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Title: Relapses of Plasmodium vivax infection usually result from activation of heterologous hypnozoites
Authors: Mallika Imwong
Georges Snounou
Sasithon Pukrittayakamee
Naowarat Tanomsing
Ryong Kim Jung
Amitab Nandy
Jean Paul Guthmann
Francois Nosten
Jane Carlton
Sornchai Looareesuwan
Shalini Nair
Daniel Sudimack
Nicholas P.J. Day
Timothy J.C. Anderson
Nicholas J. White
Mahidol University
Royal Institute
Shoklo Malaria Research Unit
Museum National d'Histoire Naturelle
Calcutta School of Tropical Medicine
Churchill Hospital
J. Craig Venter Institute
Texas Biomedical Research Institute
New York University
Keywords: Medicine
Issue Date: 1-Apr-2007
Citation: Journal of Infectious Diseases. Vol.195, No.7 (2007), 927-933
Abstract: Background. Relapses originating from hypnozoites are characteristic of Plasmodium vivax infections. Thus, reappearance of parasitemia after treatment can result from relapse, recrudescence, or reinfection. It has been assumed that parasites causing relapse would be a subset of the parasites that caused the primary infection. Methods. Paired samples were collected before initiation of antimalarial treatment and at recurrence of parasitemia from 149 patients with vivax malaria in Thailand (n = 36), where reinfection could be excluded, and during field studies in Myanmar (n = 75) and India (n = 38). Results. Combined genetic data from 2 genotyping approaches showed that novel P. vivax populations were present in the majority of patients with recurrent infection (107 [72%] of 149 patients overall [78% of patients in Thailand, 75% of patients in Myanmar {Burma}, and 63% of patients in India]). In 61% of the Thai and Burmese patients and in 55% of the Indian patients, the recurrent infections contained none of the parasite genotypes that caused the acute infection. Conclusions. The P. vivax populations emerging from hypnozoites commonly differ from the populations that caused the acute episode. Activation of heterologous hypnozoite populations is the most common cause of first relapse in patients with vivax malaria. © 2007 by the Infectious Diseases Society of America. All rights reserved.
ISSN: 00221899
Appears in Collections:Scopus 2006-2010

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