Plasmodium knowlesi Infection: Should Africa be Prepared for a New Human Malaria Threat?

Abstract

Background: Human malaria was always believed to be caused by any of four species of Plasmodium namely; Plasmodium vivax, P. falciparum, P. ovale and P. malariae. However, a few years ago, it was observed that Plasmodium knowlesi could naturally infect humans especially in South East Asia. Can we have P. knowlesi infections in Africa? Are we prepared for a new human malaria threat? African institutions might not be searching for this parasite. There is no documented endemic transmission of this parasite in Africa despite many factors that could support its occurrence probably due to clinical and laboratory challenges in the diagnosis of P. knowlesi infections. A misdiagnosis may delay appropriate therapy leading to fatal consequences.  Methodology: This article reviewed in some details many issues surrounding P. knowlesi malaria diagnosis and infection in other parts of the world and the many factors that could promote transmission and occurrence of this infection in Africa through a database search (PubMed, Google Scholar, Cab direct, and African Journals Online) using terms related to the intended review. This is an area that has not been explored by authors in the past.  Conclusion: The possibility of transmission of P. knowlesi in tourist sites in Asia and spread through international travel to Africa is a reality. The Zika and Ebola experiences are clear examples of how international travel and interactions between man and vectors could lead to fatal consequences. Subsequently, these consequences can be averted when the scientific and clinical communities are primed to recognize and combat an emergence of P. knowlesi infections in non-endemic regions.