Missed Plasmodium falciparum and Plasmodium vivax Mixed Infections in Ethiopia Threaten Malaria Elimination

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....

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Bibliographic Details
Published in:The American journal of tropical medicine and hygiene 2022-02, Vol.106 (2), p.667-670
Main Authors: Leonard, Colleen M, Mohammed, Hussein, Tadesse, Mekonnen, McCaffery, Jessica N, Nace, Doug, Halsey, Eric S, Girma, Samuel, Assefa, Ashenafi, Hwang, Jimee, Rogier, Eric
Format: Article
Language:English
Subjects:
Adolescent
Antigens
Child
Child, Preschool
Coinfection - diagnosis
Coinfection - epidemiology
Coinfection - parasitology
Dehydrogenases
Disease Eradication - standards
Disease Eradication - statistics & numerical data
DNA, Protozoan - genetics
Erythrocytes
Ethiopia - epidemiology
Female
Humans
Infections
Malaria
Malaria, Falciparum - diagnosis
Malaria, Falciparum - epidemiology
Malaria, Vivax - diagnosis
Malaria, Vivax - epidemiology
Male
Microscopy
Plasmodium falciparum - genetics
Plasmodium falciparum - isolation & purification
Plasmodium vivax - genetics
Plasmodium vivax - isolation & purification
Polymerase chain reaction
Short Report
Young Adult
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Summary: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.
ISSN:0002-9637
1476-1645
DOI:10.4269/ajtmh.21-0796