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Background  Relapse infections resulting from the activation hypnozoites produced by  Plasmodium vivax  and  Plasmodium ovale  represent an important obstacle to the successful control of these species. A single licensed drug, primaquine is available to eliminate these liver dormant forms. To date, investigations of vivax relapse infections have been few in number.    Results  Genotyping, based on polymorphic regions of two genes ( Pvmsp1 F3 and  Pvcsp ) and four microsatellite markers (MS3.27, MS3.502, MS6 and MS8), of 12 paired admission and relapse samples from  P. vivax -infected patients were treated with primaquine, revealed that in eight of the parasite populations in the admission and relapse samples were homologous, and heterologous in the remaining four patients. The patients’ CYP2D6 genotypes did not suggest that any were poor metabolisers of primaquine. Parasitaemia tended to be higher in the heterologous as compared to the homologous relapse episodes as was the IgG3 response. For the twelve pro- and anti-inflammatory cytokine levels measured for all samples, only those of IL-6 and IL-10 tended to be higher in patients with heterologous as compared to homologous relapses in both admission and relapse episodes.    Conclusions  The data from this limited number of patients with confirmed relapse episodes mirror previous observations of a significant proportion of heterologous parasites in relapses of  P. vivax  infections in Thailand. Failure of the primaquine treatment that the patients received is unlikely to be due to poor drug metabolism, and could indicate the presence of  P. vivax  populations in Thailand with poor susceptibility to 8-aminoquinolines.    Electronic supplementary material  The online version of this article (doi:10.1186/s12936-017-1877-x) contains supplementary material, which is available to authorized users.

Molecular and immunological analyses of confirmed Plasmodium vivax relapse episodes