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Background  The two main plasmodial species in French Guiana are  Plasmodium vivax  and  Plasmodium falciparum  whose respective prevalence influences the frequency of mixed plasmodial infections. The accuracy of their diagnosis is influenced by the sensitivity of the method used, whereas neither microscopy nor rapid diagnostic tests allow a satisfactory evaluation of mixed plasmodial infections.    Methods  In the present study, the frequency of mixed infections in different part of French Guiana was determined using real time PCR, a sensitive and specific technique.    Results  From 400 cases of malaria initially diagnosed by microscopy, real time PCR showed that 10.75 % of the cases were mixed infections. Their prevalence varied considerably between geographical areas. The presence, in equivalent proportions, of the two plasmodial species in eastern French Guiana was associated with a much higher prevalence of mixed plasmodial infections than in western French Guiana, where the majority of the population was Duffy negative and thus resistant to vivax malaria.    Conclusion  Clinicians must be more vigilant regarding mixed infections in co-endemic  P.   falciparum/P.   vivax  areas, in order to deliver optimal care for patients suffering from malaria. This may involve the use of rapid diagnostic tests capable of detecting mixed infections or low density single infections. This is important as French Guiana moves towards malaria elimination.

Frequency and distribution of mixed Plasmodium falciparum-vivax infections in French Guiana between 2000 and 2008