1. Missed Plasmodium falciparum and Plasmodium vivax Mixed Infections in Ethiopia Threaten Malaria Elimination.
- Author
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Leonard CM, Mohammed H, Tadesse M, McCaffery JN, Nace D, Halsey ES, Girma S, Assefa A, Hwang J, and Rogier E
- Subjects
- Adolescent, Child, Child, Preschool, Coinfection epidemiology, DNA, Protozoan genetics, Disease Eradication statistics & numerical data, Ethiopia epidemiology, Female, Humans, Malaria, Falciparum epidemiology, Malaria, Vivax epidemiology, Male, Plasmodium falciparum isolation & purification, Plasmodium vivax isolation & purification, Young Adult, Coinfection diagnosis, Coinfection parasitology, Disease Eradication standards, Malaria, Falciparum diagnosis, Malaria, Vivax diagnosis, Plasmodium falciparum genetics, Plasmodium vivax genetics
- Abstract
Plasmodium falciparum and Plasmodium vivax are co-endemic in Ethiopia. This study investigated whether mixed infections were missed by microscopy from a 2017 therapeutic efficacy study at two health facilities in Ethiopia. All patients (N = 304) were initially classified as having single-species P. falciparum (n = 148 samples) or P. vivax infections (n = 156). Dried blood spots were tested for Plasmodium antigens by bead-based multiplex assay for pan-Plasmodium aldolase, pan-Plasmodium lactate dehydrogenase, P. vivax lactate dehydrogenase, and histidine-rich protein 2. Of 304 blood samples, 13 (4.3%) contained both P. falciparum and P. vivax antigens and were analyzed by polymerase chain reaction for species-specific DNA. Of these 13 samples, five were confirmed by polymerase chain reaction for P. falciparum/P. vivax co-infection. One sample, initially classified as P. vivax by microscopy, was found to only have Plasmodium ovale DNA. Plasmodium falciparum/P. vivax mixed infections can be missed by microscopy even in the context of a therapeutic efficacy study with multiple trained readers.
- Published
- 2021
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