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Relapse of Plasmodium vivax and Plasmodium ovale Malaria With and Without Primaquine Treatment in a Nonendemic Area

BACKGROUND: The effect of primaquine in preventing Plasmodium vivax relapses from dormant stages is well established. For Plasmodium ovale, the relapse characteristics and the use of primaquine is not as well studied. We set to evaluate the relapsing properties of these 2 species, in relation to pri...

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Autores principales: Wångdahl, Andreas, Sondén, Klara, Wyss, Katja, Stenström, Christine, Björklund, David, Zhang, Jessica, Hervius Askling, Helena, Carlander, Christina, Hellgren, Urban, Färnert, Anna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994585/
https://www.ncbi.nlm.nih.gov/pubmed/34216464
http://dx.doi.org/10.1093/cid/ciab610
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author Wångdahl, Andreas
Sondén, Klara
Wyss, Katja
Stenström, Christine
Björklund, David
Zhang, Jessica
Hervius Askling, Helena
Carlander, Christina
Hellgren, Urban
Färnert, Anna
author_facet Wångdahl, Andreas
Sondén, Klara
Wyss, Katja
Stenström, Christine
Björklund, David
Zhang, Jessica
Hervius Askling, Helena
Carlander, Christina
Hellgren, Urban
Färnert, Anna
author_sort Wångdahl, Andreas
collection PubMed
description BACKGROUND: The effect of primaquine in preventing Plasmodium vivax relapses from dormant stages is well established. For Plasmodium ovale, the relapse characteristics and the use of primaquine is not as well studied. We set to evaluate the relapsing properties of these 2 species, in relation to primaquine use among imported malaria cases in a nonendemic setting. METHODS: We performed a nationwide retrospective study of malaria diagnosed in Sweden 1995–2019, by reviewing medical records of 3254 cases. All episodes of P. vivax (n = 972) and P. ovale (n = 251) were selected for analysis. RESULTS: First time relapses were reported in 80/857 (9.3%) P. vivax and 9/220 (4.1%) P. ovale episodes, respectively (P < .01). Without primaquine, the risk for relapse was higher in P. vivax, 20/60 (33.3%), compared to 3/30 (10.0%) in P. ovale (hazard ratio [HR] 3.5, 95% confidence interval [CI] 1.0–12.0). In P. vivax, patients prescribed primaquine had a reduced risk of relapse compared to episodes without relapse preventing treatment, 7.1% vs 33.3% (HR 0.2, 95% CI .1–.3). In P. ovale, the effect of primaquine on the risk of relapse did not reach statistical significance, with relapses seen in 2.8% of the episodes compared to 10.0% in patients not receiving relapse preventing treatment (HR 0.3, 95% CI .1–1.1). CONCLUSIONS: The risk of relapse was considerably lower in P. ovale than in P. vivax infections indicating different relapsing features between the two species. Primaquine was effective in preventing P. vivax relapse. In P. ovale, relapse episodes were few, and the supportive evidence for primaquine remains limited.
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spelling pubmed-89945852022-04-11 Relapse of Plasmodium vivax and Plasmodium ovale Malaria With and Without Primaquine Treatment in a Nonendemic Area Wångdahl, Andreas Sondén, Klara Wyss, Katja Stenström, Christine Björklund, David Zhang, Jessica Hervius Askling, Helena Carlander, Christina Hellgren, Urban Färnert, Anna Clin Infect Dis Major Articles and Commentaries BACKGROUND: The effect of primaquine in preventing Plasmodium vivax relapses from dormant stages is well established. For Plasmodium ovale, the relapse characteristics and the use of primaquine is not as well studied. We set to evaluate the relapsing properties of these 2 species, in relation to primaquine use among imported malaria cases in a nonendemic setting. METHODS: We performed a nationwide retrospective study of malaria diagnosed in Sweden 1995–2019, by reviewing medical records of 3254 cases. All episodes of P. vivax (n = 972) and P. ovale (n = 251) were selected for analysis. RESULTS: First time relapses were reported in 80/857 (9.3%) P. vivax and 9/220 (4.1%) P. ovale episodes, respectively (P < .01). Without primaquine, the risk for relapse was higher in P. vivax, 20/60 (33.3%), compared to 3/30 (10.0%) in P. ovale (hazard ratio [HR] 3.5, 95% confidence interval [CI] 1.0–12.0). In P. vivax, patients prescribed primaquine had a reduced risk of relapse compared to episodes without relapse preventing treatment, 7.1% vs 33.3% (HR 0.2, 95% CI .1–.3). In P. ovale, the effect of primaquine on the risk of relapse did not reach statistical significance, with relapses seen in 2.8% of the episodes compared to 10.0% in patients not receiving relapse preventing treatment (HR 0.3, 95% CI .1–1.1). CONCLUSIONS: The risk of relapse was considerably lower in P. ovale than in P. vivax infections indicating different relapsing features between the two species. Primaquine was effective in preventing P. vivax relapse. In P. ovale, relapse episodes were few, and the supportive evidence for primaquine remains limited. Oxford University Press 2021-07-03 /pmc/articles/PMC8994585/ /pubmed/34216464 http://dx.doi.org/10.1093/cid/ciab610 Text en © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Articles and Commentaries
Wångdahl, Andreas
Sondén, Klara
Wyss, Katja
Stenström, Christine
Björklund, David
Zhang, Jessica
Hervius Askling, Helena
Carlander, Christina
Hellgren, Urban
Färnert, Anna
Relapse of Plasmodium vivax and Plasmodium ovale Malaria With and Without Primaquine Treatment in a Nonendemic Area
title Relapse of Plasmodium vivax and Plasmodium ovale Malaria With and Without Primaquine Treatment in a Nonendemic Area
title_full Relapse of Plasmodium vivax and Plasmodium ovale Malaria With and Without Primaquine Treatment in a Nonendemic Area
title_fullStr Relapse of Plasmodium vivax and Plasmodium ovale Malaria With and Without Primaquine Treatment in a Nonendemic Area
title_full_unstemmed Relapse of Plasmodium vivax and Plasmodium ovale Malaria With and Without Primaquine Treatment in a Nonendemic Area
title_short Relapse of Plasmodium vivax and Plasmodium ovale Malaria With and Without Primaquine Treatment in a Nonendemic Area
title_sort relapse of plasmodium vivax and plasmodium ovale malaria with and without primaquine treatment in a nonendemic area
topic Major Articles and Commentaries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994585/
https://www.ncbi.nlm.nih.gov/pubmed/34216464
http://dx.doi.org/10.1093/cid/ciab610
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