Molecular Investigation into a Malaria Outbreak in Cusco, Peru: Plasmodium falciparum BV1 Lineage is Linked to a Second Outbreak in Recent Times

Sheila Akinyi Okoth Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Atlanta, Georgia; Instituto Nacional de Salud del Peru, Lima, Peru; Laboratorio de Referencia de La Convención, Cusco, Peru

Search for other papers by Sheila Akinyi Okoth in
Current site
Google Scholar
PubMed
Close
,
Stella M. Chenet Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Atlanta, Georgia; Instituto Nacional de Salud del Peru, Lima, Peru; Laboratorio de Referencia de La Convención, Cusco, Peru

Search for other papers by Stella M. Chenet in
Current site
Google Scholar
PubMed
Close
,
Nancy Arrospide Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Atlanta, Georgia; Instituto Nacional de Salud del Peru, Lima, Peru; Laboratorio de Referencia de La Convención, Cusco, Peru

Search for other papers by Nancy Arrospide in
Current site
Google Scholar
PubMed
Close
,
Sonia Gutierrez Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Atlanta, Georgia; Instituto Nacional de Salud del Peru, Lima, Peru; Laboratorio de Referencia de La Convención, Cusco, Peru

Search for other papers by Sonia Gutierrez in
Current site
Google Scholar
PubMed
Close
,
Cesar Cabezas Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Atlanta, Georgia; Instituto Nacional de Salud del Peru, Lima, Peru; Laboratorio de Referencia de La Convención, Cusco, Peru

Search for other papers by Cesar Cabezas in
Current site
Google Scholar
PubMed
Close
,
Jose Antonio Matta Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Atlanta, Georgia; Instituto Nacional de Salud del Peru, Lima, Peru; Laboratorio de Referencia de La Convención, Cusco, Peru

Search for other papers by Jose Antonio Matta in
Current site
Google Scholar
PubMed
Close
, and
Venkatachalam Udhayakumar Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Atlanta, Georgia; Instituto Nacional de Salud del Peru, Lima, Peru; Laboratorio de Referencia de La Convención, Cusco, Peru

Search for other papers by Venkatachalam Udhayakumar in
Current site
Google Scholar
PubMed
Close
Restricted access

In November 2013, a Plasmodium falciparum malaria outbreak of 11 cases occurred in Cusco, southern Peru, where falciparum malaria had not been reported since 1946. Although initial microscopic diagnosis reported only Plasmodium vivax infection in each of the specimens, subsequent examination by the national reference laboratory confirmed P. falciparum infection in all samples. Molecular typing of four available isolates revealed identity as the B-variant (BV1) strain that was responsible for a malaria outbreak in Tumbes, northern Peru, between 2010 and 2012. The P. falciparum BV1 strain is multidrug resistant, can escape detection by PfHRP2-based rapid diagnostic tests, and has contributed to two malaria outbreaks in Peru. This investigation highlights the importance of accurate species diagnosis given the potential for P. falciparum to be reintroduced to regions where it may have been absent. Similar molecular epidemiological investigations can track the probable source(s) of outbreak parasite strains for malaria surveillance and control purposes.

Author Notes

* Address correspondence to Sheila Akinyi Okoth, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, MS D-67, Atlanta, GA 30329-4027. E-mail: jyo3@cdc.gov

Financial support: Sheila Akinyi Okoth was supported by the Atlanta Research and Education Foundation. Stella M. Chenet was supported by the American Society of Microbiology/CDC Postdoctoral Fellowship Program. We acknowledge the support of the CDC Antimicrobial Resistance Working Group and the Atlanta Research and Education Foundation for the investigation.

Authors' addresses: Sheila Akinyi Okoth and Stella M. Chenet, Division of Parasitic Diseases and Malaria, CDC, Atlanta, GA, E-mails: jyo3@cdc.gov and ynw0@cdc.gov. Nancy Arrospide, Sonia Gutierrez, and Cesar Cabezas, Instituto Nacional de Salud del Peru, Centro Nacional de Salud Publica, Lima, Peru, E-mails: narrospide@hotmail.com, scgg68@hotmail.com, and salljaruna@yahoo.com. Jose Antonio Matta, Laboratorio de Referencia de La Convención, Cusco, Peru, E-mail: antonio_matta@hotmail.com. Venkatachalam Udhayakumar, Division of Parasitic Diseases and Malaria, Atlanta, GA, E-mail: vxu0@cdc.gov.

  • 1.

    World Health Organization, 2014. World Malaria Report, 2014—Peru. Geneva, Switzerland: World Health Organization.

  • 2.

    Ministerio de Salud del Peru, Direccion General de Epidemiologia, 2013. Casos confirmados de malaria por Plasmodium falciparum en el distrito de Echarate, provincia de la Convencion y departamento del Cusco, ano 2013. Available at: http://www.dge.gob.pe/portal/docs/vigilancia/boletines/2013/52.pdf.

    • Search Google Scholar
    • Export Citation
  • 3.

    Baldeviano GC, Okoth SA, Arrospide N, Gonzalez RV, Sanchez JF, Macedo S, Conde S, Tapia LL, Salas C, Gamboa D, Herrera Y, Edgel KA, Udhayakumar V, Lescano AG, 2015. Molecular investigation of Plasmodium falciparum re-emergence in the Peruvian North Coast maps the parasite source population to an Amazon village. Emerg Infect Dis 21: 797803.

    • Search Google Scholar
    • Export Citation
  • 4.

    Griffing SM, Viana GM, Mixson-Hayden T, Sridaran S, Alam MT, de Oliveira AM, Barnwell JW, Escalante AA, Povoa MM, Udhayakumar V, 2013. Historical shifts in Brazilian P. falciparum population structure and drug resistance alleles. PLoS One 8: e58984.

    • Search Google Scholar
    • Export Citation
  • 5.

    Griffing SM, Mixson-Hayden T, Sridaran S, Alam MT, McCollum AM, Cabezas C, Marquino Quezada W, Barnwell JW, De Oliveira AM, Lucas C, Arrospide N, Escalante AA, Bacon DJ, Udhayakumar V, 2011. South American Plasmodium falciparum after the malaria eradication era: clonal population expansion and survival of the fittest hybrids. PLoS One 6: e23486.

    • Search Google Scholar
    • Export Citation
  • 6.

    Akinyi S, Hayden T, Gamboa D, Torres K, Bendezu J, Abdallah JF, Griffing SM, Quezada WM, Arrospide N, De Oliveira AM, Lucas C, Magill AJ, Bacon DJ, Barnwell JW, Udhayakumar V, 2013. Multiple genetic origins of histidine-rich protein 2 gene deletion in Plasmodium falciparum parasites from Peru. Sci Rep 3: 2797.

    • Search Google Scholar
    • Export Citation
  • 7.

    Obaldia N 3rd, Baro NK, Calzada JE, Santamaria AM, Daniels R, Wong W, Chang HH, Hamilton EJ, Arevalo-Herrera M, Herrera S, Wirth DF, Hartl DL, Marti M, Volkman SK, 2015. Clonal outbreak of Plasmodium falciparum infection in eastern Panama. J Infect Dis 211: 10871096.

    • Search Google Scholar
    • Export Citation
  • 8.

    Daniels R, Chang HH, Sene PD, Park DC, Neafsey DE, Schaffner SF, Hamilton EJ, Lukens AK, Van Tyne D, Mboup S, Sabeti PC, Ndiaye D, Wirth DF, Hartl DL, Volkman SK, 2013. Genetic surveillance detects both clonal and epidemic transmission of malaria following enhanced intervention in Senegal. PLoS One 8: e60780.

    • Search Google Scholar
    • Export Citation
  • 9.

    Daniels RF, Schaffner SF, Wenger EA, Proctor JL, Chang HH, Wong W, Baro N, Ndiaye D, Fall FB, Ndiop M, Ba M, Milner DA Jr, Taylor TE, Neafsey DE, Volkman SK, Eckhoff PA, Hartl DL, Wirth DF, 2015. Modeling malaria genomics reveals transmission decline and rebound in Senegal. Proc Natl Acad Sci USA 112: 70677072.

    • Search Google Scholar
    • Export Citation
  • 10.

    Chenet SM, Schneider KA, Villegas L, Escalante AA, 2012. Local population structure of Plasmodium: impact on malaria control and elimination. Malar J 11: 412.

    • Search Google Scholar
    • Export Citation
  • 11.

    Murillo Solano C, Akinyi Okoth S, Abdallah J, Pava Z, Dorado E, Incardona S, Huber CS, Macedo de Oliveira A, Bell D, Udhayakumar V, Barnwell JW, 2015. Deletion of Plasmodium falciparum histidine-rich protein 2 (pfhrp2) and histidine-rich protein 3 (pfhrp3) genes in Colombian parasites. PLoS One 10: e0131576.

    • Search Google Scholar
    • Export Citation
  • 12.

    Rodriguez M, Perez L, Caicedo JC, Prieto G, Arroyo JA, Kaur H, Suarez-Mutis M, de La Hoz F, Lines J, Alexander N, 2009. Composition and biting activity of Anopheles (Diptera: Culicidae) in the Amazon region of Colombia. J Med Entomol 46: 307315.

    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 39 39 12
Full Text Views 412 105 0
PDF Downloads 146 29 0
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save