Why do Plasmodium malariae infections sometimes occur in spite of previous antimalarial medication?

Abstract

Quartan malaria due to Plasmodium malariae is commonly regarded as being preventable by current antimalarials. A case of P. malariae infection occurred in spite of previous treatment of Plasmodium falciparum malaria 4 months earlier with a full therapy course of intravenous quinine hydrochloride and oral doxycycline followed by artemether + lumefantrine. Since the patient was not anymore exposed to agents of malaria in the meantime, a new infection by P. malariae after therapy is unlikely. The present observation is difficult to explain by the current view on the origin of latent P. malariae infections and recurrences which are thought to arise from intra-erythrocytic development stages susceptible to common antimalarials. The most likely explanation of our observation is a delayed pre-erythrocytic development. The latency between infection by P. malariae and the quartan malaria fever attack might have been extended further by an initial subclinical circulation of a low number of intra-erythrocytic asexual parasites in the blood stream preceeding the clinical quartan malaria breakthrough.

Do hypnozoites cause relapse in malaria?

“…It sometimes develops more than a decade later. Extended incubation periods of P. malariae and persistence of this parasite in the body for many years (e.g., [41][42][43]) are likewise difficult to explain [6]. Both short-term and long-term P. falciparum and P. malariae recurrences are usually ascribed to the consequences of asexual division of parasites that have been in the bloodstream all along.…”

Recrudescence ofPlasmodium malariaeafter Quinine

“…A number of theories have been proposed to explain the mechanism of reinfection with P. malariae after initial antimalarial treatment [2, 3]. Firstly, it might not be a recrudescence but a case of reexposure resulting in reinfection.…”

“…These erythrocytic forms of Plasmodium malariae are known to be the most indolent of all the infective plasmodium species with infections observed decades after exposure. Recrudescence of P. malariae is common if the primary episode of infection goes untreated [1, 2]. However, only a handful of cases have reported recrudescence of Plasmodium malariae even after treatment with different antimalarials [2, 3].…”

“…Recrudescence of P. malariae is common if the primary episode of infection goes untreated [1, 2]. However, only a handful of cases have reported recrudescence of Plasmodium malariae even after treatment with different antimalarials [2, 3]. Till date no conclusive evidence is presented in the literature regarding emergence of resistance in Plasmodium malariae that can explain recrudescence in these cases [4–7].…”

Renal cortical necrosis and acute kidney injury associated with Plasmodium vivax: a neglected human malaria parasite

“…Malaria remains a serious health problem in many parts of the world (Franken et al 2012;Richter et al 2010;Jensen and Mehlhorn 2009). Plasmodium vivax is causing increasingly more cases of severe malaria worldwide (Saxena et al 2012;Tanwar et al 2011;Kochar et al 2010).…”