A Plasmodium vivax Case Identified Solely via the Use of Next-Generation Sequencing.
Christen Rune Stensvold, Henrik Vedel Nielsen, John Kerr White et al.
✦ AI-curated · Sources linked
Case in brief
A Swedish woman developed tertian fever five months after travel to Indonesia. Loop-mediated isothermal amplification repeatedly detected Plasmodium infection, but microscopy and several species-specific qPCR assays did not identify the species. Conventional PCR and Sanger sequencing confirmed Plasmodium DNA without reliable species identification. Amplicon-based next-generation sequencing of the small-subunit rRNA gene yielded more than 5,000 P. vivax reads; sequence polymorphisms in primer/probe binding regions explained the qPCR failures. After species identification and confirmation of normal G6PD activity, she received primaquine for hypnozoite eradication.
What made this case unusual
The infecting species remained unidentified by microscopy, multiple species-specific qPCR assays, and Sanger sequencing; amplicon-based next-generation sequencing provided the species identification.
Diagnostic / clinical pearl
When Plasmodium infection is detected but routine methods cannot determine the species, sequence variation at assay primer/probe binding sites may explain qPCR failure; next-generation sequencing can resolve the diagnosis.
Why it matters
Species identification matters in P. vivax malaria because relapse prevention requires radical cure.