CHALLENGES IN DIAGNOSING ASYMPTOMATIC PLASMODIUM INFECTIONS: EXPLORING THE ROLE OF ASYMPTOMATIC CARRIERS AS A RESERVOIR IN MAINTAINING THE DISEASE CYCLE

Authors

  • Kathlen Renata de Freitas de Santana Centro Universitário Jorge Amado
  • Natalie Ribeiro Rangel Coutinho Centro Universitário Jorge Amado
  • Jonathan Luís Magalhães Fontes Centro Universitário Jorge Amado

Keywords:

Malária; Asymptomatic; Diagnostic; Immunology; Plasmodium.

Abstract

Asymptomatic malária (silent Plasmodium infection) still poses many diagnostic challenges. In view of this problem, this review article aims to explain how asymptomatic carriers of the infection serve as a reservoir of the disease helping to maintain its cycle, the action of the immune system and the existing diagnostic tests, as well as their limitations. An analysis was made of information obtained over the last 20 years, using PubMed and Scielo as search tools. After this analysis it was possible to understand how asymptomatic malaria occurs and contributes to the persistence of Plasmodium in endemic areas, one of the biggest challenges in eradicating the disease in Brazil and in other countries with autochthonous cases, as well as identifying the limitations of all the methods currently used for diagnosis and control of infected people.

References

ABBA, K. et al. Rapid diagnostic tests for diagnosing uncomplicated non‐falciparum or Plasmodium vivax malaria in endemic countries. The Cochrane Database of Systematic Reviews, v. 2014, n. 12, p. CD011431, 18 dez. 2014.

ADEMOLUE, T. W. et al. Patterns of inflammatory responses and parasite tolerance vary with malaria transmission intensity. Malaria Journal, v. 16, p. 145, 11 abr. 2017.

ANDRADE, B. B. et al. Anti-Anopheles darlingi saliva antibodies as marker of Plasmodium vivax infection and clinical immunity in the Brazilian Amazon. Malaria Journal, v. 8, p. 121, 5 jun. 2009.

BRASIL. Fundação Oswaldo Cruz. Malária, 2013. Disponível em: https://agencia.fiocruz.br/mal%C3%A1ria. Acesso em: 25 mai. 2024.

BRASIL. Ministério da Saúde. Boletim Epidemiológico, v. 55, n. 1, Brasília, DF, 2024.

BRASIL. Ministério da Saúde. Guia prático de tratamento da malária no Brasil. Brasília, DF: Ministério da Saúde, 2010.

BRASIL. Ministério da Saúde. Manual de diagnóstico laboratorial da malária. 2. ed. Brasília, DF: Ministério da Saúde, 2009.

BOUSEMA, J. T. et al. Plasmodium falciparum gametocyte carriage in symptomatic children in western Kenya. Malaria Journal, v. 3, p. 18, 17 jun. 2004.

CHEAVEAU, J. et al. Asymptomatic malaria in the clinical and public health context. Expert Review of Antiinfective Therapy, v. 17, n. 12, p. 997–1010, 2 dez. 2019.

CONSULTATIVE GROUP ON DIAGNOSES AND DIAGNOSTICS (maIERA). A research agenda for malaria eradication: diagnoses and diagnostics. PLOS Medicine, v. 8, n. 1, p. e1000396, 25 jan. 2011.

CUNNINGTON, A. J. et al. Prolonged neutrophil dysfunction following Plasmodium falciparum malaria is related to hemolysis and heme oxygenase-1 induction. Journal of Immunology, v. 189, n. 11, p. 5336–5346, 1 dez. 2012.

DOOLAN, D. L.; DOBAÑO, C.; BAIRD, J. K. Acquired immunity to malaria. Clinical Microbiology Reviews, v. 22, n. 1, p. 13–36, jan. 2009.

ERDMAN, L. K.; KAIN, K. C. Molecular diagnostic and surveillance tools for global malaria control. Travel Medicine and Infectious Disease, v. 6, n. 1, p. 82–99, 1 jan. 2008.

FAYE, B. et al. Accuracy of HRP2 RDT (Malaria Antigen P.f®) compared to microscopy and PCR for malaria diagnosis in Senegal. Pathogens and Global Health, v. 107, n. 5, p. 273–278, jul. 2013.

FITRI, L. E. et al. Malaria diagnostic update: from conventional to advanced method. Journal of Clinical Laboratory Analysis, v. 36, n. 4, p. e24314, 4 mar. 2022.

FOWKES, F. J. I. et al. The relationship between anti-merozoite antibodies and incidence of Plasmodium falciparum malaria: a systematic review and meta-analysis. PLoS Medicine, v. 7, n. 1, p. e1000218, 19 jan. 2010.

FRIMPONG, A. et al. Asymptomatic malaria infection is maintained by a balanced pro- and anti-inflammatory response. Frontiers in Microbiology, v. 11, p. 559255, 17 nov. 2020.

GILLET, P. et al. Assessment of the prozone effect in malaria rapid diagnostic tests. Malaria Journal, v. 8, p. 271, 30 nov. 2009.

GOWDA, D. C.; WU, X. Parasite recognition and signaling mechanisms in innate immune responses to malaria. Frontiers in Immunology, v. 9, p. 3006, 19 dez. 2018.

HAMAINZA, B. et al. Monitoring, characterization and control of chronic, symptomatic malaria infections in rural Zambia through monthly household visits by paid community health workers. Malaria Journal, v. 13, p. 128, 31 mar. 2014.

KURTOVIC, L. et al. Complement in malaria immunity and vaccines. immunological Reviews, v. 293, n. 1, p. 38–56, jan. 2020.

KURUP, S. P.; BUTLER, N. S.; HARTY, J. T. T cell-mediated immunity to malaria. Nature Reviews Immunology, v. 19, n. 7, p. 457–471, jul. 2019.

LAUVAU, G.; SOUDJA, S. M. Mechanisms of memory T cell activation and effective immunity. Advances in Experimental Medicine and Biology, v. 850, p. 73–80, 2015.

LIN, J. T.; SAUNDERS, D. L.; MESHNICK, S. R. The role of submicroscopic malaria in malaria transmission: what is the evidence? Trends in Parasitology, v. 30, n. 4, p. 183–190, abr. 2014.

MALTHA, J.; GILLET, P.; JACOBS, J. Malaria rapid diagnostic tests in endemic settings. Clinical Microbiology and Infection, v. 19, n. 5, p. 399–407, 1 maio 2013.

MATHISON, B. A.; PRITT, B. S. Update on malaria diagnostics and test utilization. Journal of Clinical Microbiology, v. 55, n. 7, p. 2009–2017, jul. 2017.

MENDONÇA, V. R.; BARRAL-NETTO, M. Immunoregulation in human malaria: the challenge of understanding asymptomatic infection. Memórias do Instituto Oswaldo Cruz, v. 110, p. 945–955, dez. 2015.

MENS, P. F. et al. Molecular diagnosis of malaria in the field: development of a novel 1-step nucleic acid lateral flow immunoassay for the detection of all 4 human Plasmodium spp. and its evaluation in Mbita, Kenya. Diagnostic microbiology and Infectious Disease, v. 61, n. 4, p. 421–427, 1 ago. 2008.

MURPHY, S. C. et al. Malaria diagnostics in clinical trials. The American Journal of Tropical Medicine and Hygiene, v. 89, n. 5, p. 824–839, 6 nov. 2013.

NGULUBE, P. Humoral immune responses to P. falciparum circumsporozoite protein (Pfcsp) induced by the RTS, S vaccine – current update. Infection and Drug Resistance, v. 16, p. 2147–2157, 12 abr. 2023.

NIJHUIS, R. H. T. et al. Multiplex real-time PCR for diagnosing malaria in a non-endemic setting: a prospective comparison to conventional methods. European Journal of Clinical Microbiology & Infectious Diseases, v. 37, n. 12, p. 2323–2329, 1 dez. 2018.

OCKER, R. et al. Malaria diagnosis by loop-mediated isothermal amplification (LAMP) in Thailand. Revista do Instituto de Medicina Tropical de São Paulo, v. 58, p. 27, 8 abr. 2016.

ORGANIZAÇÃO MUNDIAL DA SAÚDE (OMS). World malaria report. Genebra: OMS, 2023. OPOKU AFRIYIE, S. et al. Accuracy of diagnosis among clinical malaria patients: comparing microscopy, RDT and a highly sensitive quantitative PCR looking at the implications for submicroscopic infections. Malaria Journal, v. 22, p. 76, 4 mar. 2023.

OSMAN, M. M. M. et al. Informed decision-making before changing to RDT: a comparison of microscopy, rapid diagnostic test and molecular techniques for the diagnosis and identification of malaria parasites in Kassala, eastern Sudan. Tropical Medicine & International Health, v. 15, n. 12, p. 1442–1448, 2010.

OYEGOKE, O. O. et al. Malaria diagnostic methods with the elimination goal in view. Parasitology Research, v. 121, n. 7, p. 1867–1885, 2022.

PAUL, R. E. L. et al. Aggregation in malaria parasites places limits on mosquito infection rates. Infection, Genetics and Evolution, v. 7, n. 5, p. 577–586, 1 set. 2007.

RATHNAYAKE, D.; AITKEN, E. H.; ROGERSON, S. J. Beyond binding: the outcomes of antibody-dependent

complement activation in human malaria. Frontiers in Immunology, v. 12, p. 683404, 8 jun. 2021.

SATTABONGKOT, J. et al. Loop-mediated isothermal amplification assay for rapid diagnosis of malaria infections in an area of endemicity in Thailand. Journal of Clinical Microbiology, v. 52, n. 5, p. 1471–1477, maio 2014.

SCHNEIDER, P. et al. Submicroscopic Plasmodium falciparum gametocyte densities frequently result in mosquito infection. The American Journal of Tropical Medicine and Hygiene, v. 76, n. 3, p. 470–474, 2007.

SILVA-NUNES, M. et al. Amazonian malaria: asymptomatic human reservoirs, diagnostic challenges, environmentally-driven changes in mosquito vector populations, and the mandate for sustainable control strategies. Acta Tropica, v. 121, n. 3, p. 281–291, mar. 2012.

SEMA, M. et al. Evaluation of non-instrumented nucleic acid amplification by loop-mediated isothermal amplification (NINA-LAMP) for the diagnosis of malaria in Northwest Ethiopia. Malaria Journal, v. 14, p. 44, 28 jan. 2015.

TALAPKO, J. et al. Malaria: the past and the present. Microorganisms, v. 7, n. 6, p. 179, 21 jun. 2019.

TAMBO, M.; MWINGA, M.; MUMBENGEGWI, D. R. Loop-mediated isothermal amplification (LAMP) and polymerase chain reaction (PCR) as quality ssurance tools for rapid diagnostic test (RDT) malaria diagnosis in Northern Namibia. PLoS ONE, v. 13, n. 12, p. e0206848, 12 dez. 2018.

TANGPUKDEE, N. et al. Malaria diagnosis: a brief review. The Korean Journal of Parasitology, v. 47, n. 2, p. 93–102, jun. 2009.

Published

2025-11-24

How to Cite

de Freitas de Santana, K. R., Ribeiro Rangel Coutinho, N., & Magalhães Fontes, J. L. (2025). CHALLENGES IN DIAGNOSING ASYMPTOMATIC PLASMODIUM INFECTIONS: EXPLORING THE ROLE OF ASYMPTOMATIC CARRIERS AS A RESERVOIR IN MAINTAINING THE DISEASE CYCLE. Apoena, 9(1). Retrieved from https://publicacoes.unijorge.com.br/apoena/article/view/812