Figure 1.
(A) Proposed origin and observed migration pattern of Plasmodium falciparum BV1 lineage parasites in Peru. The dotted arrows in the map indicate human migration from Loreto Department, which is proposed to be the potential origin of the P. falciparum BV1 clonal lineage in Peru, to Tumbes3 and Cusco departments, resulting in two separate malaria outbreaks. (B) Molecular profile of P. falciparum isolates from the malaria outbreak in Cusco. In the top panel, the numbers indicate the amino acid codons while the letter symbols represent the amino acid changes at those particular codons within each respective gene. In the bottom panel, the top row lists the names of the microsatellite loci while the number listed below each locus corresponds to the size (in bases) of the polymerase chain reaction (PCR)–amplified fragment. The antimalarial drug resistance marker and microsatellite allele profiles of the isolates studied were identical to those of the BV1 lineage parasites identified in the Tumbes outbreak3 and in Loreto Department. Pfdhfr = dihydrofolate reductase; Pfcrt = chloroquine resistance transporter; Pfdhps = dihydropteroate synthase; Pfmdr1 = multidrug-resistant gene, where pf denotes P. falciparum. (C) Timeline of the malaria outbreak in Cusco. The two road construction workers from Loreto who presented with malaria in Cusco in September 2013 are the likely index cases to the subsequent outbreak that occurred in November 2013. CQ = chloroquine; DIRESA = Direccion Regional de Salud (Regional Health Directorate); PQ = primaquine.