Li Minxi, Bian Yang, Ruan Shishao, Wu Zifang, Zhang Di, Ma Tongyu, Wu Yaming, Liu Xiao, Wang Duo, Lin Jia, Pan Danni, Cui Wenyan, Wang Lin, Wei Haichao, Zhang Xuexing, Wang Qinghui, Zeng Weilin, Yang Zhaoqing, Cao Yaming, Cui Liwang, Parker Daniel M, Zhao Yan
Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China.
Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China.
Infect Dis Poverty. 2025 Aug 4;14(1):79. doi: 10.1186/s40249-025-01352-2.
Understanding Plasmodium sexual differentiation is crucial for blocking transmission. This study identified risk factors for gametocyte carriage and gametocytemia in P. vivax and P. falciparum to inform malaria elimination strategies at the China-Myanmar border.
Gametocytes and asexual parasites were microscopically detected on thick smears collected from 2011 to 2020 in Laiza Township, Kachin State, Myanmar. Mono-/polyclonality were detected by genotyping at Pvmsp3α/β for P. vivax, and Pfmsp1/2 for P. falciparum. Kulldorff's retrospective time scan statistics tested for likely clusters of gametocyte-positive cases over time. Chi-square or Fisher's exact tests compared proportions of gametocyte-positive cases in categorical variables. Generalized linear models assessed risk factors (year, season, demographics, clinical/parasitological features) for gametocyte carriage (logistic regression for a binomial outcome) and gametocytemia (Gaussian regression for continuous outcome), respectively.
During 2011-2020, 8240 patients had P. vivax infections, with 7249 testing positive for gametocytes. Among 510 P. falciparum cases, 56 tested positive for gametocytes. A significant cluster of P. vivax gametocyte carriage occurred from May 2015 to August 2017 (P = 0.001). For P. vivax, dry season, previous malaria history, fever, and parasite density were associated with gametocyte carriage. Gametocyte density increased with asexual parasite density (P < 0.001) but was lower during the rainy season and in those with a history of malaria infection (P < 0.001). Over time, gametocytes carriage proportion increased while density decreased (P < 0.001). For P. falciparum, younger age and previous malaria history were associated with gametocyte carriage, and density was higher in the dry season (P = 0.0115). Polyclonal P. vivax infections had higher gametocyte densities than monoclonal infections (P < 0.0001) and P. falciparum gametocyte density tended to increase with multiplicity of infection.
Younger age, prior malaria infection, travel, and polyclonal infections correlate with higher P. vivax gametocyte prevalence. Gametocyte carriage peakes during the dry season, highlighting the need for seasonal strategies to support malaria elimination. These findings enhance understanding of risk factors for the transmissible stage of the two main human Plasmodium species in the Greater Mekong Subregion border areas.
了解疟原虫的有性分化对于阻断传播至关重要。本研究确定了间日疟原虫和恶性疟原虫配子体携带及配子体血症的危险因素，为中缅边境的疟疾消除策略提供依据。
于2011年至2020年在缅甸克钦邦莱扎镇采集厚血膜，显微镜下检测配子体和无性寄生虫。通过对间日疟原虫的Pvmsp3α/β和恶性疟原虫的Pfmsp1/2进行基因分型来检测单克隆/多克隆性。Kulldorff回顾性时间扫描统计检验了随时间可能出现的配子体阳性病例聚集情况。卡方检验或Fisher精确检验比较了分类变量中配子体阳性病例的比例。广义线性模型分别评估了配子体携带（二项式结果的逻辑回归）和配子体血症（连续结果的高斯回归）的危险因素（年份、季节、人口统计学、临床/寄生虫学特征）。
2011 - 2020年期间，8240例患者感染间日疟原虫，其中7249例配子体检测呈阳性。在510例恶性疟原虫病例中，56例配子体检测呈阳性。2015年5月至2017年8月间日疟原虫配子体携带出现显著聚集（P = 0.001）。对于间日疟原虫，旱季、既往疟疾史、发热和寄生虫密度与配子体携带有关。配子体密度随无性寄生虫密度增加而增加（P < 0.001），但在雨季和有疟疾感染史的患者中较低（P < 0.001）。随着时间推移，配子体携带比例增加而密度降低（P < 0.001）。对于恶性疟原虫，年龄较小和既往疟疾史与配子体携带有关，且旱季密度较高（P = 0.0115）。间日疟原虫多克隆感染的配子体密度高于单克隆感染（P < 0.0001），恶性疟原虫配子体密度倾向于随感染复数增加而增加。
年龄较小、既往疟疾感染、出行和多克隆感染与间日疟原虫配子体患病率较高相关。配子体携带在旱季达到峰值，突出了需要季节性策略来支持疟疾消除。这些发现增进了对大湄公河次区域边境地区两种主要人类疟原虫可传播阶段危险因素的理解。
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