From: Plasmodium vivax: the potential obstacles it presents to malaria elimination and eradication
Potential obstacles that could pose challenges to P. vivax malaria eradication and elimination | Control and eradication impacts |
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Hypnozoite | P. vivax presents a challenge for malaria management and eradication because it can develop clinically quiet, undetected, dormant liver stages that subsequently reactivate (or relapse) to generate blood-stage infections. A portion of the parasites undergo sexual differentiation during blood stage replication, and when ingested by a blood-feeding anopheline mosquito, these gametocytes can start the insect's sporogony process. Therefore, contributed substantially to both clinical episodes and transmission [25, 32] |
The puzzle of primaquine therapy | Poor treatment compliance and delaying radical cure for lactating women until their nursing infants are at least 6Â months old and determined to be G6PD normal and the risk of hemolysis in G6PD-deficient individuals [73, 162] |
Host genetics | Genetic variation in CYP2D6, a human cytochrome P-450 isoenzyme 2D6 (CYP2D6) is crucial for the conversion of primaquine to its active metabolites and for the hypnozoite killing process in hepatocytes [124] |
The younger the reticulocytes, the better for P. vivax infection | The predilection of P. vivax for reticulocytes has implications for infection dynamics, parasite reservoirs, and potential parasite elimination strategies [184] |
P. vivax is emerging and has evolved into Duffy-negative | Shape the epidemiology of P. vivax malaria: previously, it was believed that P. vivax malaria was uncommon or nonexistent in African populations that did not exhibit the Duffy blood group antigen. Recent research has, however, documented a number of P. vivax infections in Duffy-negative individuals in several African regions, including those where Duffy negativity is predominated. There are also more and more instances of P. vivax infection among Duffy-negative people in South America, which may affect the epidemiology of P. vivax malaria [75, 79112] |
P. vivax submicroscopic | Low-density P. vivax infections are frequent, particularly in places that are close to elimination. Some malaria patients do not receive prompt treatment, causing the disease to spread [9] |
sexual blood stages | keeps showing up early in the course of the disease, often before overt symptoms develop &increases the possibility of further transmission [6] |
Temperature | Sporogony occurs at lower temperatures than for P. falciparum [145] |
P. vivax populations are more genetically diverse | Wide genetic variety across parasite populations makes them more likely to evade host immune responses, complicate the development of a malaria vaccine, and possibly even reveal previously undiscovered invasion routes [94] |