title: Genetic Evidence of Importation of Drug-Resistant Plasmodium falciparum to Guatemala from the Democratic Republic of the Congo.
abstract: Imported malaria threatens control and elimination efforts in countries that have low rates of transmission. In 2010, an outbreak of Plasmodium falciparum malaria was reported among United Nations peacekeeping soldiers from Guatemala who had recently returned from the Democratic Republic of the Congo (DRC). Epidemiologic evidence suggested that the soldiers were infected in the DRC, but local transmission could not be ruled out in all cases. We used population genetic analyses of neutral microsatellites to determine the outbreak source. Genetic relatedness was compared among parasites found in samples from the soldiers and parasite populations collected in the DRC and Guatemala; parasites identified in the soldiers were more closely related to those from the DRC. A phylogenetic clustering analysis confirms this identification with >99.9% confidence. Thus, results support the hypothesis that the soldiers likely imported malaria from the DRC. This study demonstrates the utility of molecular genotyping in outbreak investigations.
authors.forename: Jaymin C
authors.initials: JC
authors.lastname: Patel
authors.forename: Steve M
authors.initials: SM
authors.lastname: Taylor
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Juliao
authors.forename: Christian M
authors.initials: CM
authors.lastname: Parobek
authors.forename: Mark
authors.initials: M
authors.lastname: Janko
authors.forename: Luis Demetrio
authors.initials: LD
authors.lastname: Gonzalez
authors.forename: Lucia
authors.initials: L
authors.lastname: Ortiz
authors.forename: Norma
authors.initials: N
authors.lastname: Padilla
authors.forename: Antoinette K
authors.initials: AK
authors.lastname: Tshefu
authors.forename: Michael
authors.initials: M
authors.lastname: Emch
authors.forename: Venkatachalam
authors.initials: V
authors.lastname: Udhayakumar
authors.forename: Kim
authors.initials: K
authors.lastname: Lindblade
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use; D016054:DNA, Protozoan / Q000235:genetics*; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004196:Disease Outbreaks; D004351:Drug Resistance; D005828:Genetics, Population; D005838:Genotype; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission*; D018895:Microsatellite Repeats; D008889:Military Personnel; D010802:Phylogeny; D010963:Plasmodium falciparum / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D014195:Travel
chemical_list: D000962:Antimalarials; D016054:DNA, Protozoan
keywords: Anopheles mosquito; Democratic Republic of the Congo; Guatemala; Malaria; Plasmodium falciparum; antimalarial; chloroquine phosphate; drug-resistant; microsatellites; molecular genotyping; parasite; protozoan