Conventional Malaria Diagnostics Vastly Undermine Plasmodium vivax Infections in Predominantly Duffy-Negative Africa
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Malaria remains a major public health concern in sub-Saharan Africa, and P. vivax is emerging in regions with predominantly Duffy-negative populations. This study investigated P. vivax prevalence and genetic diversity across three ecological zones in Cameroon. P. vivax was detected in ∼11% of febrile patients and 5.5% of asymptomatic individuals, all Duffy-negative. Clinical infections exhibited higher parasitemia than community cases. Standard PvLDH-based RDTs produced false-negative results, even at high parasitemia levels, whereas molecular tools like qPCR demonstrated superior sensitivity, particularly for low-density or mixed infections. Genetic analysis of PvDBP1 identified two prevalent mutations, I379L (73%) and E225K (61%), suggesting adaptive evolution. Phylogenetic analysis clustered Cameroonian isolates with those from Botswana, distinct from Ethiopian and Sudanese strains, indicating historical migration and local adaptation. The detection of asymptomatic P. vivax cases highlights the potential for silent transmission, reinforcing the need for enhanced surveillance in both community and clinical settings.
Article Summary Line
Emerging Plasmodium vivax infections detected in 10% of febrile malaria patients and 5% of asymptomatic individuals in Duffy-negative populations in Cameroon challenge conventional malaria resistance paradigms, highlighting the need for enhanced surveillance and revised control strategies in Africa.
