title: Finding connections in the unexpected detection of Plasmodium vivax and Plasmodium falciparum DNA in asymptomatic blood donors: a fact in the Atlantic Forest.
abstract: A recent paper in Malaria Journal reported the observation of unexpected prevalence rates of healthy individuals carrying Plasmodium falciparum (5.14%) or Plasmodium vivax (2.26%) DNA among blood donors from the main transfusion centre in the metropolitan São Paulo, a non-endemic area for malaria. The article has been challenged by a group of authors who argued that the percentages reported were higher than those found in blood banks of the endemic Amazon Region and also that that paper had not considered the literature on the classical dynamics of malaria transmission in the Atlantic Forest, which involves Anopheles (Kerteszia) cruzii and bromeliad malaria, due to P. vivax and Plasmodium malariae parasites, but not P. falciparum. The present commentary paper responds to this challenge and brings evidence and literature data supporting that the observed prevalence ratios may indicate a proportion of individuals that are exposed to Plasmodium transmission in permissive environments; that blood carrying parasite DNA may not be necessarily infective if used in transfusion; and that in the literature, there are examples supporting the circulation of P. falciparum in the area.
authors.affiliation: Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo SP 01246-904, Brazil. masallum@usp.br.
authors.forename: Maria Anice Mureb
authors.initials: MA
authors.lastname: Sallum
authors.forename: Cláudio Tadeu
authors.initials: CT
authors.lastname: Daniel-Ribeiro
authors.forename: Gabriel Zorello
authors.initials: GZ
authors.lastname: Laporta
authors.forename: Maria de Fátima
authors.initials: Mde F
authors.lastname: Ferreira-da-Cruz
authors.forename: Luciana Morganti Ferreira
authors.initials: LM
authors.lastname: Maselli
authors.forename: Débora
authors.initials: D
authors.lastname: Levy
authors.forename: Sérgio Paulo
authors.initials: SP
authors.lastname: Bydlowski
mesh_terms: D058345:Asymptomatic Infections / Q000453:epidemiology*; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis*; D016780:Malaria, Vivax / Q000175:diagnosis*; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D010966:Plasmodium vivax / Q000302:isolation & purification*; D065227:Transfusion Reaction