{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:55:14Z","timestamp":1781639714228,"version":"3.54.5"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004901","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de Minas Gerais","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004901","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["404067\/2012-3"],"award-info":[{"award-number":["404067\/2012-3"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["200075\/2022-5"],"award-info":[{"award-number":["200075\/2022-5"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Programa PrInt-Fiocruz-CAPES"},{"name":"Ministry of Health of Brazil"},{"DOI":"10.13039\/501100001409","name":"the Department of Science and Technology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001409","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"publisher","award":["U1111-1269-2062"],"award-info":[{"award-number":["U1111-1269-2062"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Plasmodium vivax is the most widespread malaria parasite, and its cocirculation with Plasmodium falciparum often leads to underdiagnosis and underestimated transmission. We investigated whether underdiagnosis contributes to the selection and spread of drug-resistant parasites in coendemic areas of the Brazilian Amazon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 727 confirmed malaria cases from three Brazilian states, primarily from Roraima in the Guiana Shield, a region characterized by cocirculation of P. vivax and P. falciparum, intense cross-border mobility, illegal mining activities, and informal antimalarial drug use. To examine indirect P. vivax exposure to antimalarial targeting P. falciparum, we evaluated pvmdr1 copy number variation (CNV).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In Roraima, molecular diagnosis revealed frequent misclassification of mixed infections, with P. vivax often missed by microscopy due to higher P. falciparum densities, demonstrating the limitations of microscopy in accurately detecting mixed infections. The pvmdr1 CNV exhibited significant geographic variation. While nearly all isolates from the western Amazon carried a single copy, pvmdr1 amplification was detected in 60% of Roraima isolates. In addition to this spatial heterogeneity, temporal analysis revealed significant shifts in amplification patterns over the years, rising to over 70% after 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings emphasize the critical importance of accurate diagnosis and rational use of antimalarials, as inadequate or unintended drug exposure may inadvertently drive the selection and spread of parasite strains with reduced drug susceptibility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiag196","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:41:43Z","timestamp":1775043703000},"page":"e1480-e1489","source":"Crossref","is-referenced-by-count":0,"title":["Hidden Infections, Emerging Resistance: Underdiagnosed\n                    <i>Plasmodium vivax<\/i>\n                    and Multidrug Resistance-1 (\n                    <i>pvmdr1<\/i>\n                    ) Gene Amplification in the Guiana Shield"],"prefix":"10.1093","volume":"233","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2580-2275","authenticated-orcid":false,"given":"Maria Carolina Silva de Barros","family":"Pu\u00e7a","sequence":"first","affiliation":[{"name":"Molecular Biology and Malaria Immunology Research Group, Instituto Ren\u00e9 Rachou, Funda\u00e7\u00e3o Oswaldo Cruz (FIOCRUZ) , Belo Horizonte, Minas Gerais ,","place":["Brazil"]},{"name":"Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet , Solna ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6116-1043","authenticated-orcid":false,"given":"Maria Eduarda Pereira","family":"Mascarenhas","sequence":"additional","affiliation":[{"name":"Molecular Biology and Malaria Immunology Research Group, Instituto Ren\u00e9 Rachou, Funda\u00e7\u00e3o Oswaldo Cruz (FIOCRUZ) , Belo 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,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2754-3971","authenticated-orcid":false,"given":"Iuri Rodrigues","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Universidade Federal de Roraima , Boa Vista, Roraima ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8465-0999","authenticated-orcid":false,"given":"Jaime","family":"Louzada","sequence":"additional","affiliation":[{"name":"Universidade Federal de Roraima , Boa Vista, Roraima ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5527-2295","authenticated-orcid":false,"given":"Anielle","family":"de Pina-Costa","sequence":"additional","affiliation":[{"name":"Universidade Federal Fluminence , Rio de Janeiro 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