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Biological concepts in recurrent Plasmodium vivax malaria

Published online by Cambridge University Press:  22 March 2018

Miles B. Markus Open the ORCID record for Miles B. Markus [Opens in a new window]
Miles B. Markus*
Affiliation:
School of Animal, Plant, and Environmental Sciences, Faculty of Science, University of the Witwatersrand, Private Bag 3, Wits, Johannesburg, 2050South Africa Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg, 2193South Africa
*
Author for correspondence: Miles B. Markus, E-mail: [email protected]
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Abstract

A curious aspect of the evolution of the hypnozoite theory of malarial relapse is its transmogrification from theory into ‘fact’, this being of historical, linguistic, scientific and sociological interest. As far as it goes, the hypnozoite explanation for relapse is almost certainly correct. I contend, however, that many of the genotypically homologous, non-reinfection, relapse-like Plasmodium vivax recurrences that researchers ascribe to hypnozoite activation are probably hypnozoite-independent. Indeed, some malariologists are starting to recognize that homologous P. vivax recurrences have most likely been overattributed to activation of hypnozoites. Hitherto identified, non-hypnozoite, possible plasmodial sources of recurrence that must be considered, besides circulating erythrocytic stages, include parasites in splenic dendritic cells, other cells in the spleen (in addition to infected erythrocytes there), bone marrow (importantly) and the skin. I argue that we need to take into account the possibility of a dual or multiple extra-vascular origin of P. vivax non-reinfection recurrences, not arbitrarily discount it. The existence of a P. vivax reservoir(s) is a topical subject and one of practical importance for malaria eradication. Pertinent drug-associated matters are also discussed, as is the dormancy-related significance of clues provided by blood-stage-induced malarial infection.

Keywords

Bone marrowhypnozoitemalariaPlasmodium cynomolgiPlasmodium vivaxprimaquinerecrudescencerecurrencerelapsespleen
Type
Special Issue Review
Information
Parasitology , Volume 145 , Special Issue 13: 2017 Autumn Symposium of the British Society for Parasitology The multi-disciplinarity of parasitology: Host-parasite evolution in an ever changing world , November 2018 , pp. 1765 - 1771
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Copyright © Cambridge University Press 2018 

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