title: Emergence of Plasmodium ovale malaria among the French Armed Forces in the Republic of Ivory Coast: 20 years of clinical and biological experience.
abstract: BACKGROUND
  French military surveillance identified an increase in Plasmodium ovale attacks among soldiers in Ivory Coast. This emergence and the low sensitivity of biological tests raise the question of a possible role of P. ovale variant species.
  
  
  METHODS
  Epidemiological data about P. ovale attacks from 1993 to 2012 were studied; the species diagnosis was based on a thin blood smear and/or a quick diagnostic test. Clinical and biological features in soldiers hospitalized in 2 French military hospitals were also reviewed. Malaria polymerase chain reaction followed by genotyping was performed when available.
  
  
  RESULTS
  French military physicians declared 328 P. ovale attacks over the 20-year study. A peak of incidence occurred in 2005. Among patients with positive blood smears, the quick diagnostic test was positive in 33 of 101 tests performed. The hospital study showed that symptoms and biological changes were not specific, which made diagnosis challenging: fever, anemia, and thrombocytopenia were not present in 20%, 71%, and 23% of the 45 confirmed cases, respectively. It was possible to perform molecular investigations on 19 clinical isolates: 18 were classic haplotypes with additional polymorphism and 1 was variant.
  
  
  CONCLUSIONS
  This emergence of P. ovale malaria enabled a good description to be made in nonimmune patients. The lack of sensitivity of both clinical features and quick diagnostic tests suggests an underestimation. Reasons for this outbreak are especially intense exposure to the vectors and the insufficient efficacy of doxycycline against P. ovale. The polymorphism of classic haplotypes of P. ovale rather than variant forms could be involved.
authors.affiliation: French Army Center for Epidemiology and Public Health.
authors.forename: F
authors.initials: F
authors.lastname: de Laval
authors.forename: F
authors.initials: F
authors.lastname: Simon
authors.forename: H
authors.initials: H
authors.lastname: Bogreau
authors.forename: C
authors.initials: C
authors.lastname: Rapp
authors.forename: N
authors.initials: N
authors.lastname: Wurtz
authors.forename: M
authors.initials: M
authors.lastname: Oliver
authors.forename: X
authors.initials: X
authors.lastname: Demaison
authors.forename: A
authors.initials: A
authors.lastname: Dia
authors.forename: J J
authors.initials: JJ
authors.lastname: De Pina
authors.forename: A
authors.initials: A
authors.lastname: Merens
authors.forename: R
authors.initials: R
authors.lastname: Migliani
mesh_terms: D000293:Adolescent; D000328:Adult; D007560:Cote d'Ivoire / Q000453:epidemiology; D016054:DNA, Protozoan / Q000235:genetics; D004196:Disease Outbreaks; D005602:France; D005838:Genotype; D060005:Genotyping Techniques; D006801:Humans; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D041122:Plasmodium ovale / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D055815:Young Adult
chemical_list: D016054:DNA, Protozoan
keywords: Plasmodium ovale; Republic of Ivory Coast; malaria; new variant; soldiers