Under the Radar: Epidemiology of <i>Plasmodium ovale</i> in the Democratic Republic of the Congo

Mitchell, C. Madeline; Brazeau, Nicholas F.; Keeler, Corinna; Mwandagalirwa, Melchior Kashamuka; Tshefu, Antoinette; Juliano, Jonathan J.; Meshnick, Steven R.

doi:10.1093/infdis/jiaa478

Cited by 27 publications

(42 citation statements)

References 36 publications

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“…Six years later, in 2013, the demographic and health survey revealed P. ovale spp. in 24/26 provinces of DRC, with an increased prevalence in several provinces [ 51 ]. This reflects a spread of P. ovale spp.…”

Section: Discussionmentioning

confidence: 99%

“…that urgently needs to be addressed, as DRC is the second most affected country by malaria in the world [ 1 ]. Several studies have also reported an equal distribution of P. ovale subspecies in AFR [ 21 , 32 , 35 , 51 ]. High prevalence of asymptomatic malaria including P. malariae [ 9 , 34 , 42 , 52 – 54 ] and P. ovale spp.…”

Section: Discussionmentioning

confidence: 99%

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Global trend of Plasmodium malariae and Plasmodium ovale spp. malaria infections in the last two decades (2000–2020): a systematic review and meta-analysis

2021

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Background Recent studies indicate that the prevalence of non-falciparum malaria, including Plasmodium malariae and Plasmodium ovale spp., is increasing, with some complications in infected individuals. The aim of this review is to provide a better understanding of the malaria prevalence and disease burden due to P. malariae and P. ovale spp. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Joanna Briggs Institute prevalence study assessment tool were used to select and evaluate the studies, respectively. Six databases: PubMed, WHOLIS, Wiley Library, ScienceDirect, Web of Science and Google Scholar were used to screen articles published during the period January 2000–December 2020. The pooled prevalence estimates for P. malariae and P. ovale spp. were analysed using a random-effects model and the possible sources of heterogeneity were evaluated through subgroup analysis and meta-regression. Results Out of the 3297 studies screened, only 113 studies were included; among which 51.33% were from the African Region. The P. malariae and P. ovale spp. pooled prevalence were 2.01% (95% CI 1.31–2.85%) and 0.77% (95% CI 0.50–1.10%) respectively, with the highest prevalence in the African Region. P. malariae was equally distributed among adults (2.13%), children (2.90%) and pregnant women (2.77%) (p = 0.862), whereas P. ovale spp. was more prevalent in pregnant women (2.90%) than in children ≤ 15 years (0.97%) and in patients > 15 years old (0.39%) (p = 0.021). In this review, data analysis revealed that P. malariae and P. ovale spp. have decreased in the last 20 years, but not significantly, and these species were more commonly present with other Plasmodium species as co-infections. No difference in prevalence between symptomatic and asymptomatic patients was observed for either P. malariae or P. ovale spp. Conclusion Our analysis suggests that knowledge of the worldwide burden of P. malariae and P. ovale spp. is very important for malaria elimination programmes and a particular focus towards improved tools for monitoring transmission for these non-falciparum species should be stressed upon to deal with increased infections in the future. Graphic Abstract

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Global trend of Plasmodium malariae and Plasmodium ovale spp. malaria infections in the last two decades (2000–2020): a systematic review and meta-analysis

2021

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“…However, despite the limitations, we believe that this short report adds another piece to the puzzle of imported non-falciparum malaria. A recent study shows that P. ovale remains broadly prevalent in the DRC (prevalence estimate 0.8%; 95% confidence interval, 0.59–0.98%) [ 30 ]. We therefore want to raise clinicians’ awareness of the challenges posed by this neglected disease in both endemic and non-endemic settings.…”

Section: Discussionmentioning

confidence: 99%

A Cluster of Plasmodium ovale Infections in Belgian Military Personnel after Deployment in Kindu, Democratic Republic of Congo: A Retrospective Study

et al. 2021

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Plasmodium ovale malaria is often neglected due to its less severe course compared to Plasmodium falciparum. In 2011–2012, Belgian Armed Forces identified a cluster of P. ovale cases among military personnel after deployment in the Democratic Republic of Congo (DRC). In this retrospective, monocentric, observational study, clinical and biological features of soldiers diagnosed with P. ovale after deployment in DRC were reviewed. Species diagnosis was based on polymerase chain reaction (PCR) and/or thick blood smear. Medical records of 149 soldiers screened at the Queen Astrid Military Hospital after deployment were reviewed. Eight cases (seven P. ovale infections and one P. ovale—falciparum coinfection) were identified. All had positive thick smears, and seven were confirmed by PCR. Chemoprophylaxis was mefloquine in all subjects. Median time of disease onset was 101 days after return from the endemic region. Median delay between return and diagnosis was 103 days. All P. ovale bouts were uncomplicated. None had relapses after primaquine treatment. This military cohort highlights a hotspot of P. ovale in Eastern DRC. Non-specific symptoms, the less severe presentation, the lack of sensitive parasitological tools in the field and long delays between infection and symptoms probably lead to underestimation of P. ovale cases.

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“…Our findings are generally in-line with prior reports of non-falciparum infection among asymptomatic subjects in the DRC. [23–25]…”

Section: Discussionmentioning

confidence: 99%

Causes of false-negative rapid diagnostic tests for symptomatic malaria in the DRC

Parr¹,

Kieto

Phanzu

et al. 2020

Preprint

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Background The majority of Plasmodium falciparum malaria diagnoses in Africa are made using rapid diagnostic tests (RDTs) that detect histidine-rich protein 2. Increasing reports of false-negative RDT results due to parasites with deletions of the pfhrp2 and/or pfhrp3 genes (pfhrp2/3) raise concern about existing malaria diagnostic strategies. We previously identified pfhrp2-negative parasites among asymptomatic children in the Democratic Republic of the Congo (DRC), but their impact on diagnosis of symptomatic malaria is unknown. Methods We performed a cross-sectional study of false-negative RDTs in symptomatic subjects in 2017. Parasites were characterized by microscopy; RDT; pfhrp2/3 genotyping and species-specific PCR assays; a multiplex bead-based immunoassay; and/or whole-genome sequencing. Results Among 3,627 symptomatic subjects, we identified 427 (11.8%) RDT-/microscopy+ cases. Parasites from eight (0.2%) samples were initially classified as putative pfhrp2/3 deletions by PCR, but antigen testing and whole-genome sequencing confirmed the presence of intact genes. Malaria prevalence was high (57%) and non-falciparum co-infection common (15%). HRP2-based RDT performance was satisfactory and superior to microscopy. Conclusions Symptomatic malaria due to pfhrp2/3-deleted P. falciparum was not observed in the DRC. Ongoing HRP2-based RDT use is appropriate for the detection of falciparum malaria in the DRC.

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Under the Radar: Epidemiology of Plasmodium ovale in the Democratic Republic of the Congo

Cited by 27 publications

References 36 publications

Global trend of Plasmodium malariae and Plasmodium ovale spp. malaria infections in the last two decades (2000–2020): a systematic review and meta-analysis

Global trend of Plasmodium malariae and Plasmodium ovale spp. malaria infections in the last two decades (2000–2020): a systematic review and meta-analysis

A Cluster of Plasmodium ovale Infections in Belgian Military Personnel after Deployment in Kindu, Democratic Republic of Congo: A Retrospective Study

Causes of false-negative rapid diagnostic tests for symptomatic malaria in the DRC

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