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Experimental treatment of avian malaria : atovaquone–proguanil achieves complete clearance of Plasmodium relictum

Palinauskas, Vaidas ; Aželytė, Justė ; Bernotienė, Rasa ; Binkienė, Rasa ; Bukauskaitė, Dovilė ; Chagas, Carolina Romeiro Fernandes ; Duc, Mélanie ; Iezhova, Tatjana ; Ilgūnas, Mikas and Platonova, Elena , et al. (2026) In Journal of Ornithology 167(3). p.849-860
Abstract

Avian malaria, caused by Plasmodium parasites, commonly persists as a chronic infection, yet reliable treatment protocols remain insufficiently evaluated. Assessing treatment efficacy is essential for improving disease management and understanding impacts on host health. We conducted a 2.5-year experimental study to assess the efficacy and safety of atovaquone-proguanil (Malarone®) against Plasmodium relictum (genetic lineage pSGS1) in canaries (Serinus canaria domestica). Seventy-six birds were assigned to four groups: experimentally infected and treated (E1), infected and untreated (E2), uninfected and treated (C1), and uninfected and untreated controls (C2). Following blood inoculation, birds in groups E1 and C1 received four... (More)

Avian malaria, caused by Plasmodium parasites, commonly persists as a chronic infection, yet reliable treatment protocols remain insufficiently evaluated. Assessing treatment efficacy is essential for improving disease management and understanding impacts on host health. We conducted a 2.5-year experimental study to assess the efficacy and safety of atovaquone-proguanil (Malarone®) against Plasmodium relictum (genetic lineage pSGS1) in canaries (Serinus canaria domestica). Seventy-six birds were assigned to four groups: experimentally infected and treated (E1), infected and untreated (E2), uninfected and treated (C1), and uninfected and untreated controls (C2). Following blood inoculation, birds in groups E1 and C1 received four treatment cycles over two months. Parasitemia was monitored by microscopy and PCR for 981 days, and survival, body mass, and biochemical parameters were assessed to evaluate long-term effects. We hypothesized that Malarone would clear blood stages, but that recrudescence might occur due to persistent exo-erythrocytic stages.Malarone treatment resulted in rapid elimination of parasitemia in E1 birds, with no relapses detected by microscopy or PCR during follow-up. In contrast, untreated infected birds exhibited persistent low-level and recurrent parasitemias. Survival did not differ among groups, and most physiological parameters remained within reference ranges. Transient increases in total protein and creatine kinase occurred only in untreated infected birds, indicating limited physiological impact of chronic infection and no detectable long-term toxicity of the treatment. Our results demonstrate complete and sustained clearance of P. relictum (pSGS1) following prolonged Malarone treatment. The absence of relapse suggests limited exo-erythrocytic persistence or effective suppression, supporting the safe and effective use of this drug for avian malaria.

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@article{09a440c1-dbc5-405e-9996-80e297b08412,
  abstract     = {{<p>Avian malaria, caused by Plasmodium parasites, commonly persists as a chronic infection, yet reliable treatment protocols remain insufficiently evaluated. Assessing treatment efficacy is essential for improving disease management and understanding impacts on host health. We conducted a 2.5-year experimental study to assess the efficacy and safety of atovaquone-proguanil (Malarone®) against Plasmodium relictum (genetic lineage pSGS1) in canaries (Serinus canaria domestica). Seventy-six birds were assigned to four groups: experimentally infected and treated (E1), infected and untreated (E2), uninfected and treated (C1), and uninfected and untreated controls (C2). Following blood inoculation, birds in groups E1 and C1 received four treatment cycles over two months. Parasitemia was monitored by microscopy and PCR for 981 days, and survival, body mass, and biochemical parameters were assessed to evaluate long-term effects. We hypothesized that Malarone would clear blood stages, but that recrudescence might occur due to persistent exo-erythrocytic stages.Malarone treatment resulted in rapid elimination of parasitemia in E1 birds, with no relapses detected by microscopy or PCR during follow-up. In contrast, untreated infected birds exhibited persistent low-level and recurrent parasitemias. Survival did not differ among groups, and most physiological parameters remained within reference ranges. Transient increases in total protein and creatine kinase occurred only in untreated infected birds, indicating limited physiological impact of chronic infection and no detectable long-term toxicity of the treatment. Our results demonstrate complete and sustained clearance of P. relictum (pSGS1) following prolonged Malarone treatment. The absence of relapse suggests limited exo-erythrocytic persistence or effective suppression, supporting the safe and effective use of this drug for avian malaria.</p>}},
  author       = {{Palinauskas, Vaidas and Aželytė, Justė and Bernotienė, Rasa and Binkienė, Rasa and Bukauskaitė, Dovilė and Chagas, Carolina Romeiro Fernandes and Duc, Mélanie and Iezhova, Tatjana and Ilgūnas, Mikas and Platonova, Elena and Tobler, Michael and Žiegytė, Rita and Hasselquist, Dennis and Valkiūnas, Gediminas}},
  issn         = {{2193-7192}},
  keywords     = {{Antimalarial treatment; Atovaquone–proguanil; Avian malaria; Canaries (Serinus canaria); Parasite clearance; Plasmodium relictum}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{849--860}},
  publisher    = {{Springer Science and Business Media B.V.}},
  series       = {{Journal of Ornithology}},
  title        = {{Experimental treatment of avian malaria : atovaquone–proguanil achieves complete clearance of Plasmodium relictum}},
  url          = {{http://dx.doi.org/10.1007/s10336-026-02421-5}},
  doi          = {{10.1007/s10336-026-02421-5}},
  volume       = {{167}},
  year         = {{2026}},
}