Prospective comparative multi-centre study on imported Plasmodium ovale wallikeri and Plasmodium ovale curtisi infections
Authors
Cuadros González, Juan; Rojo Marcos, Gerardo; Rubio Muñoz, José Miguel; Angheben, Andrea; Jaureguiberry, Stephane; [et al.]Identifiers
Permanent link (URI): http://hdl.handle.net/10017/60489DOI: 10.1186/s12936-018-2544-6
ISSN: 1475-2875
Date
2018Affiliation
Universidad de Alcalá. Departamento de Biomedicina y Biotecnología. Unidad Docente de MicrobiologíaFunders
Fundación para la Investigación Biomédica del Hospital Universitario Príncipe de Asturias
Bibliographic citation
Malaria Journal, 2018, v. , n. , p. -
Keywords
Plasmodium ovale curtisi
Plasmodium ovale wallikeri
Comparative study
Thrombocytopenia
INR
Antimalarials
Diabetes mellitus
Project
info:eu-repo/grantAgreement/FIB//FIB-PI14-04/ES//
Document type
info:eu-repo/semantics/article
Version
info:eu-repo/semantics/publishedVersion
Rights
© The Author(s) 2018
Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
Access rights
info:eu-repo/semantics/openAccess
Abstract
Abstract
Background: Few previous retrospective studies suggest that Plasmodium ovale wallikeri seems to have a longer
latency period and produces deeper thrombocytopaenia than Plasmodium ovale curtisi. Prospective studies were warranted
to better assess interspecies differences.
Methods: Patients with imported P. ovale spp. infection diagnosed by thick or thin film, rapid diagnostic test (RDT) or
polymerase chain reaction (PCR) were recruited between March 2014 and May 2017. All were confirmed by DNA isolation
and classified as P. o. curtisi or P. o. wallikeri using partial sequencing of the ssrRNA gene. Epidemiological, analytical
and clinical differences were analysed by statistical methods.
Results: A total of 79 samples (35 P. o. curtisi and 44 P. o. wallikeri) were correctly genotyped. Males predominate in
wallikeri group (72.7%), whereas were 48.6% in curtisi group. Conversely, 74.3% of curtisi group were from patients of
African ethnicity, whilst 52.3% of Caucasians were infected by P. o. wallikeri. After performing a multivariate analysis,
more thrombocytopaenic patients (p = 0.022), a lower number of platelets (p = 0.015), a higher INR value (p = 0.041),
and shorter latency in Caucasians (p = 0.034) were significantly seen in P. o. wallikeri. RDT sensitivity was 26.1% in P. o.
curtisi and 42.4% in P. o. wallikeri. Nearly 20% of both species were diagnosed only by PCR. Total bilirubin over 3 mg/
dL was found in three wallikeri cases. Two patients with curtisi infection had haemoglobin under 7 g/dL, one of them
also with icterus. A wallikeri patient suffered from haemophagocytosis. Chemoprophylaxis failed in 14.8% and 35% of
curtisi and wallikeri patients, respectively. All treated patients with various anti-malarials which included artesunate
recovered. Diabetes mellitus was described in 5 patients (6.32%), 4 patients of wallikeri group and 1 curtisi.
Conclusions: Imported P. o. wallikeri infection may be more frequent in males and Caucasians. Malaria caused by P.
o. wallikeri produces more thrombocytopaenia, a higher INR and shorter latency in Caucasians and suggests a more
pathogenic species. Severe cases can be seen in both species. Chemoprophylaxis seems less effective in P. ovale spp.
infection than in P. falciparum, but any anti-malarial drug is effective as initial treatment. Diabetes mellitus could be a
risk factor for P. ovale spp. infection.
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