Use of qPCR and Genomic Sequencing to Diagnose Plasmodium ovale wallikeri Malaria in a Returned Soldier in the Setting of a Negative Rapid Diagnostic Assay

Robert Cohen Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland; Parasitology Section, Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland; Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Headquarters, Walter Reed Army Institute of Research, Silver Spring, Maryland

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Karla Feghali Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland; Parasitology Section, Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland; Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Headquarters, Walter Reed Army Institute of Research, Silver Spring, Maryland

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Saba Alemayehu Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland; Parasitology Section, Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland; Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Headquarters, Walter Reed Army Institute of Research, Silver Spring, Maryland

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Jack Komisar Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland; Parasitology Section, Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland; Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Headquarters, Walter Reed Army Institute of Research, Silver Spring, Maryland

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Jun Hang Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland; Parasitology Section, Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland; Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Headquarters, Walter Reed Army Institute of Research, Silver Spring, Maryland

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Peter J. Weina Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland; Parasitology Section, Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland; Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Headquarters, Walter Reed Army Institute of Research, Silver Spring, Maryland

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Patricia Coggeshall Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland; Parasitology Section, Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland; Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Headquarters, Walter Reed Army Institute of Research, Silver Spring, Maryland

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Edwin Kamau Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland; Parasitology Section, Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland; Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Headquarters, Walter Reed Army Institute of Research, Silver Spring, Maryland

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Michael Zapor Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland; Parasitology Section, Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland; Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland; Headquarters, Walter Reed Army Institute of Research, Silver Spring, Maryland

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Plasmodium ovale is one of several clinically relevant malaria species known to cause disease in humans. However, in contrast to Plasmodium falciparum and Plasmodium vivax, which are responsible for most cases of human malaria, P. ovale has a wide distribution but low prevalence in tropical regions. Here, we report the case of a soldier returning from Liberia with P. ovale wallikeri malaria. This case highlights the limitations of both microscopy and the malaria rapid diagnostic test for diagnosing infection with P. ovale and for distinguishing P. ovale wallikeri from P. ovale curtisi. To our knowledge, this is the first case report in which quantitative real-time polymerase chain reaction amplification using the Cytochrome B gene, coupled with genomic sequencing of the potra locus, was used for definitive diagnosis of P. ovale wallikeri malaria.

Author Notes

* Address correspondence to Michael Zapor, 8901 Wisconsin Avenue, Bethesda, MD 20889. E-mail: Michael.J.Zapor.mil@health.mil

Authors' addresses: Robert Cohen, Walter Reed National Military Medical Center - Infectious Disease Service, Bethesda, MD, E-mail: cohen.robbie@gmail.com. Karla Feghali, Saba Alemayehu, and Jack Komisar, Walter Reed Army Institute of Research - Malaria Vaccine Branch, Silver Spring, MD, E-mails: Karla.C.Feghali.ctr@us.army.mil, Saba.Alemayehu.ctr@us.army.mil, and Jack.Komisar@us.army.mil. Jun Hang, Walter Reed Army Institute of Research - Viral Diseases Branch, Silver Spring, MD, E-mail: Jun.Hang.ctr@us.army.mil. Peter J. Weina, Walter Reed Army Institute of Research - Headquarters, Silver Spring, MD, E-mail: peter.weina@us.army.mil. Patricia Coggeshall, Walter Reed National Military Medical Center - Parasitology Section, Department of Pathology, Bethesda, MD, E-mail: Patricia.A.Coggeshall.civ@health.mil. Edwin Kamau, Walter Reed Army Institute of Research - Malaria Vaccine Development, Silver Spring, MD, E-mail: edwin.kamau@us.army.mil. Michael Zapor, Infectious Disease Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, E-mail: Michael.J.Zapor.mil@health.mil.

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