Skip to main content


  • Oral presentation
  • Open Access

Genomic analyses of complex P. vivax infections

  • 1,
  • 2,
  • 3,
  • 4 and
  • 1
Malaria Journal201413 (Suppl 1) :O41

  • Published:


  • Genome Sequence
  • Infected Patient
  • Genetic Heterogeneity
  • Genomic Study
  • Good Design


The occurrence of multiple, genetically different, parasites in P. vivax -infected patients is well known but often conveniently disregarded. This complexity of infection has long been difficult tostudy due to a lack of molecular markers. Genome sequencing approaches could circumvent this limitation but require tailored analyses that have not always been implemented.

Materials and methods

Here, we analyze genome sequence data generated by us and others from P. vivax field isolates and monkey-adapted strains to characterize, across the entire genome, SNPs and sequence rearrangements. We also genotyped several blood samples infected by the same monkey-adapted strain to better understand the changes happening during the generation of these strains.


All field isolates sequenced so far show evidence of complex infections, with typically 2-4 strains present at >5%. We show that it is possible, empirically and analytically, to rigorously differentiate these parasites and reconstruct haploid genome sequences from these complex infections. Our analyses also demonstrate that the presence of distinct parasites in the original patient infection can lead to genetic heterogeneity in monkey-adapted strains.


Our findings reveal the pervasiveness of complex infections in P. vivax and show that erroneous genetic conclusions can be made if this aspect of the parasite’s biology is not carefully addressed. We show that different approaches enable to rigorously assess complexity of infection and to separate strains within an infection. In addition to their relevance for genetic and genomic studies, our findings have important implications for in vitro and ex vivo studies of P. vivax and provide a framework to better design and control such functional studies.

Authors’ Affiliations

Cleveland Clinic, Cleveland, Ohio, USA
Institut Pasteur du Cambodge, Phnom Penh, Cambodia
Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Case Western Reserve University, Cleveland, Ohio, USA


© Chan et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.


By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Please note that comments may be removed without notice if they are flagged by another user or do not comply with our community guidelines.