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Background  Malaria, due to  Plasmodium ovale , can be challenging to diagnose due to clinically mild disease and low parasite burden. Two genetically distinct sub-species of  P. ovale  exist:  Plasmodium ovale curtisi  (classic) and  Plasmodium ovale wallikeri  (variant). It is presently unknown if the sub-species causing infection affects performance of malaria diagnostic tests. The aim of this work was to understand how the genetically distinct sub-species,  P. o. curtisi  and  P. o. wallikeri , affect malaria diagnostic tests.    Methods    Plasmodium ovale -positive whole blood specimens were sub-speciated by PCR and sequencing of 18S rRNA and  dhfr - ts . Parasitaemia, morphology, pan-aldolase positivity, 18S copy number, and  dhfr - ts  sequences were compared between sub-species.    Results  From 2006 to 2015, 49  P. ovale  isolates were identified, of which 22 were  P. o. curtisi  and 27  P. o. wallikeri ; 80% were identified in the last five years, and 88% were acquired in West Africa. Sub-species did not differ by parasitaemia, 18S copy number, or pan-aldolase positivity. Lack of Schüffner’s stippling was over-represented among  P. o. wallikeri  isolates (p = 0.02). Several nucleotide polymorphisms between the sub-species were observed, but they do not occur at sites believed to relate to antifolate binding.    Conclusions    Plasmodium ovale  is increasing among travellers to West Africa, although sub-species do not differ significantly by parasitologic features such as parasitaemia. Absence of Schüffner’s stippling may be a feature specific to  P. o. wallikeri  and is a novel finding.

Parasitological correlates of Plasmodium ovale curtisi and Plasmodium ovale wallikeri infection