title: Non-falciparum malaria in Dakar: a confirmed case of Plasmodium ovale wallikeri infection.
abstract: BACKGROUND
  Plasmodium ovale is rarely described in Senegal. A case of clinical malaria due to P. ovale wallikeri in West Central of Senegal is reported.
  
  
  METHODS
  A 34-year-old male baker in Dakar, with no significant previous medical history, was admitted to a health clinic with fever and vomiting. Fever had been lasting for 4 days with peaks every 48 h. As monospecific Plasmodium falciparum HRP-2 RDT was negative, he was treated with antibiotics. However, owing to persisting symptoms, he was referred to the emergency unit of the Youssou Mbargane Diop Hospital, Dakar, Senegal. Clinical examination found impaired general condition. All other physical examinations were normal. Laboratory tests showed anaemia (haemoglobin 11.4 g/dl), severe thrombocytopaenia (platelets 30 × 10(9)/mm(3)), leukopenia (3650/mm(3)), lymphocytopenia (650/mm(3)). Renal function was normal as indicated by creatininaemia and uraemia (11 mg/l and 0.25 g/l, respectively) and liver enzymes were slightly elevated (aspartate aminotransferase 77 UI/l and alanine aminotransferase 82 UI/l). Blood smear evaluations in Parasitology Laboratory of Aristide Le Dantec Hospital showed malaria parasites of the species P. ovale with a 0.08 % parasitaemia. Molecular confirmation was done by real time PCR targeting the 18S rRNA gene. The P. ovale infection was further analysed to species level targeting the potra gene and was identified as P. ovale wallikeri. According to the hospital's malaria treatment guidelines for severe malaria, treatment consisted of intravenous quinine at hour 0 (start of treatment) and 24 h after initial treatment, followed by artemether-lumefantrine 24 h later. A negative microscopy was noted on day 3 post-treatment and the patient reported no further symptoms.
  
  
  CONCLUSIONS
  Malaria due to non-falciparum species is probably underestimated in Senegal. RDTs specific to non-falciparum species and/or pan specific RDTs should be included as tools of diagnosis to fight against malaria in Senegal. In addition, a field-deployable molecular tool such as the loop-mediated isothermal amplification can be considered as an additional useful tool to detect low malaria parasite infections and for speciation. In addition, national malaria control policies should consider other non-falciparum species in treatment guidelines, including the provision of primaquine for the treatment of relapsing parasites.
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal. mamadoualpha.diallo@ucad.edu.sn.
authors: Mamadou A
authors: MA
authors: Diallo
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Aida S
authors: AS
authors: Badiane
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Khadim
authors: K
authors: Diongue
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Awa
authors: A
authors: Deme
authors: Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Naomi W
authors: NW
authors: Lucchi
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Marie
authors: M
authors: Gaye
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Tolla
authors: T
authors: Ndiaye
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Mouhamadou
authors: M
authors: Ndiaye
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Louise K
authors: LK
authors: Sene
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Abdoulaye
authors: A
authors: Diop
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Amy
authors: A
authors: Gaye
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Yaye D
authors: YD
authors: Ndiaye
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Diama
authors: D
authors: Samb
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Mamadou S
authors: MS
authors: Yade
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Omar
authors: O
authors: Ndir
authors: Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors: Venkatachalam
authors: V
authors: Udhayakumar
authors: Laboratoire de Parasitologie-Mycologie, Université Cheikh Anta Diop de Dakar, Avenue Cheikh Anta Diop, Fann, BP 5005, Dakar, Senegal.
authors: Daouda
authors: D
authors: Ndiaye
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use; D016054:DNA, Protozoan / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use; D005449:Fluorenes / Q000627:therapeutic use; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology* / Q000473:pathology; D008297:Male; D008853:Microscopy; D041122:Plasmodium ovale / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D011803:Quinine / Q000627:therapeutic use; D012337:RNA, Ribosomal, 18S / Q000235:genetics; D012675:Senegal; D017422:Sequence Analysis, DNA
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D016054:DNA, Protozoan; D004275:DNA, Ribosomal; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D012337:RNA, Ribosomal, 18S; D011803:Quinine
keywords: Dakar; Diagnostic; Fever; Malaria; Microscopy; Plasmodium ovale; Primaquine; RDT; Treatment