Ryleigh Repass

NGT F13
10/8/13
Plasmodium Vivax Malaria
Malaria is a disease spread by mosquitoes that infects humans and some animals. Malaria is a
parasitic protozoan of the genus Plasmodium. There are five species of Plasmodium that can infect
humans: P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi. Of these, P. falciparum and P.
vivax are the most commonly studied. While P. falciparum is most prominent in the African region, P.
vivax is extremely rare. Vivax malaria is rare in Africa due to the common lack of Duffy glycoprotein
expression on the surface of red blood cells, which prevents invasion of P vivax merozoites (Mueller et
al. 2009). However, P. vivax is the most common form of malarial infection in south Asia, Southeast
Asia, and the Americas. In fact, 26 of the 34 malaria eliminating countries have a malaria burden solely
or mainly due to P. vivax (Cotter et al. 2013).
Between the years of 2000 and 2010 gross domestic product per head increased by 3-5% most
likely due to lowered rates of malaria. During this time period, there was in an increase in funding,
effective vector control, strengthening of health systems, improved case management with more
effective treatment regimes, and improved case reporting and surveillance (Cotter et al. 2013). However,
as overall malaria rates went down, proportions of all cases caused by P. vivax rose. This information
highlights the fact that P. vivax is not necessarily eradicated with the current regimes.
Vivax malaria is different from P. falciparum in that it has a dormant liver stage that can relapse
even after treatment. In a study, vivax malaria was shown to relapse in 20-80% of treated patients even
in low transmission areas (Price et al. 2007). The lack of ability for medicine to eliminate malaria from
the system makes P. vivax next to impossible to eradicate from a community. Furthermore, early
gametocyte development in the infection of the host causes the infected individuals blood to be a
reservoir that can successfully transmit infection to a mosquito (Mueller et al. 2009). Due to this
reservoir as well as inability to eradicate latent cells, P. vivax is continues to be a serious problem.
Recent studies of hospital admissions in endemic areas have found that P. vivax is not a benign
form of malaria and causes similar symptoms as P. falciparum (Mueller et al. 2009). These symptoms
might include cerebral maloria, hepatic dysfunction with severe jaundice, acute lung injury, acute
respiratory distress syndrome, pulmonary oedema, shock, renal failure, splenic rupture, sever
thrombocytopena hemorrhage, and severe anemia (Meuller et al. 2009). It is extremely important to
note the lack of ability to distinguish between P. falciparum and P. vivax when diagnosing a patient. If a
patient is misdiagnosed as having P. falciparum malaria, the reservoirs of P. vivax could proliferate and
cause a relapse after medication. Also, this inability to distinguish between the two skews the statistical
analysis of malaria. If less rates of P. vivax are reported than actually exist, there is a lesser chance that

P. vivax will ever gain importance in the scientific world. Therefore, P. vivax has a high chance of not
being acknowledged as a very serious threat and furthermore, will continue to be understudied.
However, P. vivax has been gaining popularity as more research connecting P. vivax to other
health problems comes to light. Specifically, a study on the relationship between P. vivax and
malnutrition in young children supported the possibility that P. vivax may produce considerable global
mortality (Williams et al. 1997). The research was on 1511 children younger than ten in Espiritu Santo,
Vanuata. There were three categories of malnutrition: underweight, wasting, and stunting. The results
showed that the incidents of P. vivax malaria was significantly higher in underweight and wasted
children than in non-underweight and non-wasted children (Williams et al. 1997).
The first step in eradicating P. vivax is funding research into better understanding the biology of
the parasitic disease. Of incredible importance is the need to understand the biological determinant that
dictates the active or dormant development pathways (Mueller et al. 2009). In figuring this out, scientists
could take the next step to block the dormant development in order to erase the possibility of dormancy
in the liver. With that said, medication used to eliminate the dormant cells is understudied. Currently
recommended medications to cure malaria are chloroquine and primaquine. Primaquine is the sole
option for controlling the dormant liver stages of P. vivax. However, little to nothing is known about
how primaquine works (Mueller et al. 2009).
References:
Cotter, Chris, Hugh JW Sturrock, Michelle S. Hsiang, Jenny Liu, Allison A. Phillips, Jimee Hwang,
Cara S. Gueye, Nancy Fullman, Raly D. Gosling, and Richard G. Feachem. "The Changing
Epidemiology of Malaria Elimination: New Strategies for New Challenges." Lacet 11th ser.
382.900 (2013): n. pag.
Mueller, Ivo, Mary R. Galinski, J. Kevin Baird, Jane M. Carlton, Dhanpat K. Kochar, Pedro L. Alonso,
and Hernando A. Del Portillo. "Key Gaps in the Knowledge of Plasmodium Vivax, a
Neglected Human Malaria Parasite." The Lancet Infectious Diseases 9.9 (2009): 555-66.
Price, Ric N., Emilana Tjitra, Carlos A. Guerra, Shunmay Yeung, Nicholas J. White, and Nicholas M.
Anstey. "Vivax Malaria: Neglected and Not Benign." Am J Trop Med Hyg. 77.6 (2007): 79-87.
Williams, T. N., K. Maitland, L. Phelps, S. Bennett, T. E. Peto, J. Viji, R. Timothy, J. B. Clegg, D. J.
Weatherall, and D. K. Bowden. "Plasmodium Vivax: A Cause of Malnutrition in Young
Children." Q J Med 90 (1997): 751-57.