The primers traditionally used to detect Plasmodium ovale infections are known for not binding all P. ovale parasites within the small-subunit rRNA gene when used alone. We describe a simple, cost-and time-efficient multiplex nested PCR and a nested PCR using a novel set of primers for the simultaneous detection of P. ovale curtisi and P. ovale wallikeri.
Genes of the small-subunit (SSU) rRNA are highly conserved regions that not only allow the discrimination of different Plasmodium species but can also be used for the phylogenetic characterization of a wide range of different malaria parasites (11). For the diagnosis of human malaria parasites, a nested PCR technique (NP-1993 protocol) that binds the SSU rRNA gene was originally developed in the early 1990s (12). This technique soon became one of the most widely used and standardized PCR techniques for the detection and differentiation of human malaria parasites. The lower limits of detection were reported to be between a single parasite in 10 l blood (0.000002% parasitemia) and six parasites in 1 l blood (9, 11). Several modifications of the NP-1993 protocol followed (2,8,9). It soon became obvious that the NP-1993 protocol had some limitations for the diagnosis of Plasmodium ovale (primers rOVA1/rOVA2). Some patient samples that were positive for P. ovale by microscopy gave negative results with the nested PCR, and finally an updated protocol was described in 2002 (11). The primers for the Nest2 analysis of P. ovale were changed to genus-specific primer rPLU2 combined with rOVA1.Until 2005, more than 14 different protocols had been published specifically for the diagnosis of P. ovale. On the basis of the availability of more specific diagnostic tools, P. ovale was divided into the classic and variant types. In 2005, the NP-2005 protocol using primers rOVA1v and rOVA2v to detect variant P. ovale parasites was presented (1).Subsequent studies showed that the differences between the classic and variant types of P. ovale are not limited to the SSU rRNA gene. The P. ovale reticulocyte binding protein 2 gene (porbp2) and tryptophan-rich antigen gene (potra) are other examples of genetic differences. The perfect linkage between the two dimorphic forms of P. ovale finally led to the introduction of P. ovale curtisi (the former classic type) and P. ovale wallikeri (the former variant type) (13). Recent studies documented the sympatric distribution of P. ovale curtisi and P. ovale wallikeri in Africa and Asia and that they are morphologically indistinguishable (5, 7, 13).The combination of NP-1993 primers rOVA1 and rOVA2 for the diagnosis of P. ovale curtisi and the NP-2005 primer rOVA1v and rOVA2v has previously been published but still requires two separate PCRs (5).The principal aim of this study was to simplify the methodology for differentiating P. ovale curtisi and wallikeri (and thereby the methodology of adequate P. ovale molecular diagnosis) by developing a single PCR. We designed (i) new primers binding within the SSU rRNA gene that are highly specific for b...