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Malar J. 2018 Feb 9;17(1):78. doi: 10.1186/s12936-018-2226-4.

Molecular evidence for relapse of an imported Plasmodium ovale wallikeri infection.

Author information

1
Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
2
Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
3
Institute for Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
4
Department of Pathobiology, Institute of Parasitology, University of Veterinary Medicine Vienna, Vienna, Austria.
5
Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. michael.ramharter@medizin.uni-tuebingen.de.
6
Bernhard Nocht Hospital for Tropical Diseases, Bernhard Nocht Institute for Tropical Medicine and University Medical Center Hamburg-Eppendorf, Hamburg, Germany. michael.ramharter@medizin.uni-tuebingen.de.

Abstract

BACKGROUND:

Malaria caused by Plasmodium ovale spp. has been neglected by and large from research and has received only little scientific attention during the past decades. Ovale malaria is considered to feature relapses by liver hypnozoites although scientific evidence for this paradigm is scarce.

CASE PRESENTATION:

Here, the case of a 16-year-old male, who presented with fevers to the outpatient department in Vienna, Austria, after travelling to Uganda and Papua New Guinea is described. Infection with Plasmodium malariae was diagnosed by microscopy and the patient was treated accordingly with a full course of supervised artemether-lumefantrine. He was discharged in good clinical condition with a negative blood smear. One month after initial diagnosis, he returned complaining of fever. Thick blood smear was positive again for malaria parasites, which were confirmed as P. ovale wallikeri by PCR. Retrospective analysis revealed the identical Plasmodium spp. in the initial blood samples. Molecular analysis of various gene loci (nuclear porbp2, 18S rRNA and potra genes) gave identical results providing further evidence for relapse by an identical parasite genotype. Consecutively, the patient was retreated with artemether-lumefantrine and received a regimen of primaquine according to WHO guidelines.

CONCLUSION:

Conclusive evidence for relapses with P. ovale spp. is rare. The presented case provides convincing confirmation for the relapse paradigm based on re-appearing parasitaemia following supervised treatment in a non-endemic region with a parasite strain of identical genotype.

KEYWORDS:

Case report; Malaria; Plasmodium ovale; Plasmodium ovale wallikeri; Relapse

PMID:
29426330
PMCID:
PMC5807828
DOI:
10.1186/s12936-018-2226-4
[Indexed for MEDLINE]
Free PMC Article

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