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.   Plasmodium malariae  infections are often asymptomatic and long-lasting. Mixed infections are often underdetected in areas where  P. malariae ,  P. vivax , and  P. falciparum  are coendemic. In this study, we described the occurrence of these species circulating as single or mixed infections in Pará state, Brazil, in the Amazon region, with the purpose of clarifying the impact of misidentification of parasite species based only on morphological description using thick blood smear. By using real-time polymerase chain reaction based on the amplification of the mitochondrial DNA, we detected a prevalence of 46% (58/126) mixed infections with 33.3%  P. malariae/P. vivax  which were read as  P. vivax  monoinfections by microscopy detection. Our findings confirmed the high circulation of  P. malariae  in a malaria endemic area in the Brazilian Amazon region.

Mixed Plasmodium malariae Infections Were Underdetected in a Malaria Endemic Area in the Amazon Region, Brazil