A cluster of the first reported Plasmodium ovale spp. infections in Peru occuring among returning UN peace-keepers, a review of epidemiology, prevention and diagnostic challenges in nonendemic regions
Abstract Background Plasmodium ovale curtisi and Plasmodium ovale wallikeri are regarded as less virulent forms of malaria with a geographic distribution including Southeast Asia, Central and West Africa, and is increasingly reported as an infection in returning travellers. A species of malaria that...
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| Format: | Article |
| Language: | English |
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BMC
2019-05-01
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| Series: | Malaria Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12936-019-2809-8 |
| _version_ | 1819079203716333568 |
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| author | Rosio I. Guerra Marianela Ore Hugo O. Valdivia Danett K. Bishop Mariana Ramos Christopher N. Mores Wesley R. Campbell |
| author_facet | Rosio I. Guerra Marianela Ore Hugo O. Valdivia Danett K. Bishop Mariana Ramos Christopher N. Mores Wesley R. Campbell |
| author_sort | Rosio I. Guerra |
| collection | DOAJ |
| description | Abstract Background Plasmodium ovale curtisi and Plasmodium ovale wallikeri are regarded as less virulent forms of malaria with a geographic distribution including Southeast Asia, Central and West Africa, and is increasingly reported as an infection in returning travellers. A species of malaria that may have delayed or relapsing presentations similar to Plasmodium vivax, the clinical presentation of P. ovale spp. has been described to have prepatent periods of 2 weeks or slightly longer with reports of relapse following primary infection out to 8–9 months. This presentation may be obscured further in the setting of anti-malarial exposure, with report of delayed primary infection out to 4 years. Presented is a cluster of 4 imported P. ovale spp. cases in returning Peruvian military personnel assigned to United Nations peace-keeping operations in the Central African Republic. Case presentation From January to December 2016, Peruvian peace-keepers were deployed in support of United Nations (UN) operations in the Central African Republic (CAR). While serving abroad, Navy, Army, and Air Force members experienced 223 episodes of Plasmodium falciparum malaria following interruption of prophylaxis with mefloquine. Diagnosis was made using rapid diagnostics tests (RDTs) and/or smear with no coinfections identified. Cases of malaria were treated with locally-procured artemether-lumefantrine. Returning to Peru in January 2017, 200 peace-keepers were screened via thick and thin smear while on weekly mefloquine prophylaxis with only 1 showing nucleic acid within red blood cells consistent with Plasmodium spp. and 11 reporting syndromes of ill-defined somatic complaints. Between a period of 5 days to 11 months post return, 4 cases of P. ovale spp. were diagnosed using smear and polymerase chain reaction (PCR) following febrile complaints. All cases were subsequently treated with chloroquine and primaquine, with cure of clinical disease and documented clearance of parasitaemia. Conclusion These patients represent the first imported cases in Peru of this species of malaria as well as highlight the challenges in implementing population level prophylaxis in a deployed environment, and the steps for timely diagnosis and management in a non-endemic region where risk of introduction for local transmission exists. |
| first_indexed | 2024-12-21T19:25:16Z |
| format | Article |
| id | doaj.art-570755cd6eb044699e46d1dd9c4c90cf |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-21T19:25:16Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
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| series | Malaria Journal |
| spelling | doaj.art-570755cd6eb044699e46d1dd9c4c90cf2022-12-21T18:52:51ZengBMCMalaria Journal1475-28752019-05-011811810.1186/s12936-019-2809-8A cluster of the first reported Plasmodium ovale spp. infections in Peru occuring among returning UN peace-keepers, a review of epidemiology, prevention and diagnostic challenges in nonendemic regionsRosio I. Guerra0Marianela Ore1Hugo O. Valdivia2Danett K. Bishop3Mariana Ramos4Christopher N. Mores5Wesley R. Campbell6Dirección de Salud de la MarinaComando de Salud del EjércitoU.S. Naval Medical Research Unit No. 6U.S. Naval Medical Research Unit No. 6U.S. Naval Medical Research Unit No. 6U.S. Naval Medical Research Unit No. 6U.S. Naval Medical Research Unit No. 6Abstract Background Plasmodium ovale curtisi and Plasmodium ovale wallikeri are regarded as less virulent forms of malaria with a geographic distribution including Southeast Asia, Central and West Africa, and is increasingly reported as an infection in returning travellers. A species of malaria that may have delayed or relapsing presentations similar to Plasmodium vivax, the clinical presentation of P. ovale spp. has been described to have prepatent periods of 2 weeks or slightly longer with reports of relapse following primary infection out to 8–9 months. This presentation may be obscured further in the setting of anti-malarial exposure, with report of delayed primary infection out to 4 years. Presented is a cluster of 4 imported P. ovale spp. cases in returning Peruvian military personnel assigned to United Nations peace-keeping operations in the Central African Republic. Case presentation From January to December 2016, Peruvian peace-keepers were deployed in support of United Nations (UN) operations in the Central African Republic (CAR). While serving abroad, Navy, Army, and Air Force members experienced 223 episodes of Plasmodium falciparum malaria following interruption of prophylaxis with mefloquine. Diagnosis was made using rapid diagnostics tests (RDTs) and/or smear with no coinfections identified. Cases of malaria were treated with locally-procured artemether-lumefantrine. Returning to Peru in January 2017, 200 peace-keepers were screened via thick and thin smear while on weekly mefloquine prophylaxis with only 1 showing nucleic acid within red blood cells consistent with Plasmodium spp. and 11 reporting syndromes of ill-defined somatic complaints. Between a period of 5 days to 11 months post return, 4 cases of P. ovale spp. were diagnosed using smear and polymerase chain reaction (PCR) following febrile complaints. All cases were subsequently treated with chloroquine and primaquine, with cure of clinical disease and documented clearance of parasitaemia. Conclusion These patients represent the first imported cases in Peru of this species of malaria as well as highlight the challenges in implementing population level prophylaxis in a deployed environment, and the steps for timely diagnosis and management in a non-endemic region where risk of introduction for local transmission exists.http://link.springer.com/article/10.1186/s12936-019-2809-8Plasmodium ovaleRelapseTravelerMalariaNon-falciparum malaria |
| spellingShingle | Rosio I. Guerra Marianela Ore Hugo O. Valdivia Danett K. Bishop Mariana Ramos Christopher N. Mores Wesley R. Campbell A cluster of the first reported Plasmodium ovale spp. infections in Peru occuring among returning UN peace-keepers, a review of epidemiology, prevention and diagnostic challenges in nonendemic regions Malaria Journal Plasmodium ovale Relapse Traveler Malaria Non-falciparum malaria |
| title | A cluster of the first reported Plasmodium ovale spp. infections in Peru occuring among returning UN peace-keepers, a review of epidemiology, prevention and diagnostic challenges in nonendemic regions |
| title_full | A cluster of the first reported Plasmodium ovale spp. infections in Peru occuring among returning UN peace-keepers, a review of epidemiology, prevention and diagnostic challenges in nonendemic regions |
| title_fullStr | A cluster of the first reported Plasmodium ovale spp. infections in Peru occuring among returning UN peace-keepers, a review of epidemiology, prevention and diagnostic challenges in nonendemic regions |
| title_full_unstemmed | A cluster of the first reported Plasmodium ovale spp. infections in Peru occuring among returning UN peace-keepers, a review of epidemiology, prevention and diagnostic challenges in nonendemic regions |
| title_short | A cluster of the first reported Plasmodium ovale spp. infections in Peru occuring among returning UN peace-keepers, a review of epidemiology, prevention and diagnostic challenges in nonendemic regions |
| title_sort | cluster of the first reported plasmodium ovale spp infections in peru occuring among returning un peace keepers a review of epidemiology prevention and diagnostic challenges in nonendemic regions |
| topic | Plasmodium ovale Relapse Traveler Malaria Non-falciparum malaria |
| url | http://link.springer.com/article/10.1186/s12936-019-2809-8 |
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