HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Supplemental Figure and Table Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by KASEHAGEN, L. J. Articles by ZIMMERMAN, P. A. Search for Related Content PubMed PubMed Citation Articles by KASEHAGEN, L. J. Articles by ZIMMERMAN, P. A. Related Collections Epidemiology Malaria

CHANGING PATTERNS OF PLASMODIUM BLOOD-STAGE INFECTIONS IN THE WOSERA REGION OF PAPUA NEW GUINEA MONITORED BY LIGHT MICROSCOPY AND HIGH THROUGHPUT PCR DIAGNOSIS

In Papua New Guinea (PNG), complex patterns of malaria commonly include single and mixed infections of Plasmodium falciparum, P. vivax, P. malariae, and P. ovale. Here, we assess recent epidemiologic characteristics of Plasmodium blood-stage infections in the Wosera region through four cross-sectional surveys (August 2001 to June 2003). Whereas previous studies performed here have relied on blood smear/light microscopy (LM) for diagnosing Plasmodium species infections, we introduce a newly developed, post-polymerase chain reaction (PCR), semi-quantitative, ligase detection reaction-fluorescent microsphere assay (LDR-FMA). A direct comparison of the two methods for > 1,100 samples showed that diagnosis was concordant for > 80% of the analyses performed for P. falciparum (PF), P. vivax (PV), and P. malariae (PM). Greater sensitivity of the LDR-FMA accounted for 75% of the discordance between diagnoses. Based on LM, the prevalence of blood-stage PF, PV, and PM infections was found to be markedly reduced compared with an early 1990s survey. In addition, there were significant shifts in age distribution of infections, with PV becoming the most common parasite in children < 4 years of age. Consistent with previous studies, prevalence of all Plasmodium species infections increased significantly in samples analyzed by the PCR-based LDR-FMA. This increase was most pronounced for PM, PO, and mixed infections and in adolescent (10–19 years) and adult age groups, suggesting that LM may lead to under-reported prevalence of less common Plasmodium species, infection complexity, and a skewed distribution of infections towards younger age groups. This study shows that the application of LDR-FMA diagnosis in large epidemiologic studies or malaria control interventions is feasible and may contribute novel insights regarding the epidemiology of malaria.

Received October 18, 2005. Accepted for publication May 31, 2006.

Acknowledgments: The authors thank W. E. Collins, C. L. King, C. H. King, R. K. Mehlotra, and E. L. Goldman for critical evaluation of this manuscript and B. Genton for allowing reference to original data. This study could not have been conducted without the participation of the Wosera residents and PNGIMR demography, field, data management, and microscopy units.

Financial support: This work was supported by NIAID/NIH Grants AI063135, AI46919, and AI52312.

^* Address correspondence to Peter A. Zimmerman, Center for Global Health and Diseases, School of Medicine, Case Western Reserve University, Wolstein Research Building, 4th Floor, 2103 Cornell Road, Cleveland, OH 44106-7286. E-mail: paz{at}case.edu

Note: Supplemental Table 1 and supplemental Figure 1 appear online at www.ajtmh.org.

Authors’ addresses: L. J. Kasehagen, Oregon Department of Human Services, Office of Family Health, Portland, OR 97232. D. T. Mc-Namara, W. T. Kastens, J. W. Kazura, and P. A. Zimmerman, Center for Global Health and Diseases, School of Medicine, Case Western Reserve University, Wolstein Research Building, 4th Floor, 2103 Cornell Road, Cleveland, OH 44106-7286. I. Mueller, M. J. Bockarie, B. Kiniboro, L. Rare and K. Lorry, Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, EHP 441, Papua New Guinea. J. C. Reeder, Burnet Institute for Medical Research and Public Health, PO Box 2284, Melbourne, VIC2001, Australia.

Reprint requests: P. A. Zimmerman, Center for Global Health and Diseases, School of Medicine, Case Western Reserve University, Wolstein Research Building 4-125, 2103 Cornell Road, Cleveland, OH 44106-7286, Telephone: 216-368-0508; Fax: 216-368-4825; E-mail: paz{at}case.edu.

This article has been cited by other articles:

				J. Marfurt, I. Mueller, A. Sie, P. Maku, M. Goroti, J. C. Reeder, H.-P. Beck, and B. Genton Low Efficacy of Amodiaquine or Chloroquine Plus Sulfadoxine-Pyrimethamine against Plasmodium falciparum and P. vivax Malaria in Papua New Guinea Am J Trop Med Hyg, November 1, 2007; 77(5): 947 - 954. [Abstract] [Full Text] [PDF]

				P. MICHON, J. L. COLE-TOBIAN, E. DABOD, S. SCHOEPFLIN, J. IGU, M. SUSAPU, N. TARONGKA, P. A. ZIMMERMAN, J. C. REEDER, J. G. BEESON, et al. THE RISK OF MALARIAL INFECTIONS AND DISEASE IN PAPUA NEW GUINEAN CHILDREN Am J Trop Med Hyg, June 1, 2007; 76(6): 997 - 1008. [Abstract] [Full Text] [PDF]

				E. P. Carnevale, D. Kouri, J. T. DaRe, D. T. McNamara, I. Mueller, and P. A. Zimmerman A Multiplex Ligase Detection Reaction-Fluorescent Microsphere Assay for Simultaneous Detection of Single Nucleotide Polymorphisms Associated with Plasmodium falciparum Drug Resistance J. Clin. Microbiol., March 1, 2007; 45(3): 752 - 761. [Abstract] [Full Text] [PDF]