fold change); no LOD improvement was demonstrated in DBS archived beyond 6 years. The Plasmodium genus and P. knowlesi-assays were 100% specific for Plasmodium species and P. knowlesi detection, respectively, from 190 clinical infections and 48 healthy controls. Reference P. vivax-specific primers demonstrated known cross-reactivity with P. cynomolgi. Conclusion Our findings support the use of an 18S rRNA Plasmodium genus qPCR and species-specific nested PCR protocol with RT for highly-sensitive surveillance of zoonotic and human Plasmodium species infections.
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Affiliation(s)
- Kamil A Braima
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kim A Piera
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Inke ND Lubis
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | | | - Giri S Rajahram
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre-Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
- School of Medicine and Health Sciences, Monash University Malaysia, Kuala Lumpur, Malaysia
| | | | - Irbah RA Nainggolan
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Ranti Permatasari
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Leily Trianty
- Eijkman Research Center for Molecular Biology, BRIN, Indonesia
| | | | - Sitti Saimah binti Sakam
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Angelica F Tan
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Timothy William
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre-Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | - Jacob AF Westaway
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Centre for Tropical Bioinformatics and Molecular Biology, James Cook University, Cairns, Queensland, Australia
| | - PingChin Lee
- Biotechnology Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Faculty of Science and Natural Resources, Universiti Malaysia Sabah, Kota Kinabalu, Sabah Malaysia
| | - Sylvia Daim
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Henry Surendra
- Monash University Indonesia, Tangerang, Indonesia
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Christopher L Peatey
- Drug Resistance and Diagnostics, Australian Defence Force Malaria and Infectious Disease Institute, Brisbane, Queensland, Australia
| | - Mohd Arshil Moideen
- Malaysian Armed Forces and Faculty of Medicine & Defence Health, National Defence University of Malaysia
| | - Bridget E Barber
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Colin J Sutherland
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Matthew J Grigg
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
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Fornace KM, Zorello Laporta G, Vythilingham I, Chua TH, Ahmed K, Jeyaprakasam NK, de Castro Duarte AMR, Amir A, Phang WK, Drakeley C, Sallum MAM, Lau YL. Simian malaria: a narrative review on emergence, epidemiology and threat to global malaria elimination. THE LANCET. INFECTIOUS DISEASES 2023; 23:e520-e532. [PMID: 37454671 DOI: 10.1016/s1473-3099(23)00298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 07/18/2023]
Abstract
Simian malaria from wild non-human primate populations is increasingly recognised as a public health threat and is now the main cause of human malaria in Malaysia and some regions of Brazil. In 2022, Malaysia became the first country not to achieve malaria elimination due to zoonotic simian malaria. We review the global distribution and drivers of simian malaria and identify priorities for diagnosis, treatment, surveillance, and control. Environmental change is driving closer interactions between humans and wildlife, with malaria parasites from non-human primates spilling over into human populations and human malaria parasites spilling back into wild non-human primate populations. These complex transmission cycles require new molecular and epidemiological approaches to track parasite spread. Current methods of malaria control are ineffective, with wildlife reservoirs and primarily outdoor-biting mosquito vectors urgently requiring the development of novel control strategies. Without these, simian malaria has the potential to undermine malaria elimination globally.
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Affiliation(s)
- Kimberly M Fornace
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Gabriel Zorello Laporta
- Graduate Research and Innovation Program, Centro Universitario FMABC, Santo André, São Paulo, Brazil
| | | | | | - Kamruddin Ahmed
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia; Borneo Medical and Health Research Centre, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Nantha K Jeyaprakasam
- Biomedical Science Programme, Center for Toxicology and Health Risk Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ana Maria Ribeiro de Castro Duarte
- Laboratory of Protozoology, Institute of Tropical Medicine of São Paulo, Universidade de São Paulo, São Paulo, Brazil; Instituto Pasteur, Secretaria de Estado da Saude de São Paulo, São Paulo, Brazil
| | - Amirah Amir
- Department of Parasitology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wei Kit Phang
- Department of Parasitology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Anice M Sallum
- Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de São Paulo, São Paulo, Brazil
| | - Yee Ling Lau
- Department of Parasitology, Universiti Malaya, Kuala Lumpur, Malaysia
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Teou DC, Dorkenoo AM, Ataba E, Alidou S, Yakpa K, Abdou-Kerim A, Maman I, Agbonon A. Evaluation of the performance of advantage P.f. malaria Card ® and advantage malaria Pan + Pf Card ®, two rapid diagnostic tests for parasitological confirmation of malaria cases in field situation in Togo. Parasit Vectors 2023; 16:444. [PMID: 38037186 PMCID: PMC10691072 DOI: 10.1186/s13071-023-06062-y] [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: 08/29/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND In Togo, malaria remains a major public health problem, and the management of suspected cases requires confirmation with appropriate biological methods. Malaria diagnosis has been improved by the introduction of rapid diagnostic tests (RDTs), recommended by the World Health Organization (WHO) for areas where microscopy is not available. To be used, these RDTs must meet performance criteria defined by the WHO. This study was conducted to evaluate the diagnostic performance of two RDTs: Advantage P.f. Malaria Card® detecting HRP2 antigen and Advantage Malaria Pan + Pf Card® detecting both HRP2 and pLDH antigens. METHODS This was a cross-sectional analytical study conducted from December 2019 to February 2020 on malaria-suspected cases received in three sentinel sites in Togo and from whom capillary blood was collected to perform the two RDTs according to the manufacturer's instructions. Sensitivity and specificity were estimated by comparing to thick/thin blood smear, the gold standard, and to PCR, which is a more sensitive. RESULTS A total of 390 participants (54.9% female) with a median age of 18 (± 0.8) years were included in the study. The sensitivity of both Advantage P.f. Malaria Card® and Advantage Malaria Pan + Pf Card® compared to thick/thin blood smear was 91.8% and 91.3%, respectively, and for both the specificity was 94.7%. Compared to PCR, the sensitivity was 84.2% and 83.8%, respectively, and the specificity 96.5%. CONCLUSIONS The performances of the Advantage P.f. Malaria Card® and Advantage Malaria PAN + Pf Card® compared to microscopy, considered the gold standard, were acceptable under the field conditions found in Togo. They can therefore be used for the biological diagnosis of malaria.
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Affiliation(s)
- Diwaba Carmel Teou
- Faculté Des Sciences, Université de Lomé, Boulevard Eyadema, 01BP 1515, Lomé, Togo.
| | - Ameyo Monique Dorkenoo
- Faculté Des Sciences de La Santé, Université de Lomé, Boulevard Eyadema, 01BP 1515, Lomé, Togo
| | - Essoham Ataba
- Ministère de la Santé de L'Hygiène Publique et de L'Accès Universel Aux Soins, Programme National de Lutte Contre Le Paludisme, Quartier Administratif, 01BP 518, Lomé, Togo
| | - Smaila Alidou
- Département de Santé Publique, Unité de Formation et de Recherche en Sciences de la Santé, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Kossi Yakpa
- Ministère de la Santé de L'Hygiène Publique et de L'Accès Universel Aux Soins, Programme National de Lutte Contre Le Paludisme, Quartier Administratif, 01BP 518, Lomé, Togo
| | - Agueregna Abdou-Kerim
- Ministère de la Santé de L'Hygiène Publique et de L'Accès Universel Aux Soins, Institut National d'Hygiène, Quartier Administratif, 01BP 1396, Lomé, Togo
| | - Issaka Maman
- Ministère de la Santé de L'Hygiène Publique et de L'Accès Universel Aux Soins, Institut National d'Hygiène, Quartier Administratif, 01BP 1396, Lomé, Togo
| | - Amegnona Agbonon
- Faculté Des Sciences, Université de Lomé, Boulevard Eyadema, 01BP 1515, Lomé, Togo
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Mewara A, Sreenivasan P, Khurana S. Primate malaria of human importance. Trop Parasitol 2023; 13:73-83. [PMID: 37860614 PMCID: PMC10583777 DOI: 10.4103/tp.tp_79_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/10/2023] [Indexed: 10/21/2023] Open
Abstract
Nonhuman primate (NHP) malaria poses a major threat to the malaria control programs. The last two decades have witnessed a paradigm shift in our understanding of the malaria caused by species other than the traditionally known human Plasmodium species - Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale. The emergence of the malaria parasite of long-tailed macaque monkeys, Plasmodium knowlesi, as the fifth malaria species of humans has made the scientific community consider the risk of other zoonotic malaria, such as Plasmodium cynomolgi, Plasmodium simium, Plasmodium inui, and others, to humans. The development of knowledge about P. knowlesi as a pathogen which was earlier only known to experimentally cause malaria in humans and rarely cause natural infection, toward its acknowledgment as a significant cause of human malaria and a threat of malaria control programs has been made possible by the use of advanced molecular techniques such as polymerase chain reaction and gene sequencing. This review explores the various aspects of NHP malaria, and the association of various factors with their emergence and potential to cause human malaria which are important to understand to be able to control these emerging infections.
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Affiliation(s)
- Abhishek Mewara
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Priya Sreenivasan
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumeeta Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Malaria. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:512-524. [PMID: 35119479 PMCID: PMC8814801 DOI: 10.1007/s00103-022-03490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Grigg MJ, Lubis IN, Tetteh KKA, Barber BE, William T, Rajahram GS, Tan AF, Sutherland CJ, Noviyanti R, Drakeley CJ, Britton S, Anstey NM. Plasmodium knowlesi detection methods for human infections-Diagnosis and surveillance. ADVANCES IN PARASITOLOGY 2021; 113:77-130. [PMID: 34620386 DOI: 10.1016/bs.apar.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Within the overlapping geographical ranges of P. knowlesi monkey hosts and vectors in Southeast Asia, an estimated 1.5 billion people are considered at risk of infection. P. knowlesi can cause severe disease and death, the latter associated with delayed treatment occurring from misdiagnosis. Although microscopy is a sufficiently sensitive first-line tool for P. knowlesi detection for most low-level symptomatic infections, misdiagnosis as other Plasmodium species is common, and the majority of asymptomatic infections remain undetected. Current point-of-care rapid diagnostic tests demonstrate insufficient sensitivity and poor specificity for differentiating P. knowlesi from other Plasmodium species. Molecular tools including nested, real-time, and single-step PCR, and loop-mediated isothermal amplification (LAMP), are sensitive for P. knowlesi detection. However, higher cost and inability to provide the timely point-of-care diagnosis needed to guide appropriate clinical management has limited their routine use in most endemic clinical settings. P. knowlesi is likely underdiagnosed across the region, and improved diagnostic and surveillance tools are required. Reference laboratory molecular testing of malaria cases for both zoonotic and non-zoonotic Plasmodium species needs to be more widely implemented by National Malaria Control Programs across Southeast Asia to accurately identify the burden of zoonotic malaria and more precisely monitor the success of human-only malaria elimination programs. The implementation of specific serological tools for P. knowlesi would assist in determining the prevalence and distribution of asymptomatic and submicroscopic infections, the absence of transmission in certain areas, and associations with underlying land use change for future spatially targeted interventions.
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Affiliation(s)
- Matthew J Grigg
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.
| | - Inke N Lubis
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Kevin K A Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bridget E Barber
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia; Clinical Research Centre, Queen Elizabeth Hospital 1, Kota Kinabalu, Malaysia; Gleneagles Medical Centre, Kota Kinabalu, Malaysia
| | - Giri S Rajahram
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia; Clinical Research Centre, Queen Elizabeth Hospital 1, Kota Kinabalu, Malaysia; Queen Elizabeth Hospital 2, Kota Kinabalu, Malaysia
| | - Angelica F Tan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Colin J Sutherland
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Chris J Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sumudu Britton
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Nicholas M Anstey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
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Mwakingwe-Omari A, Healy SA, Lane J, Cook DM, Kalhori S, Wyatt C, Kolluri A, Marte-Salcedo O, Imeru A, Nason M, Ding LK, Decederfelt H, Duan J, Neal J, Raiten J, Lee G, Hume JCC, Jeon JE, Ikpeama I, Kc N, Chakravarty S, Murshedkar T, Church LWP, Manoj A, Gunasekera A, Anderson C, Murphy SC, March S, Bhatia SN, James ER, Billingsley PF, Sim BKL, Richie TL, Zaidi I, Hoffman SL, Duffy PE. Two chemoattenuated PfSPZ malaria vaccines induce sterile hepatic immunity. Nature 2021; 595:289-294. [PMID: 34194041 PMCID: PMC11127244 DOI: 10.1038/s41586-021-03684-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/01/2021] [Indexed: 02/06/2023]
Abstract
The global decline in malaria has stalled1, emphasizing the need for vaccines that induce durable sterilizing immunity. Here we optimized regimens for chemoprophylaxis vaccination (CVac), for which aseptic, purified, cryopreserved, infectious Plasmodium falciparum sporozoites (PfSPZ) were inoculated under prophylactic cover with pyrimethamine (PYR) (Sanaria PfSPZ-CVac(PYR)) or chloroquine (CQ) (PfSPZ-CVac(CQ))-which kill liver-stage and blood-stage parasites, respectively-and we assessed vaccine efficacy against homologous (that is, the same strain as the vaccine) and heterologous (a different strain) controlled human malaria infection (CHMI) three months after immunization ( https://clinicaltrials.gov/ , NCT02511054 and NCT03083847). We report that a fourfold increase in the dose of PfSPZ-CVac(PYR) from 5.12 × 104 to 2 × 105 PfSPZs transformed a minimal vaccine efficacy (low dose, two out of nine (22.2%) participants protected against homologous CHMI), to a high-level vaccine efficacy with seven out of eight (87.5%) individuals protected against homologous and seven out of nine (77.8%) protected against heterologous CHMI. Increased protection was associated with Vδ2 γδ T cell and antibody responses. At the higher dose, PfSPZ-CVac(CQ) protected six out of six (100%) participants against heterologous CHMI three months after immunization. All homologous (four out of four) and heterologous (eight out of eight) infectivity control participants showed parasitaemia. PfSPZ-CVac(CQ) and PfSPZ-CVac(PYR) induced a durable, sterile vaccine efficacy against a heterologous South American strain of P. falciparum, which has a genome and predicted CD8 T cell immunome that differs more strongly from the African vaccine strain than other analysed African P. falciparum strains.
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Affiliation(s)
- Agnes Mwakingwe-Omari
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Center for Vaccine Research, GlaxoSmithKline, Rockville, MD, USA
| | - Sara A Healy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jacquelyn Lane
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David M Cook
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sahand Kalhori
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Charles Wyatt
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Aarti Kolluri
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Omely Marte-Salcedo
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Alemush Imeru
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Martha Nason
- Biostatistical Research Branch, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Lei K Ding
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Hope Decederfelt
- Clinical Center Pharmacy Department, National Institutes of Health, Bethesda, MD, USA
| | - Junhui Duan
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jillian Neal
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jacob Raiten
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Grace Lee
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jen C C Hume
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jihyun E Jeon
- Clinical Center Pharmacy Department, National Institutes of Health, Bethesda, MD, USA
| | - Ijeoma Ikpeama
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Natasha Kc
- Sanaria, Rockville, MD, USA
- Protein Potential, Rockville, MD, USA
| | | | | | | | | | | | - Charles Anderson
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sean C Murphy
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
- Department of Microbiology, University of Washington, Seattle, WA, USA
- Seattle Malaria Clinical Trials Center, Fred Hutch Cancer Research Center, Seattle, WA, USA
- Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Sandra March
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sangeeta N Bhatia
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Koch Institute for Integrative Cancer Research, Cambridge, MA, USA
- Broad Institute, Cambridge, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - B Kim Lee Sim
- Sanaria, Rockville, MD, USA
- Protein Potential, Rockville, MD, USA
| | | | - Irfan Zaidi
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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9
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Gimenez AM, Marques RF, Regiart M, Bargieri DY. Diagnostic Methods for Non-Falciparum Malaria. Front Cell Infect Microbiol 2021; 11:681063. [PMID: 34222049 PMCID: PMC8248680 DOI: 10.3389/fcimb.2021.681063] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Malaria is a serious public health problem that affects mostly the poorest countries in the world, killing more than 400,000 people per year, mainly children under 5 years old. Among the control and prevention strategies, the differential diagnosis of the Plasmodium-infecting species is an important factor for selecting a treatment and, consequently, for preventing the spread of the disease. One of the main difficulties for the detection of a specific Plasmodium sp is that most of the existing methods for malaria diagnosis focus on detecting P. falciparum. Thus, in many cases, the diagnostic methods neglect the other non-falciparum species and underestimate their prevalence and severity. Traditional methods for diagnosing malaria may present low specificity or sensitivity to non-falciparum spp. Therefore, there is high demand for new alternative methods able to differentiate Plasmodium species in a faster, cheaper and easier manner to execute. This review details the classical procedures and new perspectives of diagnostic methods for malaria non-falciparum differential detection and the possibilities of their application in different circumstances.
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Affiliation(s)
- Alba Marina Gimenez
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rodolfo F. Marques
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Matías Regiart
- Department of Fundamental Chemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | - Daniel Youssef Bargieri
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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10
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Mahittikorn A, Masangkay FR, Kotepui KU, Milanez GDJ, Kotepui M. Quantification of the misidentification of Plasmodium knowlesi as Plasmodium malariae by microscopy: an analysis of 1569 P. knowlesi cases. Malar J 2021; 20:179. [PMID: 33836773 PMCID: PMC8033668 DOI: 10.1186/s12936-021-03714-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/26/2021] [Indexed: 02/26/2023] Open
Abstract
Background Plasmodium knowlesi is recognized as the fifth Plasmodium species causing malaria in humans. It is morphologically similar to the human malaria parasite Plasmodium malariae, so molecular detection should be used to clearly discriminate between these Plasmodium species. This study aimed to quantify the rate at which P. knowlesi is misidentified as P. malariae by microscopy in endemic and non-endemic areas. Methods The protocol of this systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID = CRD42020204770). Studies reporting the misidentification of P. knowlesi as P. malariae by microscopy and confirmation of this by molecular methods in MEDLINE, Web of Science and Scopus were reviewed. The risk of bias in the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). The pooled prevalence and 95% confidence interval (CI) of the misidentification of P. knowlesi as P. malariae by microscopy were estimated using a random effects model. Subgroup analysis of the study sites was performed to demonstrate any differences in the misidentification rates in different areas. Heterogeneity across the included studies was assessed and quantified using Cochran’s Q and I2 statistics, respectively. Publication bias in the included studies was assessed using the funnel plot, Egger’s test and contour-enhanced funnel plot. Results Among 375 reviewed studies, 11 studies with a total of 1569 confirmed P. knowlesi cases in humans were included. Overall, the pooled prevalence of the misidentification of P. knowlesi as P. malariae by microscopy was estimated at 57% (95% CI 37–77%, I2: 99.3%). Subgroup analysis demonstrated the highest rate of misidentification in Sawarak, Malaysia (87%, 95% CI 83–90%, I2: 95%), followed by Sabah, Malaysia (85%, 95% CI 79–92%, I2: 85.1%), Indonesia (16%, 95% CI 6–38%), and then Thailand (4%, 95% CI 2–9%, I2: 95%). Conclusion Although the World Health Organization (WHO) recommends that all P. malariae-positive diagnoses made by microscopy in P. knowlesi endemic areas be reported as P. malariae/P. knowlesi malaria, the possibility of microscopists misidentifying P. knowlesi as P. malariae is a diagnostic challenge. The use of molecular techniques in cases with malariae-like Plasmodium with high parasite density as determined by microscopy could help identify human P. knowlesi cases in non-endemic countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03714-1.
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Affiliation(s)
- Aongart Mahittikorn
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Frederick Ramirez Masangkay
- Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University-Manila, Manila, Philippines
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | - Giovanni De Jesus Milanez
- Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University-Manila, Manila, Philippines
| | - Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
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11
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Oresegun DR, Daneshvar C, Cox-Singh J. Plasmodium knowlesi - Clinical Isolate Genome Sequencing to Inform Translational Same-Species Model System for Severe Malaria. Front Cell Infect Microbiol 2021; 11:607686. [PMID: 33738266 PMCID: PMC7960762 DOI: 10.3389/fcimb.2021.607686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/27/2021] [Indexed: 12/03/2022] Open
Abstract
Malaria is responsible for unacceptably high morbidity and mortality, especially in Sub-Saharan African Nations. Malaria is caused by member species' of the genus Plasmodium and despite concerted and at times valiant efforts, the underlying pathophysiological processes leading to severe disease are poorly understood. Here we describe zoonotic malaria caused by Plasmodium knowlesi and the utility of this parasite as a model system for severe malaria. We present a method to generate long-read third-generation Plasmodium genome sequence data from archived clinical samples using the MinION platform. The method and technology are accessible, affordable and data is generated in real-time. We propose that by widely adopting this methodology important information on clinically relevant parasite diversity, including multiple gene family members, from geographically distinct study sites will emerge. Our goal, over time, is to exploit the duality of P. knowlesi as a well-used laboratory model and human pathogen to develop a representative translational model system for severe malaria that is informed by clinically relevant parasite diversity.
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Affiliation(s)
| | | | - Janet Cox-Singh
- Division of Infection, School of Medicine, University of St Andrews, St Andrews, United Kingdom
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12
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Cooper DJ, Rajahram GS, William T, Jelip J, Mohammad R, Benedict J, Alaza DA, Malacova E, Yeo TW, Grigg MJ, Anstey NM, Barber BE. Plasmodium knowlesi Malaria in Sabah, Malaysia, 2015-2017: Ongoing Increase in Incidence Despite Near-elimination of the Human-only Plasmodium Species. Clin Infect Dis 2021; 70:361-367. [PMID: 30889244 PMCID: PMC7768742 DOI: 10.1093/cid/ciz237] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Malaysia aims to eliminate malaria by 2020. However, while cases of Plasmodium falciparum and Plasmodium vivax have decreased substantially, the incidence of zoonotic malaria from Plasmodium knowlesi continues to increase, presenting a major challenge to regional malaria control efforts. Here we report incidence of all Plasmodium species in Sabah, including zoonotic P. knowlesi, during 2015-2017. METHODS Microscopy-based malaria notification data and polymerase chain reaction (PCR) results were obtained from the Sabah Department of Health and State Public Health Laboratory, respectively, from January 2015 to December 2017. From January 2016 this was complemented by a statewide prospective hospital surveillance study. Databases were matched, and species was determined by PCR, or microscopy if PCR was not available. RESULTS A total of 3867 malaria cases were recorded between 2015 and 2017, with PCR performed in 93%. Using PCR results, and microscopy if PCR was unavailable, P. knowlesi accounted for 817 (80%), 677 (88%), and 2030 (98%) malaria cases in 2015, 2016, and 2017, respectively. P. falciparum accounted for 110 (11%), 45 (6%), and 23 (1%) cases and P. vivax accounted for 61 (6%), 17 (2%), and 8 (0.4%) cases, respectively. Of those with P. knowlesi, the median age was 35 (interquartile range: 24-47) years, and 85% were male. CONCLUSIONS Malaysia is approaching elimination of the human-only Plasmodium species. However, the ongoing increase in P. knowlesi incidence presents a major challenge to malaria control and warrants increased focus on knowlesi-specific prevention activities. Wider molecular surveillance in surrounding countries is required.
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Affiliation(s)
- Daniel J Cooper
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah
| | - Giri S Rajahram
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah.,Clinical Research Centre - Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Ministry of Health, Sabah.,Sabah Department of Health, Kota Kinabalu, Ministry of Health, Sabah
| | | | - Jenarun Jelip
- Malaysian Ministry of Health, Kuala Lumpur, Malaysia
| | - Rashidah Mohammad
- Sabah Department of Health, Kota Kinabalu, Ministry of Health, Sabah
| | - Joseph Benedict
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah
| | - Danshy A Alaza
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah
| | - Eva Malacova
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Tsin W Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Matthew J Grigg
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah
| | - Nicholas M Anstey
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah
| | - Bridget E Barber
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah.,QIMR Berghofer Institute of Medical Research, Brisbane, Australia
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13
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Nuin NA, Tan AF, Lew YL, Piera KA, William T, Rajahram GS, Jelip J, Dony JF, Mohammad R, Cooper DJ, Barber BE, Anstey NM, Chua TH, Grigg MJ. Comparative evaluation of two commercial real-time PCR kits (QuantiFast™ and abTES™) for the detection of Plasmodium knowlesi and other Plasmodium species in Sabah, Malaysia. Malar J 2020; 19:306. [PMID: 32854695 PMCID: PMC7457277 DOI: 10.1186/s12936-020-03379-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background The monkey parasite Plasmodium knowlesi is an emerging public health issue in Southeast Asia. In Sabah, Malaysia, P. knowlesi is now the dominant cause of human malaria. Molecular detection methods for P. knowlesi are essential for accurate diagnosis and in monitoring progress towards malaria elimination of other Plasmodium species. However, recent commercially available PCR malaria kits have unpublished P. knowlesi gene targets or have not been evaluated against clinical samples. Methods Two real-time PCR methods currently used in Sabah for confirmatory malaria diagnosis and surveillance reporting were evaluated: the QuantiFast™ Multiplex PCR kit (Qiagen, Germany) targeting the P. knowlesi 18S SSU rRNA; and the abTES™ Malaria 5 qPCR II kit (AITbiotech, Singapore), with an undisclosed P. knowlesi gene target. Diagnostic accuracy was evaluated using 52 P. knowlesi, 25 Plasmodium vivax, 21 Plasmodium falciparum, and 10 Plasmodium malariae clinical isolates, and 26 malaria negative controls, and compared against a validated reference nested PCR assay. The limit of detection (LOD) for each PCR method and Plasmodium species was also evaluated. Results The sensitivity of the QuantiFast™ and abTES™ assays for detecting P. knowlesi was comparable at 98.1% (95% CI 89.7–100) and 100% (95% CI 93.2–100), respectively. Specificity of the QuantiFast™ and abTES™ for P. knowlesi was high at 98.8% (95% CI 93.4–100) for both assays. The QuantiFast™ assay demonstrated falsely-positive mixed Plasmodium species at low parasitaemias in both the primary and LOD analysis. Diagnostic accuracy of both PCR kits for detecting P. vivax, P. falciparum, and P. malariae was comparable to P. knowlesi. The abTES™ assay demonstrated a lower LOD for P. knowlesi of ≤ 0.125 parasites/µL compared to QuantiFast™ with a LOD of 20 parasites/µL. Hospital microscopy demonstrated a sensitivity of 78.8% (95% CI 65.3–88.9) and specificity of 80.4% (95% CI 67.6–89.8) compared to reference PCR for detecting P. knowlesi. Conclusion The QuantiFast™ and abTES™ commercial PCR kits performed well for the accurate detection of P. knowlesi infections. Although the QuantiFast™ kit is cheaper, the abTES™ kit demonstrated a lower LOD, supporting its use as a second-line referral-laboratory diagnostic tool in Sabah, Malaysia.
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Affiliation(s)
- Nor Afizah Nuin
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Angelica F Tan
- Infectious Diseases Society Kota Kinabalu - Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia. .,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia.
| | - Yao Long Lew
- Infectious Diseases Society Kota Kinabalu - Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Kim A Piera
- Infectious Diseases Society Kota Kinabalu - Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia
| | - Timothy William
- Infectious Diseases Society Kota Kinabalu - Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Gleneagles Hospital, Kota Kinabalu, Sabah, Malaysia.,Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | - Giri S Rajahram
- Infectious Diseases Society Kota Kinabalu - Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Clinical Research Centre, Queen Elizabeth Hospital, Ministry of Health, Kota Kinabalu, Sabah, Malaysia
| | | | - Jiloris F Dony
- State Public Health Laboratory, Sabah Department of Health, Kota Kinabalu, Malaysia
| | - Rashidah Mohammad
- State Public Health Laboratory, Sabah Department of Health, Kota Kinabalu, Malaysia
| | - Daniel J Cooper
- Infectious Diseases Society Kota Kinabalu - Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia
| | - Bridget E Barber
- Infectious Diseases Society Kota Kinabalu - Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Nicholas M Anstey
- Infectious Diseases Society Kota Kinabalu - Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia
| | - Tock H Chua
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Matthew J Grigg
- Infectious Diseases Society Kota Kinabalu - Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia. .,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, PO Box 41096, Casuarina, NT, 0810, Australia.
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14
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Goupeyou-Youmsi J, Rakotondranaivo T, Puchot N, Peterson I, Girod R, Vigan-Womas I, Paul R, Ndiath MO, Bourgouin C. Differential contribution of Anopheles coustani and Anopheles arabiensis to the transmission of Plasmodium falciparum and Plasmodium vivax in two neighbouring villages of Madagascar. Parasit Vectors 2020; 13:430. [PMID: 32843082 DOI: 10.1101/787432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 08/03/2020] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Malaria is still a heavy public health concern in Madagascar. Few studies combining parasitology and entomology have been conducted despite the need for accurate information to design effective vector control measures. In a Malagasy region of moderate to intense transmission of both Plasmodium falciparum and P. vivax, parasitology and entomology have been combined to survey malaria transmission in two nearby villages. METHODS Community-based surveys were conducted in the villages of Ambohitromby and Miarinarivo at three time points (T1, T2 and T3) during a single malaria transmission season. Human malaria prevalence was determined by rapid diagnostic tests (RDTs), microscopy and real-time PCR. Mosquitoes were collected by human landing catches and pyrethrum spray catches and the presence of Plasmodium sporozoites was assessed by TaqMan assay. RESULTS Malaria prevalence was not significantly different between villages, with an average of 8.0% by RDT, 4.8% by microscopy and 11.9% by PCR. This was mainly due to P. falciparum and to a lesser extent to P. vivax. However, there was a significantly higher prevalence rate as determined by PCR at T2 ([Formula: see text] = 7.46, P = 0.025). Likewise, mosquitoes were significantly more abundant at T2 ([Formula: see text] = 64.8, P < 0.001), especially in Ambohitromby. At T1 and T3 mosquito abundance was higher in Miarinarivo than in Ambohitromby ([Formula: see text] = 14.92, P < 0.001). Of 1550 Anopheles mosquitoes tested, 28 (1.8%) were found carrying Plasmodium sporozoites. The entomological inoculation rate revealed that Anopheles coustani played a major contribution in malaria transmission in Miarinarivo, being responsible of 61.2 infective bites per human (ib/h) during the whole six months of the survey, whereas, it was An. arabiensis, with 36 ib/h, that played that role in Ambohitromby. CONCLUSIONS Despite a similar malaria prevalence in two nearby villages, the entomological survey showed a different contribution of An. coustani and An. arabiensis to malaria transmission in each village. Importantly, the suspected secondary malaria vector An. coustani, was found playing the major role in malaria transmission in one village. This highlights the importance of combining parasitology and entomology surveys for better targeting local malaria vectors. Such study should contribute to the malaria pre-elimination goal established under the 2018-2022 National Malaria Strategic Plan.
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Affiliation(s)
- Jessy Goupeyou-Youmsi
- Immunology of Infectious Diseases Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
- Functional Genetics of Infectious Diseases Unit, Institut Pasteur, Paris, France.
- Doctoral School "Complexité du Vivant", Sorbonne University, Paris, France.
| | - Tsiriniaina Rakotondranaivo
- G4 Malaria Group, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Doctoral School "Génie du vivant et modélisation" Mahajanga University, Mahajanga, Madagascar
| | - Nicolas Puchot
- Functional Genetics of Infectious Diseases Unit, Institut Pasteur, Paris, France
- Centre National de la Recherche Scientifique UMR2000, Institut Pasteur, Paris, France
| | - Ingrid Peterson
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Romain Girod
- Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Inès Vigan-Womas
- Immunology of Infectious Diseases Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Richard Paul
- Functional Genetics of Infectious Diseases Unit, Institut Pasteur, Paris, France
- Centre National de la Recherche Scientifique UMR2000, Institut Pasteur, Paris, France
| | | | - Catherine Bourgouin
- Functional Genetics of Infectious Diseases Unit, Institut Pasteur, Paris, France.
- Centre National de la Recherche Scientifique UMR2000, Institut Pasteur, Paris, France.
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15
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Guirou EA, Schindler T, Hosch S, Donfack OT, Yoboue CA, Krähenbühl S, Deal A, Cosi G, Gondwe L, Mwangoka G, Masuki H, Salim N, Mpina M, Said J, Abdulla S, Hoffman SL, Nlavo BM, Maas C, Falla CC, Phiri WP, Garcia GA, Tanner M, Daubenberger C. Molecular malaria surveillance using a novel protocol for extraction and analysis of nucleic acids retained on used rapid diagnostic tests. Sci Rep 2020; 10:12305. [PMID: 32703999 PMCID: PMC7378824 DOI: 10.1038/s41598-020-69268-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/10/2020] [Indexed: 11/09/2022] Open
Abstract
The use of malaria rapid diagnostic tests (RDTs) as a source for nucleic acids that can be analyzed via nucleic acid amplification techniques has several advantages, including minimal amounts of blood, sample collection, simplified storage and shipping conditions at room temperature. We have systematically developed and extensively evaluated a procedure to extract total nucleic acids from used malaria RDTs. The co-extraction of DNA and RNA molecules from small volumes of dried blood retained on the RDTs allows detection and quantification of P. falciparum parasites from asymptomatic patients with parasite densities as low as 1 Pf/µL blood using reverse transcription quantitative PCR. Based on the extraction protocol we have developed the ENAR (Extraction of Nucleic Acids from RDTs) approach; a complete workflow for large-scale molecular malaria surveillance. Using RDTs collected during a malaria indicator survey we demonstrated that ENAR provides a powerful tool to analyze nucleic acids from thousands of RDTs in a standardized and high-throughput manner. We found several, known and new, non-synonymous single nucleotide polymorphisms in the propeller region of the kelch 13 gene among isolates circulating on Bioko Island, Equatorial Guinea.
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Affiliation(s)
- Etienne A Guirou
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Tobias Schindler
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Salome Hosch
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Charlene Aya Yoboue
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Silvan Krähenbühl
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Anna Deal
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Glenda Cosi
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Linda Gondwe
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Ifakara Health Institute, Bagamoyo Branch, United Republic of Tanzania
| | - Grace Mwangoka
- Ifakara Health Institute, Bagamoyo Branch, United Republic of Tanzania
| | - Heavenlight Masuki
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Maxmillian Mpina
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Ifakara Health Institute, Bagamoyo Branch, United Republic of Tanzania
| | - Jongo Said
- Ifakara Health Institute, Bagamoyo Branch, United Republic of Tanzania
| | - Salim Abdulla
- Ifakara Health Institute, Bagamoyo Branch, United Republic of Tanzania
| | | | | | - Carl Maas
- Marathon EG Production Ltd, Malabo, Equatorial Guinea
| | | | - Wonder P Phiri
- Medical Care Development International, Malabo, Equatorial Guinea
| | | | - Marcel Tanner
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Claudia Daubenberger
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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16
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Hartmeyer GN, Stensvold CR, Fabricius T, Marmolin ES, Hoegh SV, Nielsen HV, Kemp M, Vestergaard LS. Plasmodium cynomolgi as Cause of Malaria in Tourist to Southeast Asia, 2018. Emerg Infect Dis 2020; 25:1936-1939. [PMID: 31538931 PMCID: PMC6759256 DOI: 10.3201/eid2510.190448] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We report human infection with simian Plasmodium cynomolgi in a tourist from Denmark who had visited forested areas in peninsular Malaysia and Thailand in August and September 2018. Because P. cynomolgi may go unnoticed by standard malaria diagnostics, this malaria species may be more common in humans than was previously thought.
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17
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Escobar DF, Diaz-Dinamarca DA, Hernández CF, Soto DA, Manzo RA, Alarcón PI, Pinto CH, Bastias DN, Oberg-Bravo CN, Rojas R, Illanes SE, Kalergis AM, Vasquez AE. Development and analytical validation of real-time PCR for the detection of Streptococcus agalactiae in pregnant women. BMC Pregnancy Childbirth 2020; 20:352. [PMID: 32517670 PMCID: PMC7285471 DOI: 10.1186/s12884-020-03038-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Group B Streptococcus (GBS) is the leading cause of invasive neonatal infection. In this study, we aimed to evaluate the analytical validation of qualitative real-time polymerase chain reaction (qPCR) as a means to detect GBS. Methods Genomic DNA (gDNA) was purified from 12 ATCC bacterial strains, two belonging to GBS and the remainder acting as negative controls. Additionally, gDNA was isolated from 21 strains of GBS from various serotypes (Ia, Ib and II-VIII). All gDNA was used to evaluate the analytical validation of the qPCR method employing a specific Taqman probe. Inclusivity, exclusivity, anticipated reportable range, the limit of detection and robustness were evaluated. The methods used are described in international guidelines and other existing reports. The performance of this qPCR method for detecting GBS was compared to other microbiological methods used with vaginal-rectal samples from pregnant women. Results Our qPCR method for detecting GBS was analytically validated. It has a limit of detection of 0.7 GE/μL and 100% analytical specificity. It detects all strains of GBS with the same level of performance as microbiological methods. Conclusion Data suggest that this qPCR method performs adequately as a means to detect GBS in vaginal-rectal swabs from pregnant women.
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Affiliation(s)
- Daniel F Escobar
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Diego A Diaz-Dinamarca
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos F Hernández
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Departamento de Bioquímica y Biología Molecular, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santos Dumont 964, Independencia, 8380494, Santiago, Chile
| | - Daniel A Soto
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Ricardo A Manzo
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Pedro I Alarcón
- Sección Bacteriología del Departamento Biomédico, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Camila H Pinto
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Diego N Bastias
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile.,Escuela de Biotecnología y Escuela de Tecnología Médica, Facultad de Ciencias, Universidad Santo Tomas, Santiago, Chile
| | - Carolayn N Oberg-Bravo
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Escuela de Biotecnología y Escuela de Tecnología Médica, Facultad de Ciencias, Universidad Santo Tomas, Santiago, Chile
| | - Robert Rojas
- Centro de Genómica y Bioinformática, Universidad Mayor, Santiago, Chile
| | - Sebastián E Illanes
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile.,Department of Obstetrics and Gynecology, Clínica Dávila, Santiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Abel E Vasquez
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile. .,Escuela de Biotecnología y Escuela de Tecnología Médica, Facultad de Ciencias, Universidad Santo Tomas, Santiago, Chile. .,Facultad de Medicina y Ciencia, Universidad San Sebastián, Providencia, Santiago, Chile. .,Present address. Instituto de Salud Pública de Chile, Av. Marathon, Ñuñoa, 1000, Santiago, Chile.
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18
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Tainchum K, Dupont C, Chareonviriyaphap T, Jumas-Bilak E, Bangs MJ, Manguin S. Bacterial Microbiome in Wild-Caught Anopheles Mosquitoes in Western Thailand. Front Microbiol 2020; 11:965. [PMID: 32508784 PMCID: PMC7253650 DOI: 10.3389/fmicb.2020.00965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/22/2020] [Indexed: 11/13/2022] Open
Abstract
Among the complex microbial community living in the mosquito midgut, some bacteria (e.g., Enterobacter spp.) can deliver effector molecules with anti-Plasmodium effects suppressing the development of malaria parasites (Plasmodium falciparum) before the öokinete can penetrate the mosquito midgut epithelium. Despite knowledge of this phenomenon, only a few studies have defined the diversity of microbiota in wild-caught adult Anopheles species. The objective of this study was to analyze and compare the bacterial microbiota in different Anopheles species, including representatives of the primary malaria vectors in western Thailand. Wild female Anopheles species were sampled from malaria-endemic areas in Tak and Mae Hong Son provinces near the Thai-Myanmar border. Midgut/abdominal bacterial diversity was assessed by examining the 16S rRNA gene, V3 hypervariable region, using PCR-Temporal Temperature Gel Electrophoresis (PCR-TTGE) profiling and sequence analysis. A total of 24 bacterial genera were identified from eight Anopheles species. Five bacterial genera were newly reported in Anopheles mosquitoes (Ferrimonas, Megasphaera, Pectobacterium, Shimwellia, and Trabulsiella). Five genera, including Megasphaera, were detected exclusively in a single-malaria (Plasmodium vivax) infected Anopheles minimus and not observed in other non-infected mosquitoes. The use of PCR-TTGE provides the first characterization of the midgut bacterial microbiome present in wild adult Anopheles in Thailand. Evidence that microbiota might impact pathogen development (suppression) in Anopheles and thereby reduce the risk of pathogen transmission deserves more studies to describe the presence and better understand the biological role of bacteria in natural mosquito populations.
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Affiliation(s)
- Krajana Tainchum
- Agricultural Innovation and Management Division, Faculty of Natural Resources, Prince of Songkla University, Songkhla, Thailand
- Center for Advanced Studies for Agriculture and Food, KU Institute for Advanced Studies, Kasetsart University, Bangkok, Thailand
| | - Chloé Dupont
- HydroSciences Montpellier, Institut de Recherche pour le Développement, CNRS, Université Montpellier, Montpellier, France
- Centre Hospitalier Universitaire, Laboratoire d’Hygiène Hospitalière, Montpellier, France
| | - Theeraphap Chareonviriyaphap
- Center for Advanced Studies for Agriculture and Food, KU Institute for Advanced Studies, Kasetsart University, Bangkok, Thailand
| | - Estelle Jumas-Bilak
- HydroSciences Montpellier, Institut de Recherche pour le Développement, CNRS, Université Montpellier, Montpellier, France
- Centre Hospitalier Universitaire, Laboratoire d’Hygiène Hospitalière, Montpellier, France
| | - Michael J. Bangs
- Center for Advanced Studies for Agriculture and Food, KU Institute for Advanced Studies, Kasetsart University, Bangkok, Thailand
- Public Health & Malaria Control, PT Freeport Indonesia/International SOS, Kuala Kencana, Indonesia
| | - Sylvie Manguin
- HydroSciences Montpellier, Institut de Recherche pour le Développement, CNRS, Université Montpellier, Montpellier, France
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19
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Benavente ED, Gomes AR, De Silva JR, Grigg M, Walker H, Barber BE, William T, Yeo TW, de Sessions PF, Ramaprasad A, Ibrahim A, Charleston J, Hibberd ML, Pain A, Moon RW, Auburn S, Ling LY, Anstey NM, Clark TG, Campino S. Whole genome sequencing of amplified Plasmodium knowlesi DNA from unprocessed blood reveals genetic exchange events between Malaysian Peninsular and Borneo subpopulations. Sci Rep 2019; 9:9873. [PMID: 31285495 PMCID: PMC6614422 DOI: 10.1038/s41598-019-46398-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 06/28/2019] [Indexed: 12/19/2022] Open
Abstract
The zoonotic Plasmodium knowlesi parasite is the most common cause of human malaria in Malaysia. Genetic analysis has shown that the parasites are divided into three subpopulations according to their geographic origin (Peninsular or Borneo) and, in Borneo, their macaque host (Macaca fascicularis or M. nemestrina). Whilst evidence suggests that genetic exchange events have occurred between the two Borneo subpopulations, the picture is unclear in less studied Peninsular strains. One difficulty is that P. knowlesi infected individuals tend to present with low parasitaemia leading to samples with insufficient DNA for whole genome sequencing. Here, using a parasite selective whole genome amplification approach on unprocessed blood samples, we were able to analyse recent genomes sourced from both Peninsular Malaysia and Borneo. The analysis provides evidence that recombination events are present in the Peninsular Malaysia parasite subpopulation, which have acquired fragments of the M. nemestrina associated subpopulation genotype, including the DBPβ and NBPXa erythrocyte invasion genes. The NBPXb invasion gene has also been exchanged within the macaque host-associated subpopulations of Malaysian Borneo. Our work provides strong evidence that exchange events are far more ubiquitous than expected and should be taken into consideration when studying the highly complex P. knowlesi population structure.
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Affiliation(s)
- Ernest Diez Benavente
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ana Rita Gomes
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Matthew Grigg
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Harriet Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bridget E Barber
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88300, Kota Kinabalu, Sabah, Malaysia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88300, Kota Kinabalu, Sabah, Malaysia.,Clinical Research Centre, Queen Elizabeth Hospital, 88300, Kota Kinabalu, Sabah, Malaysia.,Jesselton Medical Centre, 88300, Kota Kinabalu, Sabah, Malaysia
| | - Tsin Wen Yeo
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Abhinay Ramaprasad
- King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Amy Ibrahim
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James Charleston
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin L Hibberd
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Genomics Institute, Biopolis, Singapore
| | - Arnab Pain
- King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Robert W Moon
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Auburn
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. .,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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20
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Kotepui KU, Kotepui M, Punsawad C. Knowledge, Attitude, and Practice Related to Malaria Diagnosis among Healthcare Workers in Hospitals: A Cross-Sectional Survey. J Trop Med 2019; 2019:1414079. [PMID: 31285744 PMCID: PMC6594246 DOI: 10.1155/2019/1414079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/01/2019] [Accepted: 05/27/2019] [Indexed: 11/18/2022] Open
Abstract
Malaria is a potential medical emergency and should be treated immediately because delays in diagnosis and treatment are the leading causes of death in many countries. This study aimed to assess the knowledge, attitude, and practice related to malaria diagnosis for early detection among healthcare workers in the laboratories of hospitals in Thailand. The design of the study was a descriptive cross-sectional study carried out between January 2016 and March 2017 at 11 hospitals in Thailand. The interviewees included any scientists who were currently working in a medical laboratory. Mean scores for knowledge, attitude, and practice for each healthcare group were calculated and compared between groups. Data analysis was performed using the SPSS version 11.5 software package (SPSS Inc., Chicago, IL, USA). Among a total of 118 healthcare workers, most of the healthcare workers had fair to good knowledge, attitude, and practice related to malaria detection. Among the various positions of healthcare workers, medical technologists possessed a greater knowledge on malaria detection than medical technician assistants or laboratory assistants (X2 = 9.822, d.f. = 2, and P value=0.007). This study infers that knowledge, attitude, and practice related to malaria detection among healthcare workers in laboratories were adequate. However, some points of knowledge and practice must be updated. There is a very urgent need to update knowledge on malaria, especially about the number of Plasmodium species causing relapse in malaria patients. In addition, there is an urgent need to update the practice related to malaria detection, especially about the staining process for early detection of malaria.
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Affiliation(s)
- Kwuntida Uthaisar Kotepui
- Medical Technology Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Manas Kotepui
- Medical Technology Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Chuchard Punsawad
- School of Medicine, Walailak University, Nakhon Si Thammarat 80160, Thailand
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21
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Schindler T, Robaina T, Sax J, Bieri JR, Mpina M, Gondwe L, Acuche L, Garcia G, Cortes C, Maas C, Daubenberger C. Molecular monitoring of the diversity of human pathogenic malaria species in blood donations on Bioko Island, Equatorial Guinea. Malar J 2019; 18:9. [PMID: 30646918 PMCID: PMC6332537 DOI: 10.1186/s12936-019-2639-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria can be transmitted by blood transfusion from human to human and it is responsible for the majority of transfusion-transmitted infectious diseases worldwide. In sub-Saharan Africa, it had been estimated that almost a quarter of blood donations contain malaria parasites. Since rapid diagnostic tests and thick blood smear microscopy lack sensitivity for low density parasitaemia, particularly in asymptomatic adults, the most reliable method to assess the problem of transfusion-transmitted malaria are nucleic acid-based molecular approaches such as quantitative polymerase chain reaction. The study was undertaken to determine the prevalence of sub-microscopic malaria parasite infection among blood donors in Malabo, Equatorial Guinea. METHODS Between July and August 2017, a total of 200 individual blood samples from blood donors at the Malabo Blood Bank were collected and screened by rapid diagnostic tests and thick blood smear microscopy. Retrospectively, the same samples were analysed for the presence of undetected, low-density malaria parasites using quantitative polymerase chain reaction. RESULTS In comparison to 6.5% (13/200) by rapid diagnostic test and 2.0% (4/200) by microscopy, the proportion of Plasmodium falciparum positive blood donations analysed by quantitative polymerase chain reaction was significantly higher (26%, 52/200). Densities of P. falciparum positive blood donations were ranging from 0.06 to 3707.0 parasites/µL with 79.6% below 100 parasites/µL and therefore not detectable by non-molecular malaria diagnostic tests. qPCR based species identification revealed that P. falciparum was the dominating species responsible for 88.1% (52/59) of positive blood donations, followed by Plasmodium malariae (15.3%, 9/59) and Plasmodium ovale (3.4%, 2/59). CONCLUSIONS This study confirms that in malaria endemic settings, sub-patent malaria infections among blood donors are prevalent. In blood collected from healthy donors living in Malabo, P. falciparum, P. malariae and P. ovale parasites were identified. Currently widely used malaria diagnostic tools have missed more than 75% of P. falciparum containing blood donations, demonstrating the value of quantitative polymerase chain reaction to reliably detect low density P. falciparum infections. Since the availability of molecular diagnostic methods in malaria endemic countries is still limited, the blood recipients living in malaria endemic countries should be treated following WHO recommendations.
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Affiliation(s)
- Tobias Schindler
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | | | - Julian Sax
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jose Raso Bieri
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Equatorial Guinea
| | - Maximilian Mpina
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
| | - Linda Gondwe
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
| | - Ludmila Acuche
- Equatorial Guinea Malaria Vaccine Initiative, Malabo, Equatorial Guinea
| | | | - Carlos Cortes
- Medical Care Development International, Silver Spring, USA
| | - Carl Maas
- Marathon EG Production Ltd, Malabo, Equatorial Guinea
| | - Claudia Daubenberger
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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22
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Lai MY, Ooi CH, Lau YL. Recombinase Polymerase Amplification Combined with a Lateral Flow Strip for the Detection of Plasmodium knowlesi. Am J Trop Med Hyg 2017; 98:700-703. [PMID: 29260656 DOI: 10.4269/ajtmh.17-0738] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to develop a recombinase polymerase amplification (RPA) combined with a lateral flow (LF) strip method for specific diagnosis of Plasmodium knowlesi. With incubation at 37°C, the 18S rRNA gene of P. knowlesi was successfully amplified within 12 minutes. By adding a specifically designed probe to the reaction solution, the amplified RPA product can be visualized on a LF strip. The RPA assay exhibited high sensitivity with limits of detection down to 10 parasites/μL of P. knowlesi. Nonetheless, it was demonstrated that all P. knowlesi (N = 41) and other Plasmodium sp. (N = 25) were positive while negative samples (N = 8) were negative. Therefore, a combination of RPA and LF strip detection is a highly promising approach with the potential to be suitable for use in resource-limited settings.
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Affiliation(s)
- Meng-Yee Lai
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Choo-Huck Ooi
- Sarawak State Health Department, Kuching, Sarawak, Malaysia
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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23
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Vafa Homann M, Emami SN, Yman V, Stenström C, Sondén K, Ramström H, Karlsson M, Asghar M, Färnert A. Detection of Malaria Parasites After Treatment in Travelers: A 12-months Longitudinal Study and Statistical Modelling Analysis. EBioMedicine 2017; 25:66-72. [PMID: 29050948 PMCID: PMC5704054 DOI: 10.1016/j.ebiom.2017.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 01/30/2023] Open
Abstract
The rapid clearance of malaria parasite DNA from circulation has widely been accepted as a fact without being systemically investigated. We assessed the persistence of parasite DNA in travelers treated for Plasmodium falciparum malaria in a malaria-free area. Venous blood was collected at the time of admission and prospectively up to one year. DNA and RNA were extracted and analyzed using species-specific and gametocyte-specific real-time PCR as well as merozoite surface protein 2 (msp2)-PCR. In 31 successfully treated individuals, asexual parasites were seen by microscopy until two days after treatment, whereas parasite DNA was detected by msp2- and species-specific PCR up to days 31 and 42, respectively. Statistical modelling predicted 26% (±0·05 SE) species-specific PCR positivity until day 40 and estimated 48days for all samples to become PCR negative. Gametocytes were detected by microscopy and PCR latest two days after treatment. CT values correlated well with microscopy-defined parasite densities before but not after treatment started. These results reveal that PCR positivity can persist several weeks after treatment without evidence of viable sexual or asexual parasites, indicating that PCR may overestimate parasite prevalence after treatment.
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Affiliation(s)
- Manijeh Vafa Homann
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - S Noushin Emami
- Department of Molecular Bioscience, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Victor Yman
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Christine Stenström
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Klara Sondén
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Ramström
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mattias Karlsson
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Muhammad Asghar
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anna Färnert
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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24
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Niare S, Almeras L, Tandina F, Yssouf A, Bacar A, Toilibou A, Doumbo O, Raoult D, Parola P. MALDI-TOF MS identification of Anopheles gambiae Giles blood meal crushed on Whatman filter papers. PLoS One 2017; 12:e0183238. [PMID: 28817629 PMCID: PMC5560667 DOI: 10.1371/journal.pone.0183238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/01/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Identification of the source of mosquito blood meals is an important component for disease control and surveillance. Recently, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) profiling has emerged as an effective tool for mosquito blood meal identification, using the abdomens of freshly engorged mosquitoes. In the field, mosquito abdomens are crushed on Whatman filter papers to determine the host feeding patterns by identifying the origin of their blood meals. The aim of this study was to test whether crushing engorged mosquito abdomens on Whatman filter papers was compatible with MALDI-TOF MS for mosquito blood meal identification. Both laboratory reared and field collected mosquitoes were tested. MATERIAL AND METHODS Sixty Anopheles gambiae Giles were experimentally engorged on the blood of six distinct vertebrate hosts (human, sheep, rabbit, dog, chicken and rat). The engorged mosquito abdomens were crushed on Whatman filter papers for MALDI-TOF MS analysis. 150 Whatman filter papers, with mosquitoes engorged on cow and goat blood, were preserved. A total of 77 engorged mosquito abdomens collected in the Comoros Islands and crushed on Whatman filter papers were tested with MALDI-TOF MS. RESULTS The MS profiles generated from mosquito engorged abdomens crushed on Whatman filter papers exhibited high reproducibility according to the original host blood. The blood meal host was correctly identified from mosquito abdomens crushed on Whatman filter papers by MALDI-TOF MS. The MS spectra obtained after storage were stable regardless of the room temperature and whether or not they were frozen. The MS profiles were reproducible for up to three months. For the Comoros samples, 70/77 quality MS spectra were obtained and matched with human blood spectra. This was confirmed by molecular tools. CONCLUSION The results demonstrated that MALDI-TOF MS could identify mosquito blood meals from Whatman filter papers collected in the field during entomological surveys. The application of MALDI-TOF MS has proved to be rapid and successful, making it a new and efficient tool for mosquito-borne disease surveillance.
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Affiliation(s)
- Sirama Niare
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, AP-HM, IHU Méditerranée Infection, Marseille, France
- Malaria Research and Training Center, DEAP/FMOS, UMI 3189, University of Science, Techniques and Technology, Bamako, Mali
| | - Lionel Almeras
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, AP-HM, IHU Méditerranée Infection, Marseille, France
- Unité de Parasitologie et d’Entomologie, Département des Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
| | - Fatalmoudou Tandina
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, AP-HM, IHU Méditerranée Infection, Marseille, France
- Malaria Research and Training Center, DEAP/FMOS, UMI 3189, University of Science, Techniques and Technology, Bamako, Mali
| | - Amina Yssouf
- Malaria Control Program, Moroni, Union of the Comoros
| | - Affane Bacar
- Malaria Control Program, Moroni, Union of the Comoros
| | - Ali Toilibou
- Malaria Control Program, Moroni, Union of the Comoros
| | - Ogobara Doumbo
- Malaria Research and Training Center, DEAP/FMOS, UMI 3189, University of Science, Techniques and Technology, Bamako, Mali
| | - Didier Raoult
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, AP-HM, IHU Méditerranée Infection, Marseille, France
| | - Philippe Parola
- Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198 (Dakar, Sénégal), Inserm 1095, AP-HM, IHU Méditerranée Infection, Marseille, France
- * E-mail:
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Miguel-Oteo M, Jiram AI, Ta-Tang TH, Lanza M, Hisam S, Rubio JM. Nested multiplex PCR for identification and detection of human Plasmodium species including Plasmodium knowlesi. ASIAN PAC J TROP MED 2017; 10:299-304. [DOI: 10.1016/j.apjtm.2017.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/12/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022] Open
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Piera KA, Aziz A, William T, Bell D, González IJ, Barber BE, Anstey NM, Grigg MJ. Detection of Plasmodium knowlesi, Plasmodium falciparum and Plasmodium vivax using loop-mediated isothermal amplification (LAMP) in a co-endemic area in Malaysia. Malar J 2017; 16:29. [PMID: 28086789 PMCID: PMC5237251 DOI: 10.1186/s12936-016-1676-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/30/2016] [Indexed: 01/12/2023] Open
Abstract
Background Plasmodium knowlesi is the most common cause of malaria in Malaysia. However, microscopic diagnosis is inaccurate and rapid diagnostic tests (RDTs) are insufficiently sensitive. PCR is sensitive and specific but not feasible at a district level. Loop-mediated isothermal amplification (LAMP) shows potential with only basic requirements. A commercially available LAMP assay, the Eiken Loopamp™ MALARIA Pan Detection kit, is sensitive for Plasmodium falciparum and Plasmodium vivax, but has not previously been evaluated for P. knowlesi. This study aims to determine the sensitivity of this LAMP assay for detecting P. knowlesi infection. Methods Study participants included 73 uncomplicated malaria patients with PCR species confirmation: 50 P. knowlesi, 20 P. falciparum and 3 P. vivax. Nineteen malaria-negative, non-endemic area controls were also included. The sensitivity of the Eiken Loopamp™ MALARIA Pan Detection kit (Pan LAMP) for detecting each Plasmodium species was evaluated. Sensitivity and specificity of the Eiken Loopamp™ MALARIA Pf Detection kit (Pf LAMP) for P. falciparum were also determined. The limit of detection for each LAMP assay was evaluated, with results compared to PCR. All P. knowlesi patients were also tested by CareStart™ (Pf/VOM) and OptiMAL-IT™ (Pan/Pf) RDTs. Results The sensitivity of the Pan LAMP assay was 100% for P. knowlesi (95% CI 92.9–100), P. falciparum (95% CI 83.2–100), and P. vivax (95% CI 29.2–100). The Pf LAMP was 100% sensitive and specific for P. falciparum detection, with all P. knowlesi samples having a negative reaction. LAMP sensitivity was superior to both RDTs, with only 10 and 28% of P. knowlesi samples testing positive to CareStart™ and OptiMAL-IT™, respectively. Limit of detection using the Pan LAMP for both P. knowlesi and P. vivax was 2 parasites/μL, comparable to PCR. For P. falciparum both the Pan LAMP and Pf LAMP demonstrated a limit of detection of 20 parasites/μL. Conclusions The Eiken Loopamp™ MALARIA Pan Detection kit is sensitive for detection of P. knowlesi in low parasitaemia clinical infections, as well as P. falciparum and P. vivax. However, a P. knowlesi-specific field assay in a simpler format would assist correct species identification and initiation of optimal treatment for all malaria patients.
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Affiliation(s)
- Kim A Piera
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Ammar Aziz
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.,Jesselton Medical Centre, Kota Kinabalu, Sabah, Malaysia.,Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - David Bell
- Global Good Fund/Intellectual Ventures Laboratory, Bellevue, WA, USA
| | | | - Bridget E Barber
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia.,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Matthew J Grigg
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia. .,Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.
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Grossman T, Schwartz E, Vainer J, Agmon V, Glazer Y, Goldmann D, Marva E. Contribution of real-time PCR to Plasmodium species identification and to clinical decisions: a nationwide study in a non-endemic setting. Eur J Clin Microbiol Infect Dis 2016; 36:671-675. [PMID: 27966198 DOI: 10.1007/s10096-016-2844-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/11/2016] [Indexed: 12/28/2022]
Abstract
Treatment choice for patients with malaria in Israeli hospitals is based on microscopy and rapid diagnostic tests (RDTs). Here, we demonstrate the cumulative value of real-time polymerase chain reaction (PCR) in optimizing the treatment of malaria. Between January 2009 and December 2015, 451 samples from 357 patients were tested in our laboratory using a real-time PCR assay. Hospital laboratory results (without real-time PCR) were compared to those obtained in our laboratory. A total of 307 patients had a malaria-positive laboratory finding in the hospital. Out of those, 288 were confirmed positive and 19 negative using real-time PCR. Two negative hospital results were found to be positive by real-time PCR. More specifically, of 153 cases positive for Plasmodium falciparum by real-time PCR, only 138 (90%) had been correctly identified at the hospitals. Similarly, 66 (67%) of 99 cases positive for P. vivax, 2 (11%) of 18 cases positive for P. ovale, and 3 (30%) of 10 cases positive for P. malariae had been correctly identified. Of 10 cases of mixed infection, only one had been identified as such at the hospital. Thus, real-time PCR was required for correct identification in 81 (28%) out of 290 positive cases. In 52 (18%) of those, there was an erroneous categorization of relapsing versus non-relapsing parasites. In a nationwide study, we found that the use of real-time PCR is definitely beneficial and may change the decision regarding the choice of treatment.
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Affiliation(s)
- T Grossman
- Reference Parasitology Laboratory, Central Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel.
| | - E Schwartz
- Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Vainer
- Reference Parasitology Laboratory, Central Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - V Agmon
- Reference Parasitology Laboratory, Central Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Y Glazer
- Epidemiological Division, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - D Goldmann
- Epidemiological Division, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - E Marva
- Reference Parasitology Laboratory, Central Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel
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Baum E, Sattabongkot J, Sirichaisinthop J, Kiattibutr K, Jain A, Taghavian O, Lee MC, Huw Davies D, Cui L, Felgner PL, Yan G. Common asymptomatic and submicroscopic malaria infections in Western Thailand revealed in longitudinal molecular and serological studies: a challenge to malaria elimination. Malar J 2016; 15:333. [PMID: 27333893 PMCID: PMC4918199 DOI: 10.1186/s12936-016-1393-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/15/2016] [Indexed: 11/27/2022] Open
Abstract
Background Despite largely successful control efforts, malaria remains a significant public health problem in Thailand. Based on microscopy, the northwestern province of Tak, once Thailand’s highest burden area, is now considered a low-transmission region. However, microscopy is insensitive to detect low-level parasitaemia, causing gross underestimation of parasite prevalence in areas where most infections are subpatent. The objective of this study was to assess the current epidemiology of malaria prevalence using molecular and serological detection methods, and to profile the antibody responses against Plasmodium as it relates to age, seasonal changes and clinical manifestations during infection. Three comprehensive cross-sectional surveys were performed in a sentinel village and from febrile hospital patients, and whole blood samples were collected from infants to elderly adults. Genomic DNA isolated from cellular fraction was screened by quantitative-PCR for the presence of Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi. Plasma samples were probed on protein microarray to obtain antibody response profiles from the same individuals. Results Within the studied community, 90.2 % of Plasmodium infections were submicroscopic and asymptomatic, including a large number of mixed-species infections. Amongst febrile patients, mixed-species infections comprised 68 % of positive cases, all of which went misdiagnosed and undertreated. All samples tested showed serological reactivity to Plasmodium antigens. There were significant differences in the rates of antibody acquisition against P. falciparum and P. vivax, and age-related differences in species-specific immunodominance of response. Antibodies against Plasmodium increased along the ten-month study period. Febrile patients had stronger antibody responses than asymptomatic carriers. Conclusions Despite a great decline in malaria prevalence, transmission is still ongoing at levels undetectable by traditional methods. As current surveillance methods focus on case management, malaria transmission in Thailand will not be interrupted if asymptomatic submicroscopic infections are not detected and treated. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1393-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabeth Baum
- Department of Medicine, Division of Infectious Diseases, University of California Irvine, Irvine, CA, USA.
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Kirakorn Kiattibutr
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Aarti Jain
- Department of Medicine, Division of Infectious Diseases, University of California Irvine, Irvine, CA, USA
| | - Omid Taghavian
- Department of Medicine, Division of Infectious Diseases, University of California Irvine, Irvine, CA, USA
| | - Ming-Chieh Lee
- Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - D Huw Davies
- Department of Medicine, Division of Infectious Diseases, University of California Irvine, Irvine, CA, USA
| | - Liwang Cui
- Department of Entomology, Pennsylvania State University, University Park, PA, USA
| | - Philip L Felgner
- Department of Medicine, Division of Infectious Diseases, University of California Irvine, Irvine, CA, USA
| | - Guiyun Yan
- Program in Public Health, University of California Irvine, Irvine, CA, USA
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Britton S, Cheng Q, Grigg MJ, William T, Anstey NM, McCarthy JS. A Sensitive, Colorimetric, High-Throughput Loop-Mediated Isothermal Amplification Assay for the Detection of Plasmodium knowlesi. Am J Trop Med Hyg 2016; 95:120-2. [PMID: 27162264 DOI: 10.4269/ajtmh.15-0670] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 03/28/2016] [Indexed: 11/07/2022] Open
Abstract
The simian parasite Plasmodium knowlesi is now the commonest cause of malaria in Malaysia and can rapidly cause severe and fatal malaria. However, microscopic misdiagnosis of Plasmodium species is common, rapid antigen detection tests remain insufficiently sensitive and confirmation of P. knowlesi requires polymerase chain reaction (PCR). Thus available point-of-care diagnostic tests are inadequate. This study reports the development of a simple, sensitive, colorimetric, high-throughput loop-mediated isothermal amplification assay (HtLAMP) diagnostic test using novel primers for the detection of P. knowlesi. This assay is able to detect 0.2 parasites/μL, and compared with PCR has a sensitivity of 96% for the detection of P. knowlesi, making it a potentially field-applicable point-of-care diagnostic tool.
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Affiliation(s)
- Sumudu Britton
- University of Queensland, Brisbane, Australia. QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Qin Cheng
- Australian Army Malaria Institute, Brisbane, Australia
| | - Matthew J Grigg
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Timothy William
- Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia. Jesselton Medical Center, Kota Kinabalu, Sabah, Malaysia
| | - Nicholas M Anstey
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - James S McCarthy
- University of Queensland, Brisbane, Australia. QIMR Berghofer Medical Research Institute, Brisbane, Australia
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30
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Chua KH, Lim SC, Ng CC, Lee PC, Lim YAL, Lau TP, Chai HC. Development of High Resolution Melting Analysis for the Diagnosis of Human Malaria. Sci Rep 2015; 5:15671. [PMID: 26507008 PMCID: PMC4623528 DOI: 10.1038/srep15671] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/23/2015] [Indexed: 11/18/2022] Open
Abstract
Molecular detection has overcome limitations of microscopic examination by providing greater sensitivity and specificity in Plasmodium species detection. The objective of the present study was to develop a quantitative real-time polymerase chain reaction coupled with high-resolution melting (qRT-PCR-HRM) assay for rapid, accurate and simultaneous detection of all five human Plasmodium spp. A pair of primers targeted the 18S SSU rRNA gene of the Plasmodium spp. was designed for qRT-PCR-HRM assay development. Analytical sensitivity and specificity of the assay were evaluated. Samples collected from 229 malaria suspected patients recruited from Sabah, Malaysia were screened using the assay and results were compared with data obtained using PlasmoNex(TM), a hexaplex PCR system. The qRT-PCR-HRM assay was able to detect and discriminate the five Plasmodium spp. with lowest detection limits of 1-100 copy numbers without nonspecific amplifications. The detection of Plasmodium spp. in clinical samples using this assay also achieved 100% concordance with that obtained using PlasmoNex(TM). This indicated that the diagnostic sensitivity and specificity of this assay in Plasmodium spp. detection is comparable with those of PlasmoNex(TM). The qRT-PCR-HRM assay is simple, produces results in two hours and enables high-throughput screening. Thus, it is an alternative method for rapid and accurate malaria diagnosis.
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Affiliation(s)
- Kek Heng Chua
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Siew Chee Lim
- Institutue of Biological Sciences, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ching Ching Ng
- Institutue of Biological Sciences, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ping Chin Lee
- School of Science and Technology, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Yvonne Ai Lian Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Tze Pheng Lau
- Department of Pathology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Hwa Chia Chai
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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31
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Fornace KM, Nuin NA, Betson M, Grigg MJ, William T, Anstey NM, Yeo TW, Cox J, Ying LT, Drakeley CJ. Asymptomatic and Submicroscopic Carriage of Plasmodium knowlesi Malaria in Household and Community Members of Clinical Cases in Sabah, Malaysia. J Infect Dis 2015; 213:784-7. [PMID: 26433222 PMCID: PMC4747612 DOI: 10.1093/infdis/jiv475] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/22/2015] [Indexed: 11/26/2022] Open
Abstract
Although asymptomatic carriage of human malaria species has been widely reported, the extent of asymptomatic, submicroscopic Plasmodium knowlesi parasitemia is unknown. In this study, samples were obtained from individuals residing in households or villages of symptomatic malaria cases with the aim of detecting submicroscopic P. knowlesi in this population. Four published molecular assays were used to confirm the presence of P. knowlesi. Latent class analysis revealed that the estimated proportion of asymptomatic individuals was 6.9% (95% confidence interval, 5.6%–8.4%). This study confirms the presence of a substantial number of asymptomatic monoinfections across all age groups; further work is needed to estimate prevalence in the wider community.
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Affiliation(s)
| | | | | | - Matthew J Grigg
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit Menzies School of Health Research, Darwin, Australia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit Sabah Department of Health, Clinical Research Centre Jesselton Medical Centre, Kota Kinabalu, Malaysia
| | - Nicholas M Anstey
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit Menzies School of Health Research, Darwin, Australia
| | - Tsin W Yeo
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit Menzies School of Health Research, Darwin, Australia
| | | | - Lau Tiek Ying
- Biotechnology Research Institute, Universiti Sabah Malaysia
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Ahmed MA, Cox-Singh J. Plasmodium knowlesi - an emerging pathogen. ACTA ACUST UNITED AC 2015; 10:134-140. [PMID: 26029250 PMCID: PMC4440384 DOI: 10.1111/voxs.12115] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 12/12/2022]
Abstract
Ten years have passed since the publication of a large focus of Plasmodium knowlesi infections in the human population. The discovery was made during a molecular investigation of atypical P. malariae cases in the Kapit Health Division, Sarawak, Malaysian Borneo. Patients were more symptomatic with higher parasite counts than expected in P. malariae infections. The investigation found only P. knowlesi DNA present in patient blood samples. Morphological similarity had allowed P. knowlesi to masquerade as P. malariae during routine diagnostic microscopy for malaria. P. knowlesi, a malaria parasite of macaque monkeys, had entered the human population. The subsequent development of P. knowlesi species-specific PCR assays soon demonstrated that the entry was not confined to the Kapit Division but extended across island and mainland Southeast Asia. Relevant clinical descriptions and guidelines for the treatment and management of patents with P. knowlesi malaria were not available. Nor was it clear whether P. knowlesi had undergone a host switch event into the human population or if infections were zoonotic. The outputs of studies on P. knowlesi malaria during the past 10 years will be summarized, highlighting major findings within the context of pathophysiology, virulence, host switch events, treatment, control and importantly malaria elimination.
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Affiliation(s)
- M A Ahmed
- School of Medicine, University of St Andrews St Andrews, UK
| | - J Cox-Singh
- Department of Parasitology, Faculty of Medicine, University of Malaya Kuala Lumpur, Malaysia
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Pinheiro MM, Ahmed MA, Millar SB, Sanderson T, Otto TD, Lu WC, Krishna S, Rayner JC, Cox-Singh J. Plasmodium knowlesi genome sequences from clinical isolates reveal extensive genomic dimorphism. PLoS One 2015; 10:e0121303. [PMID: 25830531 PMCID: PMC4382175 DOI: 10.1371/journal.pone.0121303] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/30/2015] [Indexed: 11/21/2022] Open
Abstract
Plasmodium knowlesi is a newly described zoonosis that causes malaria in the human population that can be severe and fatal. The study of P. knowlesi parasites from human clinical isolates is relatively new and, in order to obtain maximum information from patient sample collections, we explored the possibility of generating P. knowlesi genome sequences from archived clinical isolates. Our patient sample collection consisted of frozen whole blood samples that contained excessive human DNA contamination and, in that form, were not suitable for parasite genome sequencing. We developed a method to reduce the amount of human DNA in the thawed blood samples in preparation for high throughput parasite genome sequencing using Illumina HiSeq and MiSeq sequencing platforms. Seven of fifteen samples processed had sufficiently pure P. knowlesi DNA for whole genome sequencing. The reads were mapped to the P. knowlesi H strain reference genome and an average mapping of 90% was obtained. Genes with low coverage were removed leaving 4623 genes for subsequent analyses. Previously we identified a DNA sequence dimorphism on a small fragment of the P. knowlesi normocyte binding protein xa gene on chromosome 14. We used the genome data to assemble full-length Pknbpxa sequences and discovered that the dimorphism extended along the gene. An in-house algorithm was developed to detect SNP sites co-associating with the dimorphism. More than half of the P. knowlesi genome was dimorphic, involving genes on all chromosomes and suggesting that two distinct types of P. knowlesi infect the human population in Sarawak, Malaysian Borneo. We use P. knowlesi clinical samples to demonstrate that Plasmodium DNA from archived patient samples can produce high quality genome data. We show that analyses, of even small numbers of difficult clinical malaria isolates, can generate comprehensive genomic information that will improve our understanding of malaria parasite diversity and pathobiology.
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Affiliation(s)
- Miguel M. Pinheiro
- School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews, United Kingdom
| | - Md Atique Ahmed
- Malaria Research Centre, University Malaysia Sarawak, Kuching, Sarawak, Malaysia
| | - Scott B. Millar
- School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews, United Kingdom
| | - Theo Sanderson
- Malaria Programme, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Thomas D. Otto
- Malaria Programme, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Woon Chan Lu
- Sarikei Hospital, Sarikei, Sarawak, 96100, Malaysia
| | - Sanjeev Krishna
- Division of Clinical Sciences, St. George’s, University of London, London, United Kingdom
| | - Julian C. Rayner
- Malaria Programme, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Janet Cox-Singh
- School of Medicine, University of St Andrews, Medical and Biological Sciences Building, North Haugh, St Andrews, United Kingdom
- * E-mail:
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Lee PC, Chong ETJ, Anderios F, Al Lim Y, Chew CH, Chua KH. Molecular detection of human Plasmodium species in Sabah using PlasmoNex™ multiplex PCR and hydrolysis probes real-time PCR. Malar J 2015; 14:28. [PMID: 25651852 PMCID: PMC4318434 DOI: 10.1186/s12936-015-0542-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a vector borne-parasitic disease transmitted through the bite of the infective female Anopheles mosquitoes. Five Plasmodium species have been recognized by World Health Organization (WHO) as the causative agents of human malaria. Generally, microscopic examination is the gold standard for routine malaria diagnosis. However, molecular PCR assays in many cases have shown improvement on the sensitivity and specificity over microscopic or other immunochromatographic assays. METHODS The present study attempts to screen 207 suspected malaria samples from patients seeking treatment in clinics around Sabah state, Malaysia, using two panels of multiplex PCRs, conventional PCR system (PlasmoNex™) and real-time PCR based on hydrolysis probe technology. Discordance results between two PCR assays were further confirmed by sequencing using 18S ssu rRNA species-specific primers. RESULTS Of the 207 malaria samples, Plasmodium knowlesi (73.4% vs 72.0%) was the most prevalent species based on two PCR assays, followed by Plasmodium falciparum (15.9% vs 17.9%), and Plasmodium vivax (9.7% vs 7.7%), respectively. Neither Plasmodium malariae nor Plasmodium ovale was detected in this study. Nine discrepant species identification based on both the PCR assays were further confirmed through DNA sequencing. Species-specific real-time PCR only accurately diagnosed 198 of 207 (95.7%) malaria samples up to species level in contrast to PlasmoNex™ assay which had 100% sensitivity and specificity based on sequencing results. CONCLUSIONS Multiplex PCR accelerate the speed in the diagnosis of malaria. The PlasmoNex™ PCR assay seems to be more accurate than real-time PCR in the speciation of all five human malaria parasites. The present study also showed a significant increase of the potential fatal P. knowlesi infection in Sabah state as revealed by molecular PCR assays.
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Affiliation(s)
| | | | | | | | | | - Kek Heng Chua
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.
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Tainchum K, Ritthison W, Chuaycharoensuk T, Bangs MJ, Manguin S, Chareonviriyaphap T. Diversity of Anopheles species and trophic behavior of putative malaria vectors in two malaria endemic areas of northwestern Thailand. JOURNAL OF VECTOR ECOLOGY : JOURNAL OF THE SOCIETY FOR VECTOR ECOLOGY 2014; 39:424-436. [PMID: 25424272 DOI: 10.1111/jvec.12118] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 09/02/2014] [Indexed: 06/04/2023]
Abstract
We determined the species diversity, blood-feeding behavior, and host preference of Anopheles mosquitoes in two malaria endemic areas of Tak (Mae Sot District) and Mae Hong Son (Sop Moei District) Provinces, located along the Thai border with Myanmar, during a consecutive two-year period. Anopheline mosquitoes were collected using indoor and outdoor human-landing captures and outdoor cow-baited collections. Mosquitoes were initially identified using morphological characters, followed by the appropriate multiplex AS-PCR assay for the identification of sibling species within Anopheles (Cellia) complexes and groups present. Real-time PCR was performed for parasite-specific detection in mosquitoes (Plasmodium spp. and Wuchereria bancrofti). A total of 7,129 Anopheles females were captured, 3,939 from Mae Sot and 3,190 from Sop Moei, with 58.6% and 37% of all anophelines identified as An. minimus, respectively. All three malaria vector complexes were detected in both areas. One species within the Minimus Complex (An. minimus) was present along with two related species in the Funestus Group, (An. aconitus, An. varuna), two species within the Dirus Complex (An. dirus, An. baimaii), and four species within the Maculatus Group (An. maculatus, An. sawadwongporni, An. pseudowillmori, and An. dravidicus). The trophic behavior of An. minimus, An. dirus, An. baimaii, An. maculatus, and An. sawadwongporni are described herein. The highest An. minimus densities were detected from February through April of both years. One specimen of An. minimus from Mae Sot was found positive for Plasmodium vivax.
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Affiliation(s)
- Krajana Tainchum
- Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok 10900, Thailand
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Barber BE, Bird E, Wilkes CS, William T, Grigg MJ, Paramaswaran U, Menon J, Jelip J, Yeo TW, Anstey NM. Plasmodium knowlesi malaria during pregnancy. J Infect Dis 2014; 211:1104-10. [PMID: 25301955 DOI: 10.1093/infdis/jiu562] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Plasmodium knowlesi is the commonest cause of malaria in Malaysia, but little is known regarding infection during pregnancy. METHODS To investigate comparative risk and consequences of knowlesi malaria during pregnancy, we reviewed (1) Sabah Health Department malaria-notification records created during 2012-2013, (2) prospectively collected data from all females with polymerase chain reaction (PCR)-confirmed malaria who were admitted to a Sabah tertiary care referral hospital during 2011-2014, and (3) malaria microscopy and clinical data recorded at a Sabah tertiary care women and children's hospital during 2010-2014. RESULTS During 2012-2013, 774 females with microscopy-diagnosed malaria were notified, including 252 (33%), 172 (20%), 333 (43%), and 17 (2%) with Plasmodium falciparum infection, Plasmodium vivax infection, Plasmodium malariae/Plasmodium knowlesi infection, and mixed infection, respectively. Among females aged 15-45 years, pregnancy was reported in 18 of 124 (14.5%), 9 of 93 (9.7%), and 4 of 151 (2.6%) P. falciparum, P. vivax, and P. malariae/P. knowlesi notifications respectively (P = .002). Three females with knowlesi malaria were confirmed as pregnant: 2 had moderate anemia, and 1 delivered a preterm low-birth-weight infant. There were 17, 7, and 0 pregnant women with falciparum, vivax, and knowlesi malaria, respectively, identified from the 2 referral hospitals. CONCLUSIONS Although P. knowlesi is the commonest malaria species among females in Sabah, P. knowlesi infection is relatively rare during pregnancy. It may however be associated with adverse maternal and pregnancy outcomes.
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Affiliation(s)
- Bridget E Barber
- Menzies School of Health Research, Charles Darwin University, Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit
| | - Elspeth Bird
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit
| | - Christopher S Wilkes
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit Infectious Diseases Unit
| | - Matthew J Grigg
- Menzies School of Health Research, Charles Darwin University, Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit
| | - Uma Paramaswaran
- Menzies School of Health Research, Charles Darwin University, Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit
| | - Jayaram Menon
- Department of Medicine, Clinical Research Centre, Queen Elizabeth Hospital
| | | | - Tsin W Yeo
- Menzies School of Health Research, Charles Darwin University, Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Nicholas M Anstey
- Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital, Australia Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit
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William T, Jelip J, Menon J, Anderios F, Mohammad R, Awang Mohammad TA, Grigg MJ, Yeo TW, Anstey NM, Barber BE. Changing epidemiology of malaria in Sabah, Malaysia: increasing incidence of Plasmodium knowlesi. Malar J 2014; 13:390. [PMID: 25272973 PMCID: PMC4195888 DOI: 10.1186/1475-2875-13-390] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While Malaysia has had great success in controlling Plasmodium falciparum and Plasmodium vivax, notifications of Plasmodium malariae and the microscopically near-identical Plasmodium knowlesi increased substantially over the past decade. However, whether this represents microscopic misdiagnosis or increased recognition of P. knowlesi has remained uncertain. METHODS To describe the changing epidemiology of malaria in Sabah, in particular the increasing incidence of P. knowlesi, a retrospective descriptive study was undertaken involving a review of Department of Health malaria notification data from 2012-2013, extending a previous review of these data from 1992-2011. In addition, malaria PCR and microscopy data from the State Public Health Laboratory were reviewed to estimate the accuracy of the microscopy-based notification data. RESULTS Notifications of P. malariae/P. knowlesi increased from 703 in 2011 to 815 in 2012 and 996 in 2013. Notifications of P. vivax and P. falciparum decreased from 605 and 628, respectively, in 2011, to 297 and 263 in 2013. In 2013, P. malariae/P. knowlesi accounted for 62% of all malaria notifications compared to 35% in 2011. Among 1,082 P. malariae/P. knowlesi blood slides referred for PCR testing during 2011-2013, there were 924 (85%) P. knowlesi mono-infections, 30 (2.8%) P. falciparum, 43 (4.0%) P. vivax, seven (0.6%) P. malariae, six (0.6%) mixed infections, 31 (2.9%) positive only for Plasmodium genus, and 41 (3.8%) Plasmodium-negative. Plasmodium knowlesi mono-infection accounted for 32/156 (21%) and 33/87 (38%) blood slides diagnosed by microscopy as P. falciparum and P. vivax, respectively. Twenty-six malaria deaths were reported during 2010-2013, including 12 with 'P. malariae/P. knowlesi' (all adults), 12 with P. falciparum (seven adults), and two adults with P. vivax. CONCLUSIONS Notifications of P. malariae/P. knowlesi in Sabah are increasing, with this trend likely reflecting a true increase in incidence of P. knowlesi and presenting a major threat to malaria control and elimination in Malaysia. With the decline of P. falciparum and P. vivax, control programmes need to incorporate measures to protect against P. knowlesi, with further research required to determine effective interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bridget E Barber
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu 88560, Sabah, Malaysia.
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Grigg MJ, William T, Drakeley CJ, Jelip J, von Seidlein L, Barber BE, Fornace KM, Anstey NM, Yeo TW, Cox J. Factors that are associated with the risk of acquiring Plasmodium knowlesi malaria in Sabah, Malaysia: a case-control study protocol. BMJ Open 2014; 4:e006004. [PMID: 25149186 PMCID: PMC4156811 DOI: 10.1136/bmjopen-2014-006004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Plasmodium knowlesi has long been present in Malaysia, and is now an emerging cause of zoonotic human malaria. Cases have been confirmed throughout South-East Asia where the ranges of its natural macaque hosts and Anopheles leucosphyrus group vectors overlap. The majority of cases are from Eastern Malaysia, with increasing total public health notifications despite a concurrent reduction in Plasmodium falciparum and P. vivax malaria. The public health implications are concerning given P. knowlesi has the highest risk of severe and fatal disease of all Plasmodium spp in Malaysia. Current patterns of risk and disease vary based on vector type and competence, with individual exposure risks related to forest and forest-edge activities still poorly defined. Clustering of cases has not yet been systematically evaluated despite reports of peri-domestic transmission and known vector competence for human-to-human transmission. METHODS AND ANALYSIS A population-based case-control study will be conducted over a 2-year period at two adjacent districts in north-west Sabah, Malaysia. Confirmed malaria cases presenting to the district hospital sites meeting relevant inclusion criteria will be requested to enrol. Three community controls matched to the same village as the case will be selected randomly. Study procedures will include blood sampling and administration of household and individual questionnaires to evaluate potential exposure risks associated with acquisition of P. knowlesi malaria. Secondary outcomes will include differences in exposure variables between P. knowlesi and other Plasmodium spp, risk of severe P. knowlesi malaria, and evaluation of P. knowlesi case clustering. Primary analysis will be per protocol, with adjusted ORs for exposure risks between cases and controls calculated using conditional multiple logistic regression models. ETHICS This study has been approved by the human research ethics committees of Malaysia, the Menzies School of Health Research, Australia, and the London School of Hygiene and Tropical Medicine, UK.
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Affiliation(s)
- M J Grigg
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - T William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia Infectious Diseases Unit, Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia Sabah Department of Health, Kota Kinabalu, Sabah, Malaysia
| | - C J Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - J Jelip
- Sabah Department of Health, Kota Kinabalu, Sabah, Malaysia
| | - L von Seidlein
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - B E Barber
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - K M Fornace
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - N M Anstey
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - T W Yeo
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - J Cox
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Grigg MJ, William T, Dhanaraj P, Menon J, Barber BE, von Seidlein L, Rajahram G, Price RN, Anstey NM, Yeo TW. A study protocol for a randomised open-label clinical trial of artesunate-mefloquine versus chloroquine in patients with non-severe Plasmodium knowlesi malaria in Sabah, Malaysia (ACT KNOW trial). BMJ Open 2014; 4:e006005. [PMID: 25138814 PMCID: PMC4139630 DOI: 10.1136/bmjopen-2014-006005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Malaria due to Plasmodium knowlesi is reported throughout South-East Asia, and is the commonest cause of it in Malaysia. P. knowlesi replicates every 24 h and can cause severe disease and death. Current 2010 WHO Malaria Treatment Guidelines have no recommendations for the optimal treatment of non-severe knowlesi malaria. Artemisinin-combination therapies (ACT) and chloroquine have each been successfully used to treat knowlesi malaria; however, the rapidity of parasite clearance has not been prospectively compared. Malaysia's national policy for malaria pre-elimination involves mandatory hospital admission for confirmed malaria cases with discharge only after two negative blood films; use of a more rapidly acting antimalarial agent would have health cost benefits. P. knowlesi is commonly microscopically misreported as P. malariae, P. falciparum or P. vivax, with a high proportion of the latter two species being chloroquine-resistant in Malaysia. A unified ACT-treatment protocol would provide effective blood stage malaria treatment for all Plasmodium species. METHODS AND ANALYSIS ACT KNOW, the first randomised controlled trial ever performed in knowlesi malaria, is a two-arm open-label trial with enrolments over a 2-year period at three district sites in Sabah, powered to show a difference in proportion of patients negative for malaria by microscopy at 24 h between treatment arms (clinicaltrials.gov #NCT01708876). Enrolments started in December 2012, with completion expected by September 2014. A total sample size of 228 is required to give 90% power (α 0.05) to determine the primary end point using intention-to-treat analysis. Secondary end points include parasite clearance time, rates of recurrent infection/treatment failure to day 42, gametocyte carriage throughout follow-up and rates of anaemia at day 28, as determined by survival analysis. ETHICS AND DISSEMINATION This study has been approved by relevant institutional ethics committees in Malaysia and Australia. Results will be disseminated to inform knowlesi malaria treatment policy in this region through peer-reviewed publications and academic presentations. TRIAL REGISTRATION NUMBER NCT01708876.
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Affiliation(s)
- M J Grigg
- Global Health and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, KotaKinabalu, Sabah, Malaysia
| | - T William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, KotaKinabalu, Sabah, Malaysia Infectious Diseases Unit, Clinical Research Centre, Queen Elizabeth Hospital, KotaKinabalu, Sabah, Malaysia Sabah Department of Health, KotaKinabalu, Sabah, Malaysia
| | - P Dhanaraj
- Sabah Department of Health, KotaKinabalu, Sabah, Malaysia Kudat District Hospital, Kudat, Sabah, Malaysia
| | - J Menon
- Sabah Department of Health, KotaKinabalu, Sabah, Malaysia
| | - B E Barber
- Global Health and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, KotaKinabalu, Sabah, Malaysia
| | - L von Seidlein
- Global Health and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia Mahidol-Oxford Research Unit, Bangkok, Thailand
| | - G Rajahram
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, KotaKinabalu, Sabah, Malaysia Infectious Diseases Unit, Clinical Research Centre, Queen Elizabeth Hospital, KotaKinabalu, Sabah, Malaysia
| | - R N Price
- Global Health and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - N M Anstey
- Global Health and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, KotaKinabalu, Sabah, Malaysia Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - T W Yeo
- Global Health and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, KotaKinabalu, Sabah, Malaysia Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Ngo CT, Dubois G, Sinou V, Parzy D, Le HQ, Harbach RE, Manguin S. Diversity of Anopheles mosquitoes in Binh Phuoc and Dak Nong Provinces of Vietnam and their relation to disease. Parasit Vectors 2014; 7:316. [PMID: 25008314 PMCID: PMC4227083 DOI: 10.1186/1756-3305-7-316] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/25/2014] [Indexed: 11/17/2022] Open
Abstract
Background Human malaria is still a burden in Dak Nong and Binh Phuoc Provinces in south-central Vietnam that border Cambodia. Several Anopheles species that transmit human malarial Plasmodium may also transmit Wuchereria bancrofti, the nematode that causes Bancroftian lymphatic filariasis. The objective of this study was to investigate the role of Anopheles species in the transmission of these two pathogens in the two highly malaria endemic provinces of Vietnam. Methods Anopheles mosquitoes were collected in Dak Nong and Binh Phuoc Provinces in November and December of 2010 and 2011. Human landing catches, paired collections on human and buffalo, and resting captures were made with mouth aspirators. Collections were also made with light traps. Morphological and PCR-based methods were used to identify the species. Real-time PCR was used to detect Plasmodium species and W. bancrofti in individual mosquitoes. Results Twenty-four Anopheles species were identified among 797 captured mosquitoes. Anopheles dirus was found in both provinces and was the predominant species in Binh Phuoc Province; An. maculatus was the most prevalent species in Dak Nong Province. Anopheles minimus was collected only in Binh Phuoc Province. Some specimens of An. minimus and An. pampanai were misidentified based on morphology. Four specimens of An. scanloni were identified, and this is the first report of this species of the Dirus Complex in Vietnam. Two females, one An. dirus and one An. pampanai, collected in Binh Phuoc Province were infected with P. vivax, for an overall infection rate of 0.41% (2/486): 0.28% for An. dirus (1/361) and 20% for An. pampanai (1/5). No mosquitoes were found to be infected with P. falciparum, P. knowlesi or W. bancrofti in either province. Conclusion A diversity of Anopheles species occurs in Dak Nong and Binh Phuoc Provinces of Vietnam, several of which are considered to be actual and potential vectors of malarial protozoa and microfilariae. It is highly likely that two of the species, An. dirus and An. pampanai, are active in malaria transmission based on the detection of P. vivax in females of these species. This is the first report of An. scanloni in Vietnam.
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Affiliation(s)
| | | | | | | | | | | | - Sylvie Manguin
- Institut de Recherche pour le Développement (IRD), LIPMC, UMR-MD3, Faculté de Pharmacie, F-34093 Montpellier, France.
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Hobbs CV, Neal J, Conteh S, Donnelly L, Chen J, Marsh K, Lambert L, Orr-Gonzalez S, Hinderer J, Healy S, Borkowsky W, Penzak SR, Chakravarty S, Hoffman SL, Duffy PE. HIV treatments reduce malaria liver stage burden in a non-human primate model of malaria infection at clinically relevant concentrations in vivo. PLoS One 2014; 9:e100138. [PMID: 24988386 PMCID: PMC4079689 DOI: 10.1371/journal.pone.0100138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/21/2014] [Indexed: 11/18/2022] Open
Abstract
We have previously shown that the HIV protease inhibitor lopinavir-ritonavir (LPV-RTV) and the antibiotic trimethoprim sulfamethoxazole (TMP-SMX) inhibit Plasmodium liver stages in rodent malarias and in vitro in P. falciparum. Since clinically relevant levels are better achieved in the non-human-primate model, and since Plasmodium knowlesi is an accepted animal model for the study of liver stages of malaria as a surrogate for P. falciparum infection, we investigated the antimalarial activity of these drugs on Plasmodium knowlesi liver stages in rhesus macaques. We demonstrate that TMP-SMX and TMP-SMX+LPV-RTV (in combination), but not LPV-RTV alone, inhibit liver stage parasite development. Because drugs that inhibit the clinically silent liver stages target parasites when they are present in lower numbers, these results may have implications for eradication efforts.
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Affiliation(s)
- Charlotte V. Hobbs
- Laboratory of Malaria Immunology and Vaccinology, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
- * E-mail:
| | - Jillian Neal
- Laboratory of Malaria Immunology and Vaccinology, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Solomon Conteh
- Laboratory of Malaria Immunology and Vaccinology, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Liam Donnelly
- Laboratory of Malaria Immunology and Vaccinology, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Jingyang Chen
- Laboratory of Malaria Immunology and Vaccinology, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Kennan Marsh
- AbbVie Inc., North Chicago, Illinois, United States of America
| | - Lynn Lambert
- Laboratory of Malaria Immunology and Vaccinology, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Sachy Orr-Gonzalez
- Laboratory of Malaria Immunology and Vaccinology, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Jessica Hinderer
- Laboratory of Malaria Immunology and Vaccinology, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - Sara Healy
- Laboratory of Malaria Immunology and Vaccinology, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
| | - William Borkowsky
- Division of Infectious Disease and Immunology, Department of Pediatrics, New York University School of Medicine, New York, New York, United States of America
| | - Scott R. Penzak
- Clinical Center Pharmacy Department, Clinical Pharmacokinetics Research Laboratory, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | | | | | - Patrick E. Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America
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Jeremiah S, Janagond AB, Parija SC. Challenges in diagnosis of Plasmodium knowlesi infections. Trop Parasitol 2014; 4:25-30. [PMID: 24754023 PMCID: PMC3992798 DOI: 10.4103/2229-5070.129156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/20/2014] [Indexed: 11/15/2022] Open
Abstract
Plasmodium knowlesi is the fifth species of Plasmodium recently identified to cause human malaria. Infections with P. knowlesi are currently being reported from South-East Asian countries and the incidence is on the rise with a possibility of spread to the geographically contiguous countries. P. knowlesi infections can result in a high degree of parasitemia causing severe malaria in a larger proportion of infected individuals. If detected early and treated with appropriate antimicrobials, these infections show a significant clinical improvement. The widely used microscopic methods usually misidentify P. knowlesi as the less pathogenic Plasmodium malariae leading to inadequate therapy and adverse clinical outcomes. The currently popular rapid immuno-chromatographic card tests have a very low sensitivity in diagnosing knowlesi malaria and can erroneously report P. knowlesi as other Plasmodia and vice-versa. At present molecular methods are the most efficacious in diagnosing P. knowlesi infections, but these tests can produce a false positive report in Plasmodium vivax infections and require expensive equipment and trained personnel. An ideal diagnostic test for P. knowlesi infections, which is potent, cost-effective and practically feasible in the resource limited setting is yet to be developed.
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Affiliation(s)
- Ss Jeremiah
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Anand B Janagond
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
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Hakimi H, Kawai S, Kawazu SI. Molecular epidemiology of the emerging human malaria parasite "Plasmodium knowlesi". Trop Parasitol 2014; 4:20-4. [PMID: 24754022 PMCID: PMC3992797 DOI: 10.4103/2229-5070.129154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/20/2014] [Indexed: 12/02/2022] Open
Abstract
Malaria is the most important parasitic disease with global concern. Plasmodium knowlesi recently has emerged from its natural simian host as a significant cause of human malaria, particularly in Malaysian Borneo. Therefore, it has been added as the fifth human Plasmodium specie which is widely distributed in Southeast Asia. Recent developments of new molecular tools enhanced our understanding about the key features of this malaria parasite. Here, we review some of the ways in which molecular approaches might be used for epidemiology of P. knowlesi and finally lead to an efficient control of malaria.
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Affiliation(s)
- Hassan Hakimi
- Department of Disease Control, National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
| | - Satoru Kawai
- Laboratory of Tropical Medicine and Parasitology, Institute of International Education and Research, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Shin-Ichiro Kawazu
- Department of Disease Control, National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
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Wong SSY, Fung KSC, Chau S, Poon RWS, Wong SCY, Yuen KY. Molecular diagnosis in clinical parasitology: When and why? Exp Biol Med (Maywood) 2014; 239:1443-60. [DOI: 10.1177/1535370214523880] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Microscopic detection and morphological identification of parasites from clinical specimens are the gold standards for the laboratory diagnosis of parasitic infections. The limitations of such diagnostic assays include insufficient sensitivity and operator dependence. Immunoassays for parasitic antigens are not available for most parasitic infections and have not significantly improved the sensitivity of laboratory detection. Advances in molecular detection by nucleic acid amplification may improve the detection in asymptomatic infections with low parasitic burden. Rapidly accumulating genomic data on parasites allow the design of polymerase chain reaction (PCR) primers directed towards multi-copy gene targets, such as the ribosomal and mitochondrial genes, which further improve the sensitivity. Parasitic cell or its free circulating parasitic DNA can be shed from parasites into blood and excreta which may allow its detection without the whole parasite being present within the portion of clinical sample used for DNA extraction. Multiplex nucleic acid amplification technology allows the simultaneous detection of many parasitic species within a single clinical specimen. In addition to improved sensitivity, nucleic acid amplification with sequencing can help to differentiate different parasitic species at different stages with similar morphology, detect and speciate parasites from fixed histopathological sections and identify anti-parasitic drug resistance. The use of consensus primer and PCR sequencing may even help to identify novel parasitic species. The key limitation of molecular detection is the technological expertise and expense which are usually lacking in the field setting at highly endemic areas. However, such tests can be useful for screening important parasitic infections in asymptomatic patients, donors or recipients coming from endemic areas in the settings of transfusion service or tertiary institutions with transplantation service. Such tests can also be used for monitoring these recipients or highly immunosuppressed patients, so that early preemptive treatment can be given for reactivated parasitic infections while the parasitic burden is still low.
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Affiliation(s)
- Samson SY Wong
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Kitty SC Fung
- Department of Pathology, United Christian Hospital, Kwun Tong of New Kowloon, Hong Kong
| | - Sandy Chau
- Department of Pathology, United Christian Hospital, Kwun Tong of New Kowloon, Hong Kong
| | - Rosana WS Poon
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Sally CY Wong
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Kwok-Yung Yuen
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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Plasmodium knowlesi in travellers, update 2014. Int J Infect Dis 2014; 22:55-64. [PMID: 24631521 DOI: 10.1016/j.ijid.2013.12.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/16/2013] [Accepted: 12/19/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Since the initial discovery of Plasmodium knowlesi in Malaysia, cases have been reported from several neighbouring countries. Tourism has also resulted in an increasing number of cases diagnosed in Europe, America, and Oceania. In this review we focus on the risk of the travel-associated acquisition of P. knowlesi malaria. METHODS A search of the literature in PubMed was carried out to identify articles and literature on the distribution of P. knowlesi infections in Southeast Asia and details of its acquisition and importation by travellers to other continents. The cut-off date for the search was December 1, 2013. Search words used were: "Plasmodium knowlesi", "Plasmodium knowlesi infections", "Plasmodium knowlesi travellers", "Plasmodium knowlesi prevalence", "Plasmodium knowlesi host", "Plasmodium knowlesi vector" "Plasmodium knowlesi RDT", and "Plasmodium knowlesi Malaysia". Traveller numbers to Malaysia were obtained from the Tourism Malaysia website. RESULTS A total of 103 articles were found. Using a selection of these and others identified from the reference lists of the papers, we based our review on a total of 66 articles. RESULTS P. knowlesi malaria appears to be the most common malaria species in Malaysian Borneo and is also widely distributed on the Malaysian mainland. Furthermore, locally transmitted cases of P. knowlesi malaria have been reported in Thailand, the Philippines, Vietnam, Singapore, Myanmar, Indonesian Borneo, and Cambodia. Two cases have been reported from non-endemic countries in Asia (Japan and Taiwan) in people with a history of travel to Malaysia and the Philippines. Twelve cases were imported to their home countries by travellers from other continents: two from the USA, two from the Netherlands, two from Germany, and one each from Spain, France, Sweden, Finland, Australia, and New Zealand. In most cases, the infection was associated with a trip to or near forested areas. The symptoms were fever (n=12), headache (n=6), chills (n=6), nausea (n=4), myalgia (n=3), back pain (n=3), abdominal problems (n=1), anorexia (n=2), fatigue (n=2), malaise (n=1), arthralgia (n=1), sore throat (n=1) vomiting (n=2), and jaundice (n=1). All patients were treated successfully with currently available antimalaria treatments. The identification of the pathogen by microscopy can be problematic due to the morphological similarity of P. knowlesi to Plasmodium malariae. CONCLUSION P. knowlesi appears to be a threat not only to the local population in Malaysia, but also to the estimated 25 million annual tourists and occupational travellers to Malaysia, especially those who visit rural, forested areas of the country. The P. knowlesi risk is not limited to Malaysia, and travellers from Southeast Asia presenting with possible malaria should be considered for a diagnostic work-up that includes P. knowlesi.
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Calderaro A, Piccolo G, Gorrini C, Rossi S, Montecchini S, Dell'Anna ML, De Conto F, Medici MC, Chezzi C, Arcangeletti MC. Accurate identification of the six human Plasmodium spp. causing imported malaria, including Plasmodium ovale wallikeri and Plasmodium knowlesi. Malar J 2013; 12:321. [PMID: 24034175 PMCID: PMC3847200 DOI: 10.1186/1475-2875-12-321] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/09/2013] [Indexed: 11/20/2022] Open
Abstract
Background Accurate identification of Plasmodium infections in non-endemic countries is of critical importance with regard to the administration of a targeted therapy having a positive impact on patient health and management and allowing the prevention of the risk of re-introduction of endemic malaria in such countries. Malaria is no longer endemic in Italy where it is the most commonly imported disease, with one of the highest rates of imported malaria among European non-endemic countries including France, the UK and Germany, and with a prevalence of 24.3% at the University Hospital of Parma. Molecular methods showed high sensitivity and specificity and changed the epidemiology of imported malaria in several non-endemic countries, highlighted a higher prevalence of Plasmodium ovale, Plasmodium vivax and Plasmodium malariae underestimated by microscopy and, not least, brought to light both the existence of two species of P. ovale (Plasmodium ovale curtisi and Plasmodium ovale wallikeri) and the infection in humans by Plasmodium knowlesi, otherwise not detectable by microscopy. Methods In this retrospective study an evaluation of two real-time PCR assays able to identify P. ovale wallikeri, distinguishing it from P. ovale curtisi, and to detect P. knowlesi, respectively, was performed applying them on a subset of 398 blood samples belonging to patients with the clinical suspicion of malaria. Results These assays revealed an excellent analytical sensitivity and no cross-reactivity versus other Plasmodium spp. infecting humans, suggesting their usefulness for an accurate and complete diagnosis of imported malaria. Among the 128 patients with malaria, eight P. ovale curtisi and four P. ovale wallikeri infections were detected, while no cases of P. knowlesi infection were observed. Discussion and conclusions Real-time PCR assays specific for P. ovale wallikeri and P. knowlesi were included in the panel currently used in the University Hospital of Parma for the diagnosis of imported malaria, accomplishing the goal of adhering to the recommendations of the World Health Organization to countries that are malaria-free to include the improvement of the early diagnosis of all cases of imported malaria.
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Affiliation(s)
- Adriana Calderaro
- Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Parma, Viale A, Gramsci 14, Parma, Italy.
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Van Hong N, van den Eede P, Van Overmeir C, Vythilingham I, Rosanas-Urgell A, Vinh Thanh P, Thang ND, Hung NM, Hung LX, D'Alessandro U, Erhart A. A modified semi-nested multiplex malaria PCR (SnM-PCR) for the identification of the five human Plasmodium species occurring in Southeast Asia. Am J Trop Med Hyg 2013; 89:721-723. [PMID: 23980132 PMCID: PMC3795103 DOI: 10.4269/ajtmh.13-0027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We have modified an existing semi-nested multiplex polymerase chain reaction (PCR) by adding one Plasmodium knowlesi-specific nested PCR, and validated the latter against laboratory and clinical samples. This new method has the advantage of being relatively affordable in low resource settings while identifying the five human Plasmodium species with a three-step PCR.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Annette Erhart
- *Address correspondence to Annette Erhart, Malariology Unit, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. E-mail:
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Abstract
Plasmodium knowlesi is a malaria parasite that is found in nature in long-tailed and pig-tailed macaques. Naturally acquired human infections were thought to be extremely rare until a large focus of human infections was reported in 2004 in Sarawak, Malaysian Borneo. Human infections have since been described throughout Southeast Asia, and P. knowlesi is now recognized as the fifth species of Plasmodium causing malaria in humans. The molecular, entomological, and epidemiological data indicate that human infections with P. knowlesi are not newly emergent and that knowlesi malaria is primarily a zoonosis. Human infections were undiagnosed until molecular detection methods that could distinguish P. knowlesi from the morphologically similar human malaria parasite P. malariae became available. P. knowlesi infections cause a spectrum of disease and are potentially fatal, but if detected early enough, infections in humans are readily treatable. In this review on knowlesi malaria, we describe the early studies on P. knowlesi and focus on the epidemiology, diagnosis, clinical aspects, and treatment of knowlesi malaria. We also discuss the gaps in our knowledge and the challenges that lie ahead in studying the epidemiology and pathogenesis of knowlesi malaria and in the prevention and control of this zoonotic infection.
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Affiliation(s)
- Balbir Singh
- Malaria Research Centre, Universiti Malaysia Sarawak, Kuching, Sarawak, Malaysia.
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Plasmodium knowlesi: the emerging zoonotic malaria parasite. Acta Trop 2013; 125:191-201. [PMID: 23088834 DOI: 10.1016/j.actatropica.2012.10.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 10/03/2012] [Accepted: 10/14/2012] [Indexed: 11/20/2022]
Abstract
Plasmodium knowlesi was initially identified in the 30s as a natural Plasmodium of Macaca fascicularis monkey also capable of experimentally infecting humans. It gained a relative notoriety in the mid-30s as an alternative to Plasmodium vivax in the treatment of the general paralysis of the insane (neurosyphilis). In 1965 the first natural human infection was described in a US military surveyor coming back from the Pahang jungle of the Malaysian peninsula. P. knowlesi was again brought to the attention of the medical community when in 2004, Balbir Singh and his co-workers reported that about 58% of malaria cases observed in the Kapit district of the Malaysian Borneo were actually caused by P. knowlesi. In the following years several reports showed that P. knowlesi is much more widespread than initially thought with cases reported across Southeast Asia. This infection should also be considered in the differential diagnosis of any febrile travellers coming back from a recent travel to forested areas of Southeast Asia. P. knowlesi can cause severe malaria with a rate of 6-9% and with a case fatality rate of 3%. Respiratory distress, acute renal failure, shock and hyperbilirubinemia are the most frequently observed complications of severe P. knowlesi malaria. Chloroquine is considered the treatment of choice of uncomplicated malaria caused by P. knowlesi.
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Barber BE, William T, Dhararaj P, Anderios F, Grigg MJ, Yeo TW, Anstey NM. Epidemiology of Plasmodium knowlesi malaria in north-east Sabah, Malaysia: family clusters and wide age distribution. Malar J 2012; 11:401. [PMID: 23216947 PMCID: PMC3528466 DOI: 10.1186/1475-2875-11-401] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 11/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The simian parasite Plasmodium knowlesi is a common cause of human malaria in Malaysian Borneo, with a particularly high incidence in Kudat, Sabah. Little is known however about the epidemiology in this substantially deforested region. METHODS Malaria microscopy records at Kudat District Hospital were retrospectively reviewed from January 2009-November 2011. Demographics, and PCR results if available, were recorded for each positive result. Medical records were reviewed for patients suspected of representing family clusters, and families contacted for further information. Rainfall data were obtained from the Malaysian Meteorological Department. RESULTS "Plasmodium malariae" mixed or mono-infection was diagnosed by microscopy in 517/653 (79%) patients. Of these, PCR was performed in 445 (86%) and was positive for P. knowlesi mono-infection in 339 (76%). Patients with knowlesi malaria demonstrated a wide age distribution (median 33, IQR 20-50, range 0.7-89 years) with P. knowlesi predominating in all age groups except those <5 years old, where numbers approximated those of Plasmodium falciparum and Plasmodium vivax. Two contemporaneous family clusters were identified: a father with two children (aged 10-11 years); and three brothers (aged one-11 years), all with PCR-confirmed knowlesi malaria. Cases of P. knowlesi demonstrated significant seasonal variation, and correlated with rainfall in the preceding three to five months. CONCLUSIONS Plasmodium knowlesi is the most common cause of malaria admissions to Kudat District Hospital. The wide age distribution and presence of family clusters suggest that transmission may be occurring close to or inside people's homes, in contrast to previous reports from densely forested areas of Sarawak. These findings have significant implications for malaria control. Prospective studies of risk factors, vectors and transmission dynamics of P. knowlesi in Sabah, including potential for human-to-human transmission, are needed.
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Affiliation(s)
- Bridget E Barber
- Global Health Division, Menzies School of Health Research, PO Box 41096, Casuarina 0810,, Northern Territory, Australia
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