<i>Plasmodium falciparum</i>in Asymptomatic Immigrants from Sub-Saharan Africa, Spain

Monge‐Maíllo, Begoña; Norman, Francesca; Pérez‐Molina, José A.; Díaz‐Menéndez, Marta; Rubio, José Miguel; López‐Vélez, Rogelio

doi:10.3201/eid1801.111283

Cited by 26 publications

(10 citation statements)

References 10 publications

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“…The median time since arrival was 4.5 months, and three subjects (1.4%) had arrived more than 1 year before. 7 Late-onset clinical malaria in migrants is most probably secondary to decaying P. falciparum-specific immunity. A study conducted in Spain has shown that a significant proportion of immigrants who had left an endemic area for years still had a detectable amount of immunoglobulins G specific for the erythrocytic antigens of P. falciparum.…”

Section: Discussionmentioning

confidence: 99%

“…3 Nevertheless, emerging evidence from both epidemiological studies and case reports indicates that migrants are particularly at risk to present clinical P. falciparum malaria later after return from an endemic area. [4][5][6][7] Plasmodium falciparum malaria has also been anecdotally reported in subjects, with no recent history of travel after blood transfusion or organ transplant 8 and in subjects living near airports probably after a bite of an imported mosquito (airport or odyssean malaria). 9,10 We report three cases of P. falciparum malaria occurring years after arrival in Europe and review the literature for additional cases of delayed clinical P. falciparum infection in migrants from an endemic area.…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Delayed or Recurrent Plasmodium falciparum Malaria in Migrants: A Report of Three Cases with a Literature Review

Dauby

Ferreira

Konopnicki³

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Emerging evidence indicates that migrants from endemic regions are at risk of delayed presentation of malaria. We report three cases of malaria occurring years after arrival in Europe. All patients were originally from Sub-Saharan Africa. Two subjects had controlled human immunodeficiency virus infection and one was a pregnant woman. We performed a literature review of all published cases of delayed presentation of in migrants and identified 32 additional cases. All cases but one originate from sub-Saharan Africa. There was a median time of 36 months between the last visit to a malaria-endemic country and clinical malaria (range: 3 months to 10 years). Pregnancy was the most frequently reported risk factor (11/35 or 31.4%). Parasitemia was ≤ 0.1% in 38% of cases (11/29 reported), and no death was reported. The underlying possible mechanisms for this delayed presentation in migrants from an endemic area probably include the persistence of submicroscopic parasitemia combined with decaying -specific immunity. Suspicion of delayed malaria should remain high in migrants, mainly from sub-Saharan Africa, even without a recent travel history, especially in those presenting risk factors for impaired parasite clearance or distinct immune responses such as pregnancy and HIV infection. In these patients, new prevention and screening strategies should be studied and blood safety policies adapted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Case Report: Delayed or Recurrent Plasmodium falciparum Malaria in Migrants: A Report of Three Cases with a Literature Review

Dauby

Ferreira

Konopnicki³

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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“…In contrast, the maintenance of Ab responses against DBL-α and EBA-175, which have been shown to be important in protection from clinical and severe malaria, could represent evidence that immunity to the most severe manifestations of clinical malaria is largely maintained, as clinical data appear to show [14–20]. Data comparing IgG levels in immigrants with malaria against IgG levels in naïve adults with a primary infection represent further evidence of maintenance of immunity, as immigrants had higher IgG levels against all antigens and IEs.…”

Section: Discussionmentioning

confidence: 99%

High Antibody Responses against Plasmodium falciparum in Immigrants after Extended Periods of Interrupted Exposure to Malaria

et al. 2013

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BackgroundMalaria immunity is commonly believed to wane in the absence of Plasmodium falciparum exposure, based on limited epidemiological data and short-lived antibody responses in some longitudinal studies in endemic areas.MethodsA cross-sectional study was conducted among sub-Saharan African adults residing in Spain for 1 up to 38 years (immigrants) with clinical malaria (n=55) or without malaria (n=37), naïve adults (travelers) with a first clinical malaria episode (n=20) and life-long malaria exposed adults from Mozambique (semi-immune adults) without malaria (n=27) or with clinical malaria (n=50). Blood samples were collected and IgG levels against the erythrocytic antigens AMA-1 and MSP-142 (3D7 and FVO strains), EBA-175 and DBL-α were determined by Luminex. IgG levels against antigens on the surface of infected erythrocytes (IEs) were measured by flow cytometry.ResultsImmigrants without malaria had lower IgG levels than healthy semi-immune adults regardless of the antigen tested (P≤0.026), but no correlation was found between IgG levels and time since migration. Upon reinfection, immigrants with malaria had higher levels of IgG against all antigens than immigrants without malaria. However, the magnitude of the response compared to semi-immune adults with malaria depended on the antigen tested. Thus, immigrants had higher IgG levels against AMA-1 and MSP-142 (P≤0.015), similar levels against EBA-175 and DBL-α, and lower levels against IEs (P≤0.016). Immigrants had higher IgG levels against all antigens tested compared to travelers (P≤0.001), both with malaria.ConclusionsUpon cessation of malaria exposure, IgG responses to malaria-specific antigens were maintained to a large extent, although the conservation and the magnitude of the recall response depended on the nature of the antigen. Studies on immigrant populations can shed light on the factors that determine the duration of malaria specific antibody responses and its effect on protection, with important implications for future vaccine design and public health control measures.

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“…The established and still prevailing 'liver and blood' restriction concept [37] of the life cycle of human-infecting Plasmodium species does not seem to be entirely compatible with the phenomena of initial or recurrent onset of symptomatic P. falciparum malaria long after mosquitoes have bitten (e.g., [3,6,[38][39][40]). It sometimes develops more than a decade later.…”

Section: Box 3 Outstanding Questions and Research Directions (Also Smentioning

confidence: 99%

Do hypnozoites cause relapse in malaria?

Markus

2015

Trends in Parasitology

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Plasmodium falciparumin Asymptomatic Immigrants from Sub-Saharan Africa, Spain

Cited by 26 publications

References 10 publications

Case Report: Delayed or Recurrent Plasmodium falciparum Malaria in Migrants: A Report of Three Cases with a Literature Review

Case Report: Delayed or Recurrent Plasmodium falciparum Malaria in Migrants: A Report of Three Cases with a Literature Review

High Antibody Responses against Plasmodium falciparum in Immigrants after Extended Periods of Interrupted Exposure to Malaria

Do hypnozoites cause relapse in malaria?

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