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African Plasmodium vivax malaria improbably rare or benign
1Eijkman-Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Plasmodium vivax malaria transmission is occurring in Duffy-negative African populations, challenging previous assumptions of protection. This review explores the potential for P. vivax to cause disease in these individuals through novel infectious pathways.
Area of Science:
- Malariology
- Hematology
- Infectious Diseases
Background:
- Duffy negativity in sub-Saharan Africans was thought to confer protection against Plasmodium vivax malaria.
- Recent findings indicate P. vivax transmission in Duffy-negative African populations, with unknown scope and impact.
- P. vivax exhibits tropism for extravascular tissues like bone marrow and spleen outside Africa.
Purpose of the Study:
- To investigate the plausibility of P. vivax causing disease in Duffy-negative Africans.
- To explore potential unrecognized health consequences of P. vivax infection in this demographic.
- To re-evaluate the role of Duffy negativity in malaria protection.
Main Methods:
- Review of existing epidemiological data on P. vivax distribution.
- Analysis of recent studies on P. vivax tropism and pathogenesis.
- Examination of biological mechanisms for extravascular infection and disease.
Main Results:
- Evidence suggests P. vivax can infect Duffy-negative individuals.
- Extravascular tissue tropism can lead to persistent, low-parasitemia infections.
- These infections may manifest as acute or chronic diseases of unknown origin.
Conclusions:
- The protective role of Duffy negativity against P. vivax malaria in Africa may be incomplete.
- P. vivax could be an underdiagnosed cause of illness in Duffy-negative African populations.
- Further research is crucial to understand the distribution and clinical significance of P. vivax in Africa.
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