title: Activation of minority-variant Plasmodium vivax hypnozoites following artesunate + amodiaquine treatment in a 23-year old man with relapsing malaria in Antananarivo, Madagascar.
abstract: In endemic areas, Plasmodium vivax relapses are difficult to distinguish from new infections. Genotyping of patients who experience relapse after returning to a malaria-free area can be used to explore the nature of hypnozoite activation and relapse. This paper describes a person who developed P. vivax malaria for the first time after travelling to Boriziny in the malaria endemic coastal area of Madagascar, then suffered two P. vivax relapses 11 weeks and 21 weeks later despite remaining in Antananarivo in the malaria-free central highlands area. He was treated with the combination artesunate + amodiaquine according to the national malaria policy in Madagascar. Genotyping by PCR-RFLP at pvmsp-3α as well as pvmsp1 heteroduplex tracking assay (HTA) showed the same dominant genotype at each relapse. Multiple recurring minority variants were also detected at each relapse, highlighting the propensity for multiple hypnozoite clones to activate simultaneously to cause relapse.
authors.forename: Voahangy
authors.initials: V
authors.lastname: Andrianaranjaka
authors.forename: Jessica T
authors.initials: JT
authors.lastname: Lin
authors.forename: Christopher
authors.initials: C
authors.lastname: Golden
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Juliano
authors.forename: Milijaona
authors.initials: M
authors.lastname: Randrianarivelojosia
mesh_terms: D000328:Adult; D000655:Amodiaquine / Q000008:administration & dosage / Q000009:adverse effects*; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects*; D037621:Artemisinins / Q000008:administration & dosage / Q000009:adverse effects*; D004338:Drug Combinations; D006801:Humans; D008270:Madagascar; D016780:Malaria, Vivax / Q000188:drug therapy* / Q000469:parasitology*; D008297:Male; D010966:Plasmodium vivax / Q000187:drug effects / Q000235:genetics*; D012008:Recurrence; D034101:Sporozoites / Q000187:drug effects; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine