title: Differential prevalence of Plasmodium infections and cryptic Plasmodium knowlesi malaria in humans in Thailand.
abstract: BACKGROUND
  A case of human infection with Plasmodium knowlesi has been recently discovered in Thailand. To investigate the prevalence of this malaria species, a molecular-based survey was performed.
  
  
  METHODS
  Blood samples from 1874 patients were tested for Plasmodium species by microscopy and nested polymerase chain reaction. P. knowlesi was characterized by sequencing the merozoite surface protein 1 gene (msp-1).
  
  
  RESULTS
  Of all Plasmodium species identified, P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi contributed 43.52%, 68.08%, 1.37%, 1.03%, and 0.57%, respectively. Mixed-species infections were more common in northwestern and southwestern regions bordering Myanmar (23%-24%) than in eastern and southern areas (3%-5%). In northwestern and southwestern regions, mixed-species infections had a significantly higher prevalence in dry than in rainy seasons (P < .001). P. knowlesi was found in 10 patients, mostly from southern and southwestern areas-9 were coinfected with either P. falciparum or P. vivax. Most of the P. knowlesi Thai isolates were more closely related to isolates from macaques than to isolates from Sarawak patients. The msp-1 sequences of isolates from the same area of endemicity differed and possessed novel sequences, indicating genetic polymorphism in P. knowlesi infecting humans.
  
  
  CONCLUSIONS
  This survey highlights the widespread distribution of P. knowlesi in Thailand, albeit at low prevalence and mostly occurring as cryptic infections.
authors.affiliation: Molecular Biology of Malaria and Opportunistic Parasites Research Unit, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Chaturong
authors.initials: C
authors.lastname: Putaporntip
authors.forename: Thongchai
authors.initials: T
authors.lastname: Hongsrimuang
authors.forename: Sunee
authors.initials: S
authors.lastname: Seethamchai
authors.forename: Teerayot
authors.initials: T
authors.lastname: Kobasa
authors.forename: Kriengsak
authors.initials: K
authors.lastname: Limkittikul
authors.forename: Liwang
authors.initials: L
authors.lastname: Cui
authors.forename: Somchai
authors.initials: S
authors.lastname: Jongwutiwes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000595:Amino Acid Sequence; D000818:Animals; D002648:Child; D002675:Child, Preschool; D005260:Female; D005786:Gene Expression Regulation / Q000502:physiology; D014644:Genetic Variation; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology / Q000469:parasitology*; D008297:Male; D020066:Merozoite Surface Protein 1 / Q000737:chemistry / Q000235:genetics; D008875:Middle Aged; D008969:Molecular Sequence Data; D010802:Phylogeny; D016790:Plasmodium knowlesi / Q000235:genetics / Q000302:isolation & purification* / Q000378:metabolism; D015995:Prevalence; D012621:Seasons; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D020066:Merozoite Surface Protein 1