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. 2021 Feb;27(2):372-384.
doi: 10.3201/eid2702.202143.

Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013-2018

Valentin Joste, Justine Bailly, Véronique Hubert, Cécile Pauc, Mathieu Gendrot, Emilie Guillochon, Marylin Madamet, Marc Thellier, Eric Kendjo, Nicolas Argy, Bruno Pradines, Sandrine Houzé; French National Reference Center for Imported Malaria Study Group1

Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013-2018

Valentin Joste et al. Emerg Infect Dis. 2021 Feb.

Abstract

We retrospectively analyzed epidemiologic, clinical, and biologic characteristics of 368 Plasmodium ovale wallikeri and 309 P. ovale curtisi infections treated in France during January 2013–December 2018. P. ovale wallikeri infections displayed deeper thrombocytopenia and shorter latency periods. Despite similar clinical manifestations, P. ovale wallikeri–infected patients were more frequently treated with artemisinin-based combination therapy. Although the difference was not statistically significant, P. ovale wallikeri–infected patients were 5 times more frequently hospitalized in intensive care or intermediate care and had a higher proportion of severe thrombocytopenia than P. ovale curtisi–infected patients. Rapid diagnostic tests that detect aldolase were more efficient than those detecting Plasmodium lactate dehydrogenase. Sequence analysis of the potra gene from 90 P. ovale isolates reveals an insufficient polymorphism for relapse typing.

Keywords: France; Plasmodium ovale curtisi; Plasmodium ovale wallikeri; diagnosis; imported malaria; malaria; malaria-endemic countries; parasites.

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Figures

Figure 1
Figure 1
Flow-chart of the retrospective study analyzing characteristics of Plasmodium ovale wallikeri and P. ovale curtisi infections treated in France during January 2013–December 2018. All reported P. ovale infection cases were confirmed with microscopy and PCR analysis, and co-infections were excluded. A total of 59 P. ovale isolates initially misdiagnosed by the hospital correspondent were added. A total of 677 P. ovale infection cases were included in the study.
Figure 2
Figure 2
Number of Plasmodium ovale infection cases included in a study analyzing characteristics of P. ovale wallikeri and P. ovale curtisi infections treated in France during January 2013–December 2018, by month of inclusion (A) and year of inclusion (B).
Figure 3
Figure 3
Geographic repartition of the origin countries of imported Plasmodium ovale wallikeri and P. ovale curtisi infection cases into France, January 2013–December 2018. Pie charts showed the repartition of cases between both species in each country.
Figure 4
Figure 4
Comparison of parasite count according to RDT results in study analyzing characteristics of Plasmodium ovale wallikeri and P. ovale curtisi infections treated in France during January 2013–December 2018. Ald, aldolase RDTs; pLDH, plasmodium lactate dehydrogenase RDTs; Poc, P. ovale curtisi; Pow, P. ovale wallikeri; RDT, rapid diagnostic test.
Figure 5
Figure 5
Effects of the new ACT treatment recommendations for Plasmodium spp. infections from La Société de Pathologie Infectieuse de Langue Française, revised in June 2017. ACT, chloroquine- or artemisinin-based combination therapy.
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