A PCR-RFLP Technique to Assess the Geographic Origin of Plasmodium falciparum Strains in Central America

Abstract

The elimination of malaria requires strengthening diagnosis and offering adequate and timely treatment. Imported cases of falciparum malaria represent a major challenge for pre-elimination areas, such as Central America, where chloroquine and primaquine continue to be used as first-line treatment. The pfs47 gene has been previously described as a precise molecular marker to track the geographic origin of the parasite. The aim of this study was to design a simple and low-cost technique using the polymorphic region of pfs47 to assess the geographic origin of P. falciparum strains. A PCR-RFLP technique was developed and evaluated using the MseI enzyme that proved capable of discriminating, with reasonable precision, the geographical origin of the parasites. This method could be used by national surveillance laboratories and malaria elimination programs in countries such as Honduras and Nicaragua in cases of malaria where an origin outside the Central American isthmus is suspected.

Advocating for PCR-RFLP as molecular tool within malaria programs in low endemic areas and low resource settings

“…Insight in the genetic diversity of Plasmodium spp. has not only been extremely valuable in the identification of malaria drug resistance associated markers, but also enables the distinction between reinfection, recrudescence and relapse [2] and even facilitates tracking of the origin of an isolate [3], which is particularly important to signal possible source(s) of outbreaks. Furthermore, global and local mapping of P. vivax population structure [4] will provide detailed knowledge of the spatial distribution, transmission and clinical burden of P. vivax, which is required to set attainable control targets and strategize about roll-out of interventions.…”

“…Recent use of this tool has been successful in Plasmodium vivax (P. vivax) investigations, to provide insight in genetic diversity in Panama [11] and for reconstruction of a malaria outbreak in a low transmission area [12]. In addition, PCR-RFLP has been utilized to assess the geographic origin of Plasmodium falciparum strains (P. falciparum) in Central America [3].…”