Evidence of Submicroscopic Plasmodium knowlesi Mono-Infection in Remote Indigenous Communities in Kelantan, Peninsular Malaysia

Nor Diyana, Dian and Ahmad Basyir, Muhammad and Elora, Nor Azman and Nur Ashrina, Eddie and Nur Iman, Azmi and Valerie Chong, Tze Yee and Mohd Amirul Fitri A., Rahim and Mohd Bakhtiar, Munajat and Rakna, Mohd Ikhwan Mukmin Seri and Muhd Rafiq, Mohd Kasri and Ahmad Imran, Mohamed and Nuraffini, Ghazali and Noor Wanie, Hassan and Siti Nor Azreen, Abdul Manap and Emelia, Osman and Wathiqah, Wahid and Sriwipa, Chuangchaiya and Inke Nadia, D. Lubis and Paul C. S., Divis and Sherwin, Chan and Zulkarnain, Md Idris (2023) Evidence of Submicroscopic Plasmodium knowlesi Mono-Infection in Remote Indigenous Communities in Kelantan, Peninsular Malaysia. The American Journal of Tropical Medicine and Hygiene. pp. 1-5. ISSN 0002-9637

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Abstract

Malaysia has maintained zero cases of indigenous human malaria since 2018. However, zoonotic malaria is still prevalent in underdeveloped areas and hard-to-reach populations. This study aimed to determine the prevalence of malaria among remote indigenous communities in Peninsular Malaysia. A cross-sectional survey was conducted in six settlements in Kelantan state, from June to October 2019. Blood samples were tested for malaria using microscopy and nested polymerase chain reaction (nPCR) targeting the Plasmodium cytochrome c oxidase subunit III (cox3) gene. Of the 1,954 individuals who appeared healthy, no malaria parasites were found using microscopy. However, nPCR revealed seven cases of Plasmodium knowlesi mono-infection (0.4%), and six out of seven infections were in the group of 19 to 40 years old (P = 0.026). No human malaria species were detected by nPCR. Analysis of the DNA sequences also showed high similarity that reflects common ancestry to other P. knowlesi isolates. These findings indicate low submicroscopic P. knowlesi infections among indigenous communities in Malaysia, requiring PCR-based surveillance to support malaria control activities in the country.

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