Search Results (180)

Malaria remains a considerable challenge to international health, especially in returning travelers from endemic regions where exposure risk may be downplayed. Prompt and accurate diagnosis is crucial, especially when conventional diagnostic techniques are insufficient. This case report presents a 59-year-old man who developed fever, rash, and myalgia after returning from the Amazon rainforest. Initial laboratory tests demonstrated leukopenia, thrombocytopenia, transaminitis, and hyperbilirubinemia. Despite these abnormal results and a clinically suspicious presentation, malaria smears were negative. Since the symptoms did not resolve, a Karius test—a plasma-based microbial cell-free DNA sequencing assay—successfully detected the presence of Plasmodium vivax, thus establishing the diagnosis. The patient needed several treatment regimens for the recurrent attacks, including chloroquine and primaquine, artemether-lumefantrine, and eventually a combination of quinine and doxycycline together with a prolonged course of primaquine. His symptoms resolved completely after the last treatment regimen, along with the normalization of the blood counts and liver function tests. This case demonstrates the limitations of smear microscopy diagnosis in P. vivax infections, highlights the role of molecular diagnostics like the Karius test, and stresses the importance of preventing relapses with adequate hypnozoite clearance. It further highlights the importance of clinician awareness and diligent follow-up in cases of travel-related Malaria, especially those with unusual presentations or recurrent symptoms. Full article

As Honduras approaches malaria elimination, imported infections pose a growing challenge to disease surveillance and control. In this study, we analyzed 14 molecular markers—six from Plasmodium falciparum and eight from P. vivax—in samples from local and migrant subjects to assess their utility in differentiating local versus imported infections. All P. falciparum isolates carried the wild-type pfcrt haplotype associated with chloroquine susceptibility. However, polymorphisms in pfmdr1, pfama1, pfglurp, and pfs47 revealed distinct genotypes in migrant versus local samples, suggesting external origins. For P. vivax, three novel pvcsp VK210 haplotypes and the first detection of a VK247 variant in Honduras were identified in migrants. Additional novel haplotypes were found in pvmsp1, pvmsp3α, pvmsp3β, pvs47, and pvs48/45. Several of these markers—particularly pfmdr1, pfs47, pvs47, and pvs48/45—proved informative for inferring geographic origin. This study demonstrates the value of molecular surveillance in low-transmission settings, supporting public health efforts by identifying potentially imported cases. Full article

Dengue and malaria are common vector-borne tropical diseases and are associated with high morbidity and mortality. Co-infection of dengue and malaria is underestimated due to parsimonious diagnostic approaches once the diagnosis of either is made, particularly using point-of-care assays, such as rapid diagnostic tests (RDTs). We present a case of dengue and Plasmodium vivax co-infection in a returned traveler from an endemic region, in whom the epidemiology and clinical course are highly suggestive of dengue triggering a P. vivax relapse. The literature on the co-occurrence of dengue and malaria in travelers is reviewed, as is the state of knowledge surrounding dengue as a precipitant to relapsing malaria. Full article

In Mexico, Plasmodium vivax transmission has been confined to the northwestern and southern regions since 2000. Parasites from five malaria foci were analyzed using three genetic markers. The circumsporozoite gene was examined by PCR-RFLP and sequencing, and pvs25 mutations and variants of ribosomal 18S SSU rRNA S-type were also determined. Previous data from the southernmost Pacific in Chiapas were included in the analysis. Both the VK210 and VK247 types of pvcsp were detected, and VK210 had greater haplotype diversity (0.860) than VK247 parasites (0.198). Two pvs25 mutations (Q87K and I130T) yielded three haplotypes, and two ribosomal variants were detected. Gene and multilocus haplotype frequencies varied among malarious foci (p < 0.001). An AMOVA test, F_ST values, and Spearman’s correlation suggested a structured P. vivax population among the malaria foci. Each malaria focus across the northwestern and southern regions retained a portion of the past countrywide P. vivax population, which seems unique in Latin America. In the Lacandon region (LR), a linkage equilibrium between pvs25 haplotypes and the ribosomal variants within the VK247 or VK210 populations was observed. This region harbored the broadest reservoir of P. vivax haplotypes, and the high adaptation of parasites in the northwestern region represents a challenge for malaria elimination. These finding are relevant for monitoring and epidemiological surveillance. Full article

Background: Recurrent malaria refers to repeated episodes of the disease in the same individual. Plasmodium vivax is known for its ability to relapse due to dormant liver-stage hypnozoites and poses a particular risk to travelers returning from endemic areas. Prompt diagnosis and treatment are crucial to prevent recurrences. Case Presentation: We present the case of a 41-year-old man from Romania who developed Plasmodium vivax malaria after traveling through Southeast Asia without chemoprophylaxis. He presented with fever, chills, myalgia, headache, vomiting, and abdominal pain. Clinical findings included mild jaundice and slight neurological signs. Laboratory tests showed severe thrombocytopenia, elevated bilirubin, inflammatory markers, and borderline creatinine levels. Malaria was confirmed by a rapid diagnostic test and blood smear microscopy. The patient was treated with doxycycline and atovaquone–proguanil. He improved and was discharged, but experienced two relapses, both confirmed as Plasmodium vivax by RT-PCR. Despite receiving primaquine as radical cure after the first Plasmodium vivax malaria relapse, a second relapse occurred. Each episode was managed with blood-stage antimalarial therapy, leading to full clinical and biological recovery. Conclusions: Malaria rarely occurs in non-endemic areas; it should be considered in patients with compatible travel history and symptoms. Given the high relapse potential of Plasmodium vivax, accurate species identification is critical to guide appropriate long-term management. Full article

Neglected tropical diseases (NTDs) constitute a group of infectious diseases that severely affect the health of impoverished populations, and the health, economies, and health systems of affected countries. Leishmaniasis and human African trypanosomiasis (HAT) are particularly notable, and malaria, despite not being neglected, is part of the “big three” (HIV, tuberculosis, and malaria) with high incidence, increasing the probability of infection by NTDs. Therefore, efforts are ongoing in the search for new drugs targeting the enzyme N-myristoyltransferase (NMT), a potential drug target that has been explored. Thus, we provide a review here that highlights the epidemiological data for these diseases and the importance of discovering new drugs against these agents. Here, the importance of NMT and its inhibitors is clear, with this study highlighting thiochromene, pyrazole, thienopyridine, oxadiazole, benzothiophene, and quinoline scaffolds, identified by computational methods followed by biological assays to validate the findings; for example, this study shows the action of the aminoacylpyrrolidine derivative 13 against Leishmania donovani NMT (IC₅₀ of 1.6 nM) and the pyrazole analog 23 against Plasmodium vivax NMT (IC₅₀ of 9.48 nM), providing several insights that can be used in drug design in further work. Furthermore, the selectivity and improvement in activity are related to interactions with the residues Val⁸¹, Phe⁹⁰, Tyr²¹⁷, Tyr³²⁶, Tyr³⁴⁵, and Met⁴²⁰ for leishmaniasis (LmNMT); Tyr²¹¹, Leu⁴¹⁰, and Ser³¹⁹ for malaria (PvNMT); and Lys²⁵ and Lys³⁸⁹ for HAT (TbNMT). We hope our work provides valuable insights that research groups worldwide can use to search for innovative drugs to combat these diseases. Full article

Asymptomatic malaria infection is a major concern in the fight against malaria, as it can act as a significant reservoir for its silent spread or transmission. Therefore, surveillance to detect asymptomatic subjects, particularly in regions with high malaria endemicity, is essential. This study aimed to investigate the status of asymptomatic submicroscopic malaria infections in Gia Lai province, Vietnam, and to analyze molecular profiles of antimalarial drug resistance in the parasites from the asymptomatic carriers. A total of 2171 individuals were included from three districts of Gia Lai province, Vietnam, an area where malaria is endemic. Asymptomatic submicroscopic infection was confirmed by quantitative real-time PCR, and the infected Plasmodium species were confirmed by sequencing. Antimalarial drug-resistant genes, including pfk13, pfcrt, pvmdr-1, and pvcrt-o, were analyzed in the parasites from asymptomatic cases. The rate of asymptomatic submicroscopic malaria infection was 2.67%. P. falciparum and P. vivax mono-infections, as well as mixed infections of P. falciparum and P. vivax, were identified, with P. vivax being more prevalent, a significant observation given the challenge of P. vivax relapses and its contribution to sustained malaria transmission. Adults, including young, middle-aged, and older adults, were the predominant affected groups. Asymptomatic infections were more common in females than in males. Interestingly, high frequencies of mutations in genetic markers associated with antimalarial drug resistance, particularly pfk13 (C580Y, 100%), pfcrt (M74I/N75E/K76T, 100%), and pvmdr-1 (F1076L, 100%), were observed in asymptomatic individuals, which may increase the risk of spreading drug resistance. These findings emphasize the urgent necessity for improved surveillance and targeted intervention to prevent the silent spread of malaria, supporting the National Malarial Control and Elimination Program in formulating malaria elimination strategies for Vietnam. Full article

Introduction: Malaria is a tropical disease caused by the parasite Plasmodium sp., which is considered a significant public health challenge, particularly in Africa. Among the species related to human infection, P. falciparum and P. vivax are known for their high incidence and pathogenicity. Despite several approved drugs in the treatment, the increase in resistance mechanisms is becoming increasingly prevalent, which makes the discovery of effective and safer drugs challenging. Thus, it is necessary to explore new mechanisms of action for the discovery of innovative antimalarial agents. Among the explored targets, proteases, especially subtilisin, have shown great promise in the development of new therapeutic options. Method: A narrative review was conducted using the main databases to provide critical information about the subtilisin to design antimalarial drugs. Results: Critical data were found about the isoforms of subtilisins, highlighting SUB1 and SUB2. SBDD approaches were able to show that compounds designed to target the catalytic Asp³⁷², His⁴²⁸, and Ser⁶⁰⁶, and other such Leu⁴⁶⁹, Gly⁴⁶⁷, and Asn⁵²⁰ against SUB1, presented critical results. In addition, quinoline, benzopyran, and triterpene derivatives and peptide inhibitors show their importance, and these scaffolds can be explored in further work. Conclusions: Considering the relevance of this target, this review provided insights into medicinal chemistry, the discovery of antimalarial drugs that act by inhibiting subtilisin, and promoted a promising initiative to combat malaria. Full article

Malaria is a parasitic disease caused by Plasmodium protozoa, which is a serious public health issue in Madagascar, an island country located off the coast of Africa in the Indian Ocean. Despite significant efforts to prevent the spread of communicable diseases, the country’s epidemiological situation is worrying and has been deteriorating in recent years, mostly due to poverty and limited access to healthcare. The aim of the present study was to assess the prevalence rates of malaria in northern Madagascar, as exemplified by the Mampikony District, between 2023 and 2024, as well as to assess the effectiveness of the methods used for malaria diagnosis. Material and methods. The study was conducted on a sample of 782 local residents who reported to healthcare centres in Mampikony between 2023 and 2024. The methods used to establish the diagnosis of malaria included rapid diagnostic tests (mRDTs) and molecular assays (RT-PCRs). Results. The 2023 study conducted on a sample of 484 patients demonstrated malaria prevalence of 4.5% (by mRDTs) and 8.2% (by RT-PCR), while the 2024 study carried out on a sample of 298 patients demonstrated malaria prevalence of 8.4% (by mRDTs) and 12.4% (by RT-PCR). The analysis of demographic variables showed that malaria was more prevalent in women and in adults; however, the differences between individual study groups were not statistically significant. In this study, positive malaria cases were predominantly caused by P. falciparum, but we also found cases caused by P. vivax as well as mixed infections. Conclusions. The study results support the need to apply more sensitive diagnostic tools for malaria diagnosis, e.g., RT-PCR. Also, our findings indicate the necessity to reassess and update the strategies for the treatment of malaria in the region due to a growing asymptomatic malaria carriage. To control the spread of malaria in Madagascar, it is essential to apply a wide range of interventions. Full article

Identifying the diversity of wildlife hosts for malaria parasites in wildlife is crucial for understanding transmission dynamics in endemic regions where humans, vectors, and wildlife heavily overlap. We examined the presence of Plasmodium parasites in free-ranging ring-tailed coatis (Nasua nasua, n = 44) and nine-banded armadillos (Dasypus novemcinctus, n = 66) from an Indigenous community in the Peruvian Amazon. Nested PCR targeting the mitochondrial cytb gene detected Plasmodium spp. DNA in two coatis (4.7%). Sequencing revealed one lineage identical to Plasmodium vivax/P. simium and another to P. malariae/P. brasilianum. A subset of samples was reanalyzed using cox3-based PCR and sequencing in an independent laboratory, confirming P. malariae/P. brasilianum in one coati. No infections were observed in armadillos. These results indicate that coatis in the wild may host diverse Plasmodiidae parasites and that coatis may even carry Plasmodium spp., likely as incidental hosts. Expanding surveillance to additional non-primate mammals will help clarify their role in sylvatic malaria ecology and evaluate potential zoonotic risks. Full article

Given the overlap of epidemiological and clinical presentations of both rickettsioses and malaria infections, diagnostic testing where malaria is confirmed or excluded, without subsequent rickettsial testing, specifically in the case of Plasmodium vivax or P. ovale infection, may mask the possibility of relapse. A lack of clinical suspicion of co-infections, absence of knowledge on the geographic distribution of diseases, and lack of availability of point-of-care diagnostic testing for other tropical diseases can often lead to missed diagnosis or misdiagnosis of common tropical infections, including rickettsioses. We herein describe a case of confirmed intercurrent rickettsial and P. vivax infection, with the former potentially triggering a relapse of the latter in a febrile traveler returning to Canada from South America, and review the literature on tropical coinfections in returning travelers. Full article

In Brazil, Plasmodium infections in non-human primates (NHPs) have been associated with P. simium and P. brasilianum, which are morphologically and genetically similar to the human-infecting species P. vivax and P. malariae, respectively. Surveillance and monitoring of wild NHPs are crucial for understanding the distribution of these parasites and assessing the risk of zoonotic transmission. This study aimed to detect the presence of Plasmodium spp. genetic material in Platyrrhini primates from 47 municipalities in the states of Bahia and Minas Gerais. The animals were captured using Tomahawk-type live traps baited with fruit or immobilized with tranquilizer darts. Free-ranging individuals were chemically restrained via inhalation anesthesia using VetBag^® or intramuscular anesthesia injection. Blood samples were collected from the femoral vein. A total of 298 blood and tissue samples were collected from 10 primate species across five genera: Alouatta caraya (25), Alouatta guariba clamitans (1), Callicebus melanochir (1), Callithrix geoffroyi (28), Callithrix jacchus (4), Callithrix kuhlii (31), Callithrix penicillata (175), Callithrix spp. hybrids (15), Leontopithecus chrysomelas (16), Sapajus robustus (1), and Sapajus xanthosthernos (1). Molecular diagnosis was performed using a nested PCR targeting the 18S small subunit ribosomal RNA (18S SSU rRNA) gene, followed by sequencing. Of the 298 samples analyzed, only one (0.3%) from Bahia tested positive for Plasmodium brasilianum/P. malariae. This represents the first detection of this parasite in a free-living C. geoffroyi in Brazil. These findings highlight the importance of continued surveillance of Plasmodium infections in NHPs to identify regions at risk for zoonotic transmission. Full article

Plasmodium vivax malaria continues to pose a significant and enduring public health challenge across the Americas. Transmission-blocking vaccines (TBVs), which target gametocyte surface antigens such as Pvs47 and Pvs48/45, are being investigated as promising tools to interrupt transmission and advance toward disease elimination. To investigate the genetic diversity and phylogeographic structure of the pvs47 and pvs48/45 genes in P. vivax, we conducted molecular analyses on samples collected from seven malaria-endemic regions of Honduras using PCR-based sequencing, population genetics, and phylogenetic approaches. This study presents the first complete characterization of the pvs47 gene and expands the available data on pvs48/45 in P. vivax from Honduras. We observed a low level of genetic diversity with no evidence of geographic structuring within the country. At a global scale, Honduran sequences shared variants with other Latin American strains and exhibited region-specific amino acid signatures. These findings suggest that local selective pressures, possibly driven by mosquito vector compatibility, are shaping the evolution of these TBV candidate genes. Our results underscore the importance of regional surveillance to inform the development and deployment of effective transmission-blocking strategies. Full article

The risk of non-human primate (NHP) malaria transmission to humans is increasing, with Plasmodium knowlesi and Plasmodium cynomolgi emerging as significant zoonotic threats, particularly in Malaysia. While P. knowlesi is well-documented, P. cynomolgi infections in humans remain underreported, largely due to diagnostic challenges. Routine microscopy and standard molecular diagnostic tools often misdiagnose P. cynomolgi infections as P. vivax due to morphological similarities and genetic homology. We report a new case of a human P. cynomolgi infection misdiagnosed as Plasmodium vivax in a 32-year-old male with no prior malaria history or travel to endemic countries. The initial diagnoses made by the microscopy and qPCR conducted by the Kota Bharu Public Health Laboratory in Kelantan identified the infection as P. vivax. However, cross-examination by the Institute for Medical Research (IMR) revealed the presence of mixed-species infection, prompting further analysis. The real-time PCR and sequencing performed at MAPELAB, Spain, confirmed the co-infection of P. vivax and P. cynomolgi. This case highlights the diagnostic limitations in detecting P. cynomolgi, which shares high genetic similarity with P. vivax, leading to potential cross-reactivity and diagnostic inaccuracies. As P. cynomolgi emerges as the second zoonotic malaria species after P. knowlesi capable of infecting humans in Southeast Asia, improved diagnostic methods are urgently needed. Enhanced molecular diagnostics and comprehensive epidemiological studies are essential to elucidate transmission dynamics, assess public health implications, and inform effective malaria control strategies. Full article

Background/Objectives: Malaria, caused by infection with Plasmodium parasites, exacts a heavy toll worldwide. There are two licensed vaccines for malaria as well as two monoclonal antibodies that have shown promising efficacy in field trials. The vaccines and monoclonal antibodies target the major surface protein (circumsporozoite protein, CSP) of Plasmodium falciparum. Yet P. falciparum is only one of the four major species of Plasmodium that infect humans. Plasmodium vivax is the second leading cause of malaria, but the P. vivax vaccine and monoclonal development lags far behind that for P. falciparum owing to the lack of basic preclinical tools such as in vitro culture or mouse models that replicate the key biological features of P. vivax. Notably among these features is the ability to form dormant liver stages (hypnozoites) that reactivate and drive the majority of the P. vivax malaria burden. Plasmodium cynomolgi is a simian parasite which is genotypically very close and phenotypically similar to P. vivax; it can infect non-human primates commonly used in research and replicates many features of P. vivax, including relapsing hypnozoites. Methods: Recently, a strain of P. cynomolgi has been adapted to in vitro cultures allowing parasite transgenesis. Here, we created a transgenic P. cynomolgi parasite in which the endogenous P. cynomolgi CSP has been replaced with P. vivax CSP, with the goal of enabling the preclinical study of anti-P. vivax CSP interventions to protect against primary and relapse infections. Results: We show that the in vitro-generated transgenic Pcy[PvCSP] parasite expresses both serotypes of P. vivax CSP and retains full functionality in vivo, including the ability to transmit to laboratory-reared Anopheles mosquitoes and cause relapsing infections in rhesus macaques. To our knowledge, this is the first gene replacement in a relapsing Plasmodium species. Conclusions: This work can directly enable the in vivo development of anti-P. vivax CSP interventions and provide a blueprint for the study of relapsing malaria through reverse genetics. Full article