In areas with seasonal transmission, proper management of acute malaria cases that arise in the transmission season can markedly reduce the disease burden. However, asymptomatic carriage of Plasmodium falciparum sustains a long-lasting reservoir in the transmission-free dry season that seeds cyclical malaria outbreaks. Clinical trials targeting asymptomatic parasitaemia in the dry season failed to interrupt the malaria epidemics that follow annual rains. These asymptomatic infections tend to carry multiple-clones, capable of producing gametocytes and infecting Anopheles mosquitoes. Different clones within an infection fluctuate consistently, indicative of interaction between clones during the long course of asymptomatic carriage. However, the therapy-free environment that prevails in the dry season dis-advantages the drug resistant lineages and favors the wild-type parasites. This review highlights some biological and epidemiological characteristics of asymptomatic parasitaemia and calls for consideration of policies to diminish parasite exposure to drugs "therapy-free" and allow natural selection to curb drug resistance in the above setting.

中文翻译：

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无症状恶性疟原虫寄生虫血症在季节性传播地区抗疟药耐药性演变中的作用。

在季节性传播的地区，对在传播季节出现的急性疟疾病例进行适当的管理可以显着减轻疾病负担。然而，无症状的恶性疟原虫在无传播的旱季维持了一个长期的库，从而播种了周期性疟疾。针对旱季无症状寄生虫病的临床试验未能中断每年降雨后的疟疾流行。这些无症状的感染倾向于携带多克隆，能够产生配子细胞并感染蚊子。感染内的不同克隆会持续波动，这表明在无症状运输的长期过程中克隆之间的相互作用。然而，干旱季节盛行的无治疗环境不利于耐药谱系，有利于野生型寄生虫。这篇综述着重介绍了无症状寄生虫病的一些生物学和流行病学特征，并呼吁考虑采取减少“无治疗”药物寄生虫暴露并在上述情况下自然选择以抑制耐药性的政策。