First evidence of plasmodium falciparum-plasmodium ovale co-infection with delayed clinical presentation in an Ivorian patient: observations and diagnostic challenges
- 1Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, 125, route de Stalingrad, Bobigny cedex, Bobigny, 93009 France
- 2Unité des Virus Émergents (UVE: Aix-Marseille Univ, Università di Corsica, IRBA), IRD 190, Inserm 1207, Marseille, France
- 3UMR1137 INSERM, IAME, Sorbonne Paris Nord University, Bobigny, France
Abstract
Background: Malaria remains highly endemic in Côte d’Ivoire, where repeated exposure to infective mosquito bites increases the risk of both mono- and mixed-species Plasmodium infections. While Plasmodium falciparum predominates and accounts for most acute clinical cases, co-infections with non-falciparum species are under-recognized due to diagnostic limitations and complex interspecies interactions.
Case presentation: Unlike previous reports of concomitant mixed infections, we report the first case of P. falciparum and P. ovale infection in a 69-year-old Ivorian patient residing in France, who experienced latent recurrent malaria episodes following travel to the Man District in the western part of the country. Initial episodes were attributed to P. falciparum, whereas a subsequent episode, occurring in the absence of any re-exposure, was diagnosed as P. ovale infection. This report highlights the critical role of a putative co-infection and species-specific incubation strategies in malaria pathophysiology. The temporal dissociation between P. falciparum and P. ovale detection strongly suggests an initial co-infection, with P. ovale likely remaining subclinical due to low parasitemia (0.02%) and plausible interspecies competition. Unlike P. falciparum, P. ovale is capable of forming dormant hepatic stages (hypnozoites), leading to delayed clinical recurrence 4 months after the primary infection. The late clinical presentation observed in this patient, without recent travel and new exposure, supports the hypothesis of hypnozoite reactivation rather than reinfection.
Conclusions: This report underscores the importance of considering mixed-species malaria infections and variable incubation periods in diagnostic and clinical management. It also highlights the importance of sensitive molecular diagnostic tools and appropriate radical treatment strategies targeting both blood-stage parasites and dormant hepatic forms.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12879-026-14628-1.
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BibTeX
@article{akhoundi2026first,
title = {{First evidence of plasmodium falciparum-plasmodium ovale co-infection with delayed clinical presentation in an Ivorian patient: observations and diagnostic challenges}},
author = {Mohammad Akhoundi and Ghassen Guedri and Sophie Brun and Anthony Marteau},
journal = {BMC Infectious Diseases},
year = {2026},
month = oct,
doi = {10.1186/s12879-026-14628-1},
url = {https://doi.org/10.1186/s12879-026-14628-1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - First evidence of plasmodium falciparum-plasmodium ovale co-infection with delayed clinical presentation in an Ivorian patient: observations and diagnostic challenges
AU - Mohammad Akhoundi
AU - Ghassen Guedri
AU - Sophie Brun
AU - Anthony Marteau
PY - 2026
DA - 2026/10/13
JO - BMC Infectious Diseases
DO - 10.1186/s12879-026-14628-1
UR - https://doi.org/10.1186/s12879-026-14628-1
AB - Background: Malaria remains highly endemic in Côte d’Ivoire, where repeated exposure to infective mosquito bites increases the risk of both mono- and mixed-species Plasmodium infections. While Plasmodium falciparum predominates and accounts for most acute clinical cases, co-infections with non-falciparum species are under-recognized due to diagnostic limitations and complex interspecies interactions. Case presentation: Unlike previous reports of concomitant mixed infections, we report the first case of P. falciparum and P. ovale infection in a 69-year-old Ivorian patient residing in France, who experienced latent recurrent malaria episodes following travel to the Man District in the western part of the country. Initial episodes were attributed to P. falciparum, whereas a subsequent episode, occurring in the absence of any re-exposure, was diagnosed as P. ovale infection. This report highlights the critical role of a putative co-infection and species-specific incubation strategies in malaria pathophysiology. The temporal dissociation between P. falciparum and P. ovale detection strongly suggests an initial co-infection, with P. ovale likely remaining subclinical due to low parasitemia (0.02%) and plausible interspecies competition. Unlike P. falciparum, P. ovale is capable of forming dormant hepatic stages (hypnozoites), leading to delayed clinical recurrence 4 months after the primary infection. The late clinical presentation observed in this patient, without recent travel and new exposure, supports the hypothesis of hypnozoite reactivation rather than reinfection. Conclusions: This report underscores the importance of considering mixed-species malaria infections and variable incubation periods in diagnostic and clinical management. It also highlights the importance of sensitive molecular diagnostic tools and appropriate radical treatment strategies targeting both blood-stage parasites and dormant hepatic forms. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12879-026-14628-1.
SN - 1471-2334
ER -