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Abstract
Plasmodium vivax is geographically the most widely distributed cause of malaria in
people, with up to 2.5 billion people at risk and an estimated 80 million to 300 million
clinical cases every year--including severe disease and death. Despite this large
burden of disease, P vivax is overlooked and left in the shadow of the enormous problem
caused by Plasmodium falciparum in sub-Saharan Africa. The technological advances
enabling the sequencing of the P vivax genome and a recent call for worldwide malaria
eradication have together placed new emphasis on the importance of addressing P vivax
as a major public health problem. However, because of this parasite's biology, it
is especially difficult to interrupt the transmission of P vivax, and experts agree
that the available methods for preventing and treating infections with P vivax are
inadequate. It is thus imperative that the development of new methods and strategies
become a priority. Advancing the development of such methods needs renewed emphasis
on understanding the biology, pathogenesis, and epidemiology of P vivax. This Review
critically examines what is known about P vivax, focusing on identifying the crucial
gaps that create obstacles to the elimination of this parasite in human populations.
The complete life-cycle of P. falciparum and P. vivax (the two major species causing disease in humans)has two phases: 1) a sexual phase that occurs in the Anopheles spp. mosquito vector; and 2) an asexual phase in the intermediate vertebrate host (i.e. humans).
This review by Mueller and colleagues shows the complexity of the Plasmodium spp. life-cycle. It puts into focus one of the most important differences between P. falciparum and P. vivax liver-stage cycle: whereas P. falciparum will mitotically divide into thousands of merozoites that will be released into the bloodstream, P. vivax can either develop directly into merozoites, or differentiate into a dormant stage (i.e., the hypnozoite), which is completely undetectable and can reactivate months to years after the first infection, causing new blood-stage infections in the absence of a mosquito bite.