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Am. J. Trop. Med. Hyg., 81(6), 2009, pp. 950-960
doi:10.4269/ajtmh.2009.09-0132;
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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Plasmodium falciparum and Plasmodium vivax Infections in the Peruvian Amazon: Propagation of Complex, Multiple Allele-Type Infections without Super-Infection

Patrick L. Sutton, Victor Neyra, Jean N. Hernandez, AND OraLee H. Branch*
Department of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama; Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru; Universidad Nacional de la Amazonia Peruana–Laboratorio de Investigaciones Productos Naturales Anti-parasitarios, Iquitos, Peru; Department of Medical Parasitology, New York University School of Medicine, New York, New York

Outcrossing potential between Plasmodium parasites is defined by the population-level diversity (PLD) and complexity of infection (COI). There have been few studies of PLD and COI in low transmission regions. Since the 1995–1998 Peruvian Amazon epidemic, there has been sustained transmission with < 0.5 P. falciparum and < 1.6 P. vivax infections/person/year. Using weekly active case detection, we described PLD by heterozygosity (He) and COI using P. falciparum Pfmsp1-B2 and P. vivax Pvmsp3{alpha}. Not being homologous genes, we limited comparisons to within species. P. falciparum (N = 293) had low (He = 0.581) and P. vivax (N = 186) had high (He = 0.845) PLD. A total of 9.5% P. falciparum infections and 26.3% P. vivax infections had COI > 1. Certain allele types were in more mixed infections than expected by chance. The few appearances of new alleles could be explained by stochastic polymerase chain reaction detection or synchronization/sequestration. The results suggest propagation of mixed infections by multiple inocula, not super-infection, implying decade-long opportunity for outcrossing in these mixed infections.

Received March 13, 2009. Accepted for publication July 4, 2009.

Acknowledgments: The authors thank the Zungarococha community members and authorities for their ongoing commitment to the Malaria Immunology and Genetics in the Amazon (MIGIA) Study. The authors thank the Director of the Universidad Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Dr. Eduardo Gotuzzo, as well as Dr. Alejandro Llanos and Dr. Humberto Guerra, for their coordination and guidance. The authors thank the Universidad Nacional de la Amazonía Peruana, Laboratorio Naturales Antiparasitarios de la Amazonía, Dr. Lastenia Ruiz, and investigators for their coordination and technical assistance in completing a portion of the Pfmsp1-B2 genotyping. The authors thank Dr. Willy Diaz for patient care and follow-up, Freddy Alava for enrollment and follow-up, Ever Alvarez and Anibal Sanchez for microscopy, Zoila Reategui and Elva Sanchez for patient visits, Dania Vela and Noelia Escobar for preparation of materials, separation and storage of blood samples, and data entry, Dr. Julian Rayner for consultation and manuscript review, and Dr. Robert Oster for his review of the statistics reported in this manuscript.

Financial support: This study was supported by RO1 Grant AI064831 from the National Institute of Health/National Institute of Allergy and Infectious Disease (2005–present) and pilot funding from the Gorgas Memorial Institute (2003) and Sparkman International Center for Public Health (2003).

* Address correspondence to OraLee H. Branch, Department of Medical Parasitology, New York University, 341 E. 25th Street, OPH, New York, NY 10010. E-mail: OraLee.Branch{at}nyumc.org

Note: Supplementary Data Figure 1 can be found online at www.ajtmh.org.

Authors’ addresses: Patrick L. Sutton and OraLee H. Branch, Department of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL 35294. Victor Neyra, Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Peru. Jean N. Hernandez, Universidad Nacional de la Amazonia Peruana–Laboratorio de Investigaciones Productos Naturales Anti-parasitarios, Iquitos, Peru. OraLee H. Branch, Department of Medical Parasitology, New York University School of Medicine, New York, NY 10010.






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