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Plasmodium vivax Infections in Duffy-Negative Individuals in the Democratic Republic of the Congo
Although Plasmodium vivax has been assumed to be absent from sub-Saharan Africa because of the protective mutation conferring the Duffy-negative phenotype, recent evidence has suggested that P. vivax cases are prevalent in these regions. We selected 292 dried blood spots from children who participated in the 2013–2014 Demographic and Health Survey of the Democratic Republic of the Congo (DRC), to assess for P. vivax infection. Four P. vivax infections were identified by polymerase chain reaction, each in a geographically different survey cluster. Using these as index cases, we tested the remaining 73 samples from the four clusters. With this approach, 10 confirmed cases, three probable cases, and one possible case of P. vivax were identified. Among the 14 P. vivax cases, nine were coinfected with Plasmodium falciparum. All 14 individuals were confirmed to be Duffy-negative by sequencing for the single point mutation in the GATA motif that represses the expression of the Duffy antigen. This finding is consistent with a growing body of literature that suggests that P. vivax can infect Duffy-negative individuals in Africa. Future molecular and sequencing work is needed to understand the relationship of these isolates with other P. vivax samples from Asia and South America and discover variants linked to P. vivax virulence and erythrocyte invasion.
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Author Notes
Financial support: This work was supported by the National Institutes of Health (grant numbers R21AI111108, R01TW010870, and R01AI107949) and National Science Foundation (BSC-1339949). Nicholas Ford Brazeau was supported by the Triangle Center for Evolutionary Medicine (TriCEM), which is supported by Duke University, University of North Carolina-Chapel Hill, North Carolina Central University, and North Carolina State Universities.
Authors’ addresses: Nicholas F. Brazeau, Amy Whitesell, Stephanie M. Doctor, and Steven R. Meshnick, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, E-mails: nbrazeau@med.unc.edu, awhitese@live.unc.edu, stephanie.doctor@gmail.com, and meshnick@email.unc.edu. Corinna Keeler, Department of Geography, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, E-mail: cykeeler@live.unc.edu. Melchior K. Mwandagalirwa and Antoinette K. Tshefu, University of Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo, E-mails: mkashamuka@yahoo.com and antotshe@yahoo.com. Joris L. Likwela, Programme National de la Lutte Contre le Paludisme, Kinshasa, Democratic Republic of Congo, E-mail: jorislikwela@gmail.com. Jonathan J. Juliano, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, E-mail: jonathan_juliano@med.unc.edu.