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Nana RRD, Ngum NL, Makoge V, Amvongo-Adja N, Hawadak J, Singh V. Rapid diagnostic tests for malaria diagnosis in Cameroon: impact of histidine rich protein 2/3 deletions and lactate dehydrogenase gene polymorphism. Diagn Microbiol Infect Dis 2024; 108:116103. [PMID: 37944271 DOI: 10.1016/j.diagmicrobio.2023.116103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/20/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Malaria rapid diagnostic tests (mRDT) play a vital role in malaria control in endemic areas. In this study, histidine-rich protein (hrp) and lactate dehydrogenase (ldh) genes were genotyped in Plasmodium falciparum (Pf) and Plasmodium ovale (Po) spp. isolates. Deletions in P. falciparum hrp2/3 (pfhrp2/3) proteins and single nucleotide polymorphisms (SNPs) were analyzed. Twenty-four samples were analyzed for pfhrp2/3 gene deletions and 25 for SNPs in ldh gene (18 Pf and 7 Po spp.). Deletions in pfhrp2/3 genes were observed in 1.9% malaria positive isolates. The pfldh gene sequences showed one SNP at codon 272 (D272N) in 22.2% of samples while in Po spp., sequences were 100% similar to P. ovale curtisi but when compared to P. ovale wallikeri reference sequence, SNPs at positions 143 (P143S), 168 (K168N), 204 (V204I) were found. Findings suggest low prevalence in pfhrp2/3 genes and highlight the circulation of P. ovale curtisi in the studies areas.
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Affiliation(s)
- Rodrigue Roman Dongang Nana
- Institute of Medical Research and Medicinal Plants studies (IMPM), P.O Box 13033 Yaoundé, Cameroon; Parasite and Host Biology Group, ICMR-National Institute of Malaria Research, New Delhi 110077, India..
| | - Ngum Lesly Ngum
- Institute of Medical Research and Medicinal Plants studies (IMPM), P.O Box 13033 Yaoundé, Cameroon
| | - Valerie Makoge
- Institute of Medical Research and Medicinal Plants studies (IMPM), P.O Box 13033 Yaoundé, Cameroon
| | - Nathalie Amvongo-Adja
- Institute of Medical Research and Medicinal Plants studies (IMPM), P.O Box 13033 Yaoundé, Cameroon
| | - Joseph Hawadak
- Parasite and Host Biology Group, ICMR-National Institute of Malaria Research, New Delhi 110077, India
| | - Vineeta Singh
- Parasite and Host Biology Group, ICMR-National Institute of Malaria Research, New Delhi 110077, India..
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Xu C, Wang Y, Li J, Zhou B, Xiao T, Sun H, Zhao G, Kong X, Wei Q, Yan G, Yin K. Molecular detection and species identification of Plasmodium spp. infection among imported cases in Eastern China, 2012-2018. Parasitol Res 2023:10.1007/s00436-023-07865-9. [PMID: 37199766 DOI: 10.1007/s00436-023-07865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
Due to the increasing number of returnees from malaria endemic areas, imported malaria has become a public health challenge in China. To better understand the characteristics of imported Plasmodium species and adjust appropriate strategies for malaria prevention and control in Eastern China, we conducted molecular detection and species identification on 1282 imported malaria cases in Shandong Province between 2012 and 2018. The findings showed that P. falciparum was predominant, particularly in cases imported from Africa. P. vivax was the dominant species imported from Asian countries. Additionally, imported P. ovale and P. malariae emerged in the province. Further surveillance and control of imported malaria among returnees from Africa and Southeast Asia is needed to be strengthened in Eastern China.
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Affiliation(s)
- Chao Xu
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, 272033, China
| | - Yongbin Wang
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, 272033, China
| | - Jin Li
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, 272033, China
| | | | - Ting Xiao
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, 272033, China
| | - Hui Sun
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, 272033, China
| | - Guihua Zhao
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, 272033, China
| | - Xiangli Kong
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, 272033, China
| | - Qingkuan Wei
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, 272033, China
| | - Ge Yan
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, 272033, China
| | - Kun Yin
- Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, 272033, China.
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Global Analysis of Plasmodium falciparum Dihydropteroate Synthase Variants Associated with Sulfadoxine Resistance Reveals Variant Distribution and Mechanisms of Resistance: A Computational-Based Study. Molecules 2022; 28:molecules28010145. [PMID: 36615340 PMCID: PMC9822128 DOI: 10.3390/molecules28010145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
The continual rise in sulfadoxine (SDX) resistance affects the therapeutic efficacy of sulfadoxine-pyrimethamine; therefore, careful monitoring will help guide its prolonged usage. Mutations in Plasmodium falciparum dihydropteroate synthase (Pfdhps) are being surveilled, based on their link with SDX resistance. However, there is a lack of continuous analyses and data on the potential effect of molecular markers on the Pfdhps structure and function. This study explored single-nucleotide polymorphisms (SNPs) in Pfdhps that were isolated in Africa and other countries, highlighting the regional distribution and its link with structure. In total, 6336 genomic sequences from 13 countries were subjected to SNPs, haplotypes, and structure-based analyses. The SNP analysis revealed that the key SDX resistance marker, A437G, was nearing fixation in all countries, peaking in Malawi. The mutation A613S was rare except in isolates from the Democratic Republic of Congo and Malawi. Molecular docking revealed a general loss of interactions when comparing mutant proteins to the wild-type protein. During MD simulations, SDX was released from the active site in mutants A581G and A613S before the end of run-time, whereas an unstable binding of SDX to mutant A613S and haplotype A437A/A581G/A613S was observed. Conformational changes in mutant A581G and the haplotypes A581G/A613S, A437G/A581G, and A437G/A581G/A613S were seen. The radius of gyration revealed an unfolding behavior for the A613S, K540E/A581G, and A437G/A581G systems. Overall, tracking such mutations by the continuous analysis of Pfdhps SNPs is encouraged. SNPs on the Pfdhps structure may cause protein-drug function loss, which could affect the applicability of SDX in preventing malaria in pregnant women and children.
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Wang X, Zhang X, Chen H, Lu Q, Ruan W, Chen Z. Molecular Determinants of Sulfadoxine-Pyrimethamine Resistance in Plasmodium falciparum Isolates from Central Africa between 2016 and 2021: Wide Geographic Spread of Highly Mutated Pfdhfr and Pfdhps Alleles. Microbiol Spectr 2022; 10:e0200522. [PMID: 36121226 PMCID: PMC9602997 DOI: 10.1128/spectrum.02005-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/27/2022] [Indexed: 12/31/2022] Open
Abstract
Sulfadoxine-pyrimethamine (SP) resistance impairs the efficacy of antimalarial drugs. Monitoring molecular markers in exported malaria infections provides an efficient way to trace the emergence of drug resistance in countries where malaria is endemic. Molecular markers in Pfdhfr and Pfdhps of 237 Plasmodium falciparum infections imported from central Africa between 2016 and 2021 were detected. The spatial and temporal distributions of Pfdhfr and Pfdhps mutations were analyzed. A high prevalence of Pfdhfr single-nucleotide polymorphisms (SNPs) (~92.34% to 99.10%) and a high frequency of the triple mutation haplotype I51R59N108 were observed. Cameroon, Equatorial Guinea, and Gabon showed a higher frequency (~96.61% to 100.00%) of I51R59N108 than other countries (~71.11% to 88.10%). The prevalence of C59R and I51R59N108 increased while that of other SNPs or haplotypes did not fluctuate greatly from 2016 to 2021. Large proportions of Pfdhps SNPs (A437G and K540E) were demonstrated. The SNP distribution of Pfdhps differed between countries, with S436A dominating in northern countries and A437G dominating in others. The proportions of I431V, A437G, and the triple mutant haplotype declined between 2016 and 2021, whereas the prevalence of the single mutant haplotype rose from 61.60% to 73.68%. Combinations of Pfdhfr-Pfdhps alleles conferring partial resistance, full resistance, and superresistance to SP, as defined in the text, were detected in 63.64%, 8.64%, and 0.91% of the samples, respectively. The octuple Pfdhfr-Pfdhps allele (I51R59N108-V431A436G437K540G581S613) was seen in 5.00% of the samples. We demonstrated the wide geographic spread and increasing trends in highly SP-resistant Pfdhfr genes and varying spatial patterns of Pfdhps mutants across countries in central Africa. The high prevalences of partially resistant, fully resistant, and superresistant Pfdhfr-Pfdhps combinations observed here indicated impaired SP efficacy. Increased molecular surveillance is required to monitor the changing status of the Pfdhfr and Pfdhps genes. IMPORTANCE Monitoring drug resistance is important for malaria control because its early detection enables timely action to prevent its spread and mitigate its impact. The wide geographic spread and the increasing trend of highly resistant Pfdhfr genes between 2016 and 2021 found in our study are worrisome and emphasize the urgency to monitor their updated status in central Africa. This study also illustrated the wide spread of the novel mutant Pfdhps I431V as well as the high prevalence of "partially resistant," "fully resistant," and "superresistant" Pfdhfr-Pfdhps combinations, indicating the urgent concern for SP efficacy in central Africa. These findings are alarming in central African countries where malaria is endemic, where SP was is widely used for the intermittent preventive treatment of malaria in pregnancy (IPTp) and the intermittent preventive treatment of malaria in infants below 5 years of age (IPTi), and urge enhanced molecular surveillance and responses to the threat of drug resistance.
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Affiliation(s)
- Xiaoxiao Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Xuan Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Hualiang Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Qiaoyi Lu
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Wei Ruan
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Zhiping Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
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Enato IG, Sadoh AE, Ibadin OM, Odunvbun ME, Osaigbovo II. Distinct pattern and prevalence of Plasmodium falciparum dihydropteroate synthase gene mutations in children with sickle cell anaemia and haemoglobin AA in Benin City, Nigeria: the impact of HbAA. Pan Afr Med J 2022; 43:80. [PMID: 36590995 PMCID: PMC9789784 DOI: 10.11604/pamj.2022.43.80.34334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/02/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction specific mutations on the Plasmodium falciparum dihydropteroate synthase (Pfdhps) gene mediate sulphadoxine/pyrimethamine (SP) resistance and thus, pose a threat to the efficacy of SP-Intermittent Preventive Therapy (SP-IPT) in malaria chemoprevention in children, including those with sickle cell anaemia (SCA). This study determined the distinct pattern and prevalence of Pfdhps mutations in children with SCA and in those with homozygous haemoglobin A (HbAA) in Benin City, Nigeria; showing the impact of haemoglobin phenotype. Methods this was a cross-sectional study involving children with SCA and HbAA. Those with successfully amplified Pfdhps genes were included in the study. Point mutations and mutant haplotypes of the Pfdhps gene were identified. Parasite density (PD) was determined by estimating the parasite numbers/μl of blood from the thick film. Descriptive, univariable and multivariable analysis were used appropriately. Results a total of 146 children: 71 with SCA and 75 with HbAA were recruited, with a mean age of 46.6 ± 13.0 and 36.4 ± 17.6 respectively; proportion of males were 45(63.4%) and 43(57.3%) respectively. I431V, S436A, A437G, A581G, and A613G mutations were present; but the K540E mutation was absent. ISGKAA 41(28.1%) and VAGKGS 61(41.8%) were the most prevalent mutant haplotypes in this study. The prevalence of VAGKGS haplotype 43(57.3%) was significantly higher in HbAA group compared to that 18(25.4%) in the SCA group (p < 0.001). The prevalence of ISGKAA in SCA group 25(35.2%) was significantly higher than that 16(21.3%) in the HbAA group (p=0.032). HbAA phenotype was the only significant predictor for the presence of the VAGKGS mutant haplotype (aOR: 3.0, 95%CI: 1.375 to 6.499; p=0.006). Conclusion the HbAA phenotype was a significant predictor for the occurrence of the quintuple mutant haplotype (VAGKGS). The K540E mutation was absent; thus, SP-IPT can be explored in children younger than five years with SCA.
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Affiliation(s)
- Izehiuwa Gertrude Enato
- Edo State University, Uzairue, Edo State, Nigeria,,Institute of Child Health, University of Benin, Benin City, Edo State, Nigeria,,Corresponding author: Izehiuwa Gertrude, Enato, Edo State University, Uzairue, Edo State, Nigeria.
| | - Ayebo Evawere Sadoh
- Institute of Child Health, University of Benin, Benin City, Edo State, Nigeria,,Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Okoeguale Michael Ibadin
- Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | | | - Iriagbonse Iyabo Osaigbovo
- Department of Medical Microbiology, University of Benin, Edo State, Nigeria,,Department of Medical Microbiology, University of Benin Teaching Hospital, Edo State, Nigeria
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Molecular Epidemiology of Drug Resistance Genes in Plasmodium falciparum Isolates Imported from Nigeria between 2016 and 2020: Continued Emergence of Fully Resistant
Pfdhfr
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Pfdhps
Alleles. Microbiol Spectr 2022; 10:e0052822. [PMID: 36106887 PMCID: PMC9604097 DOI: 10.1128/spectrum.00528-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Malaria poses public health threats worldwide. Nigeria accounted for the highest numbers of cases (26.8%) and deaths (31.9%) among countries where malaria is endemic in 2020. Currently, monitoring molecular markers in imported malaria cases provides an efficient means to screen for emerging drug resistance in countries where malaria is endemic, particularly in those where field surveillance is challenging. Here, we investigated 165 Plasmodium falciparum infections imported from Nigeria to Zhejiang Province, China, between 2016 and 2020. Multiple molecular markers in k13, Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps were detected. The prevalences and patterns of mutations were analyzed. Polymorphism of k13 was limited to 5 of 156 (3.21%) isolates. The wild-type CVMNK allele of Pfcrt became predominant (65.36%) compared with the triple mutation CVIET. A low frequency (4.73%) of double mutations (N86Y and Y184F) in Pfmdr1 was observed. The dominant haplotypes of Pfdhfr and Pfdhps were IRNDI (92.41%) and ISGKAA (36.84%), respectively. The newly discovered mutant I431V was identified in 21.71% of isolates. A “fully resistant” combination of Pfdhfr-Pfdhps, IRN-GE, was found in eight (5.67%) samples, which was hardly seen in Nigeria. The current study demonstrated a high frequency of wild-type Pfcrt. Limited polymorphism of Pfmdr1 but a high prevalence of Pfdhfr and Pfdhps mutations was illustrated. Our data so far serve as comprehensive surveillance of molecular markers of the k13, Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps genes. Based on our findings, it has become crucial to evaluate the impact of the emerging fully resistant type of Pfdhfr-Pfdhps as well as its combination with I431V on the efficacy of sulfadoxine-pyrimethamine (SP) in Nigeria. IMPORTANCE Monitoring the current resistance to antimalarial drugs is critical to enable timely action to prevent its spread and limit its impact. The high prevalence of wild-type Pfcrt found in our study is an optimistic signal to reevaluate chloroquine (CQ) sensitivity in Nigeria, which is cost-effective and once played a crucial role in the fight against malaria. Based on the continued emergence of fully resistant Pfdhfr-Pfdhps alleles illustrated in the current investigation, actions are needed in Nigeria, such as national systemic surveillance to monitor their updated epidemiology as well as assessments of their influence on SP efficacy to minimize any public health impact. These findings urge a response to the threat of drug resistance to facilitate appropriate drug policies in the study area.
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Lingani M, Zango SH, Valéa I, Somé G, Sanou M, Samadoulougou SO, Ouoba S, Rouamba E, Robert A, Dramaix M, Donnen P, Tinto H. Low birth weight and its associated risk factors in a rural health district of Burkina Faso: a cross sectional study. BMC Pregnancy Childbirth 2022; 22:228. [PMID: 35313840 PMCID: PMC8935822 DOI: 10.1186/s12884-022-04554-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/09/2022] [Indexed: 12/30/2022] Open
Abstract
Background Low birth weight (LBW) is a major factor of neonate mortality that particularly affects developing countries. However, the scarcity of data to support decision making to reduce LBW occurrence is a major obstacle in sub-Saharan Africa. The aim of this research was to determine the prevalence and associated factors of LBW at the Yako health district in a rural area of Burkina Faso. Methods A cross sectional survey was conducted at four peripheral health centers among mothers and their newly delivered babies. The mothers’ socio-demographic and obstetrical characteristics were collected by face-to-face interview or by review of antenatal care books. Maternal malaria was tested by standard microscopy and neonates’ birth weights were documented. Multivariate logistic regression was used to determine factors associated with LBW. A p-value < 0.05 was considered statistically significant. Results Of 600 neonates examined, the prevalence of low birth weight was 11.0%. Adjustment for socio-demographic characteristic, medical conditions, obstetrical history, malaria prevention measures by multivariate logistic regression found that being a primigravid mother (aOR = 1.8, [95% CI: 1.1–3.0]), the presence of malaria infection (aOR = 1.9, [95% CI: 1.1–3.5]), the uptake of less than three doses of sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy (IPTp-SP) (aOR = 2.2, [95% CI: 1.3–3.9]), the presence of maternal fever at the time of delivery (aOR = 2.8, [95% CI: 1.5–5.3]) and being a female neonate (aOR = 1.9, [95% CI: 1.1–3.3]) were independently associated with an increased risk of LBW occurrence. The number of antenatal visits performed by the mother during her pregnancy did not provide any direct protection for low birth weight. Conclusion The prevalence of LBW remained high in the study area. Maternal malaria, fever and low uptake of sulfadoxine-pyrimethamine doses were significantly associated with LBW and should be adequately addressed by public health interventions.
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Affiliation(s)
- Moussa Lingani
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso. .,École de Santé publique, Université Libre de Bruxelles, Bruxelles, Belgium.
| | - Serge Henri Zango
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso.,Epidemiology and Biostatistics Research Division, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Bruxelles, Belgium
| | - Innocent Valéa
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
| | - Georges Somé
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
| | - Maïmouna Sanou
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
| | - Sékou O Samadoulougou
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Center, Quebec, Canada
| | - Serge Ouoba
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
| | - Eli Rouamba
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
| | - Annie Robert
- Epidemiology and Biostatistics Research Division, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Bruxelles, Belgium
| | - Michèle Dramaix
- École de Santé publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Philippe Donnen
- École de Santé publique, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
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Lingani M, Zango SH, Valéa I, Valia D, Sanou M, Samandoulougou SO, Robert A, Tinto H, Dramaix M, Donnen P. Magnitude of low birthweight in malaria endemic settings of Nanoro, rural Burkina Faso: a secondary data analysis. Sci Rep 2021; 11:21332. [PMID: 34716389 PMCID: PMC8556330 DOI: 10.1038/s41598-021-00881-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/15/2021] [Indexed: 12/02/2022] Open
Abstract
Low birthweight (LBW) is a worldwide problem that particularly affects developing countries. However, limited information is available on its magnitude in rural area of Burkina Faso. This study aimed to estimate the prevalence of low birthweight and to identify its associated factors in Nanoro health district. A secondary analysis of data collected during a cross-sectional survey was conducted to assess the prevalence of low birthweight in Nanoro health and demographic surveillance system area (HDSS). Maternal characteristics extracted from antenatal care books or by interview, completed by malaria diagnosis were examined through a multi-level logistic regression to estimate odd-ratios of association with low birthweight. Significance level was set at 5%. Of the 291 neonates examined, the prevalence of low birthweight was 12%. After adjustment for socio-demographic, obstetric and malaria prevention variables, being primigravid (OR = 8.84, [95% CI: 3.72-21.01]), or multigravid with history of stillbirth (OR = 5.03, [95% CI: 1.54-16.40]), as well as the lack of long-lasting insecticide treated bed net use by the mother the night preceding the admission for delivery (OR = 2.5, [95% CI: 1.1-5.9]) were significantly associated with neonate low birthweight. The number of antenatal visits however did not confer any direct benefit on birthweight status within this study area. The prevalence of low birthweight was high in the study area and represents an important public health problem in Burkina Faso. In light of these results, a redefinition of the content of the antenatal care package is needed.
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Affiliation(s)
- Moussa Lingani
- École de Santé Publique, Université Libre de Bruxelles, Route de Lennik 808, CP594, 1070, Bruxelles, Belgique.
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 218, 11, Nanoro, Burkina Faso.
| | - Serge H Zango
- Epidemiology and Biostatistics Research Division, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Clos Chapelle-aux-Champs 30, B1.30.13, 1200, Brussels, Belgique
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 218, 11, Nanoro, Burkina Faso
| | - Innocent Valéa
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 218, 11, Nanoro, Burkina Faso
| | - Daniel Valia
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 218, 11, Nanoro, Burkina Faso
| | - Maïmouna Sanou
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 218, 11, Nanoro, Burkina Faso
| | - Sékou O Samandoulougou
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Center, Quebec City, QC, G1V 4G5, Canada
| | - Annie Robert
- Epidemiology and Biostatistics Research Division, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Clos Chapelle-aux-Champs 30, B1.30.13, 1200, Brussels, Belgique
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 218, 11, Nanoro, Burkina Faso
| | - Michèle Dramaix
- École de Santé Publique, Université Libre de Bruxelles, Route de Lennik 808, CP594, 1070, Bruxelles, Belgique
| | - Philippe Donnen
- École de Santé Publique, Université Libre de Bruxelles, Route de Lennik 808, CP594, 1070, Bruxelles, Belgique
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Diagnosing the drug resistance signature in Plasmodium falciparum: a review from contemporary methods to novel approaches. J Parasit Dis 2021; 45:869-876. [PMID: 34475670 DOI: 10.1007/s12639-020-01333-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022] Open
Abstract
The genome sequence project of the human malaria parasite Plasmodium falciparum reveal variations in the parasite DNA sequence. Most of these variations are single nucleotide polymorphism (SNP). A high frequency of single nucleotide polymorphism (SNP) in the Plasmodium falciparum population is usually a benchmark for anti-malarial resistance which allows parasites to be elusive to the chemotherapeutic agents, vaccine and vector control strategies, resulting in the leading cause of morbidity and mortality globally. The high density of drug resistance signature markers such as pfcrt,pfmdr1, pfdhps, pfdhfr, pfkelch13, pfatpase6 and pfmrp1 in the genome opens up a scope for the study of the genetic basis of this elusive parasite. The precise and prompt diagnosis of resistance strains of parasite plays vital role in malaria elimination program.This review probably shed light on contemporary SNP diagnostic tools used in molecular surveillance of Plasmodium falciparum drug resistance in terms of mechanism, reaction modalities, and development with their virtues and shortcomings.
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Tuedom AGB, Sarah-Matio EM, Moukoko CEE, Feufack-Donfack BL, Maffo CN, Bayibeki AN, Awono-Ambene HP, Ayong L, Berry A, Abate L, Morlais I, Nsango SE. Antimalarial drug resistance in the Central and Adamawa regions of Cameroon: Prevalence of mutations in P. falciparum crt, Pfmdr1, Pfdhfr and Pfdhps genes. PLoS One 2021; 16:e0256343. [PMID: 34411157 PMCID: PMC8376100 DOI: 10.1371/journal.pone.0256343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022] Open
Abstract
The spread of Plasmodium falciparum resistant parasites remains one of the major challenges for malaria control and elimination in Sub Saharan Africa. Monitoring of molecular markers conferring resistance to different antimalarials is important to track the spread of resistant parasites and to optimize the therapeutic lifespan of current drugs. This study aimed to evaluate the prevalence of known mutations in the drug resistance genes Pfcrt, Pfmdr1, Pfdhfr and Pfdhps in two different epidemiological settings in Cameroon. Dried blood spots collected in 2018 and 2019 from asymptomatic individuals were used for DNA extraction and then the Plasmodium infection status was determined byPCR. Detection of SNPs was performed by nested PCR followed by allele-specific restriction analysis (ASRA). The prevalence of each genotype was compared between sites using the Chi square and Fisher’s exact tests. A high prevalence of the Pfcrt K76 wild type allele was found in both sites (88.5 and 62.29% respectively; P< 0,0001). The prevalence of Pfmdr1 mutations 86Y and 1246Y was respectively 55.83 and 1.45% in Mfou and 45.87 and 5.97% in Tibati, with significant difference between the studied areas (P<0.0001). Overall, the Pfdhfr triple-mutant genotype (51I/59R/108N) was highly prevalent (> 96%), however no SNP was detected at codon 164. In Pfdhps, the prevalence of the 437G mutation reached (90%) and was at higher frequency in Mfou (P< 0.0001). Overall, the Pfdhps mutations 540E and 581G were less common (0.33 and 3.26%, respectively). The quadruple resistant genotype (Pfdhfr 51I/59R/108N+Pfdhp437G) was found almost 90% of the samples. The wild-type genotype (Pfdhfr N51/C59/S108/164I+Pfdhps A437/K540/A581) was never identified and the sextuple mutant (Pfdhfr 51I/59R/108N+Pfdhp437G/540E/581G), kwon as super resistant appeared in two samples from Tibati. These findings demonstrate declining trends in the prevalence of mutations conferring resistance to 4-aminoquinolines, especially to chloroquine. However, a high level of mutations in P. falciparum genes related to SP resistance was detected and this raises concerns about the future efficacy of IPTp-SP and SMC in Cameroon.
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Affiliation(s)
- Aline Gaelle Bouopda Tuedom
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroun
| | - Elangwe Milo Sarah-Matio
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroun
- UMR MIVEGEC, IRD, CNRS, Institut de Recherche pour le Développement, Université Montpellier, Montpellier Cedex, France
| | - Carole Else Eboumbou Moukoko
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroun
| | - Brice Lionel Feufack-Donfack
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroun
- CNRS UPR9022, INSERM U963, Strasbourg, France
| | - Christelle Ngou Maffo
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroun
- UMR MIVEGEC, IRD, CNRS, Institut de Recherche pour le Développement, Université Montpellier, Montpellier Cedex, France
| | - Albert Ngano Bayibeki
- Université Catholique d’Afrique Centrale, Yaoundé-Campus Messa Cameroun, Yaoundé, Cameroun
| | - Hermann Parfait Awono-Ambene
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), Yaoundé, Cameroun
| | - Lawrence Ayong
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroun
| | - Antoine Berry
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse et UMR152 UPS-IRD, Université de Toulouse, Toulouse, France
| | - Luc Abate
- UMR MIVEGEC, IRD, CNRS, Institut de Recherche pour le Développement, Université Montpellier, Montpellier Cedex, France
| | - Isabelle Morlais
- UMR MIVEGEC, IRD, CNRS, Institut de Recherche pour le Développement, Université Montpellier, Montpellier Cedex, France
| | - Sandrine Eveline Nsango
- Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Malaria Research Unit, Centre Pasteur du Cameroun, Yaoundé, Cameroun
- * E-mail: ,
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Cherif MS, Dahal P, Beavogui AH, Delamou A, Lama EK, Camara A, Diallo MP. Malaria epidemiology and anti-malarial drug efficacy in Guinea: a review of clinical and molecular studies. Malar J 2021; 20:272. [PMID: 34134728 PMCID: PMC8206902 DOI: 10.1186/s12936-021-03809-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022] Open
Abstract
Malaria is one of the leading causes of mortality and morbidity in Guinea. The entire country is considered at risk of the disease. Transmission occurs all year round with peaks occurring from July through October with Plasmodium falciparum as the primary parasite species. Chloroquine (CQ) was the first-line drug against uncomplicated P. falciparum in Guinea until 2005, prior to the adoption of artemisinin-based combination therapy (ACT). In this review, data on therapeutic efficacy of CQ and artemisinin-based combinations reported in published literature is summarized. Against CQ, a failure rate of 27% (12/44) was reported in a study in 1992; a median failure rate of 15.6% [range: 7.7–28.3; 8 studies] was observed during 1996–2001, and 81% (17/21) of the patients failed to clear parasitaemia in a study conducted in 2007. For artemisinin-based combinations, three published studies were identified (1495 patients; 2004–2016); all three studies demonstrated day 28 polymerase chain reaction corrected efficacy > 95%. One study characterized kelch-13 mutations (389 tested; samples collected in 2016) with no evidence of mutations currently known to be associated with artemisinin resistance. The impact of the ongoing COVID-19 pandemic and widespread usage of counterfeit medicines are immediate challenges to malaria control activities in Guinea.
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Affiliation(s)
- Mahamoud Sama Cherif
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea. .,Centre National de Formation et Recherche en Sante Rurale de Maferinyah, Maferinyah, Guinea.
| | - Prabin Dahal
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Abdoul Habib Beavogui
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea.,Centre National de Formation et Recherche en Sante Rurale de Maferinyah, Maferinyah, Guinea
| | - Alexandre Delamou
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea.,Centre National de Formation et Recherche en Sante Rurale de Maferinyah, Maferinyah, Guinea
| | | | - Alioune Camara
- National Malaria Control Programme (NMCP), Conakry, Guinea
| | - Mamadou Pathe Diallo
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
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12
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Chaturvedi R, Chhibber-Goel J, Verma I, Gopinathan S, Parvez S, Sharma A. Geographical spread and structural basis of sulfadoxine-pyrimethamine drug-resistant malaria parasites. Int J Parasitol 2021; 51:505-525. [PMID: 33775670 DOI: 10.1016/j.ijpara.2020.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 12/22/2022]
Abstract
The global spread of sulfadoxine (Sdx, S) and pyrimethamine (Pyr, P) resistance is attributed to increasing number of mutations in DHPS and DHFR enzymes encoded by malaria parasites. The association between drug resistance mutations and SP efficacy is complex. Here we provide an overview of the geographical spread of SP resistance mutations in Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) encoded dhps and dhfr genes. In addition, we have collated the mutation data and mapped it on to the three-dimensional structures of DHPS and DHFR which have become available. Data from genomic databases and 286 studies were collated to provide a comprehensive landscape of mutational data from 2005 to 2019. Our analyses show that the Pyr-resistant double mutations are widespread in Pf/PvDHFR (P. falciparum ∼61% in Asia and the Middle East, and in the Indian sub-continent; in P. vivax ∼33% globally) with triple mutations prevailing in Africa (∼66%) and South America (∼33%). For PfDHPS, triple mutations dominate South America (∼44%), Asia and the Middle East (∼34%) and the Indian sub-continent (∼27%), while single mutations are widespread in Africa (∼45%). Contrary to the status for P. falciparum, Sdx-resistant single point mutations in PvDHPS dominate globally. Alarmingly, highly resistant quintuple and sextuple mutations are rising in Africa (PfDHFR-DHPS) and Asia (Pf/PvDHFR-DHPS). Structural analyses of DHFR and DHPS proteins in complexes with substrates/drugs have revealed that resistance mutations map proximal to Sdx and Pyr binding sites. Thus new studies can focus on discovery of novel inhibitors that target the non-substrate binding grooves in these two validated malaria parasite drug targets.
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Affiliation(s)
- Rini Chaturvedi
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India; Department of Toxicology, Jamia Hamdard, New Delhi, India
| | - Jyoti Chhibber-Goel
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ishika Verma
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Sreehari Gopinathan
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Suhel Parvez
- Department of Toxicology, Jamia Hamdard, New Delhi, India
| | - Amit Sharma
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India; National Institute of Malaria Research, Dwarka, New Delhi, India.
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Zhao D, Zhang H, Ji P, Li S, Yang C, Liu Y, Qian D, Deng Y, Wang H, Lu D, Zhou R, Zhao Y. Surveillance of Antimalarial Drug-Resistance Genes in Imported Plasmodium falciparum Isolates From Nigeria in Henan, China, 2012-2019. Front Cell Infect Microbiol 2021; 11:644576. [PMID: 33968801 PMCID: PMC8102827 DOI: 10.3389/fcimb.2021.644576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/31/2021] [Indexed: 12/01/2022] Open
Abstract
Malaria remains a major public health issue in Nigeria, and Nigeria is one of the main sources of imported malaria in China. Antimalarial drug resistance is a significant obstacle to the control and prevention of malaria globally. The molecular markers associated with antimalarial drug resistance can provide early warnings about the emergence of resistance. The prevalence of antimalarial drug resistant genes and mutants, including PfK13, Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps, was evaluated among the imported Plasmodium falciparum isolates from Nigeria in Henan, China, from 2012 to 2019. Among the 167 imported P. falciparum isolates, the wild-type frequency of PfK13, Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps was 98.7, 63.9, 34.8, 3.1, and 3.1%, respectively. The mutation of PfK13 was rare, with just two nonsynonymous (S693F and Q613H) and two synonymous mutations (C469C and G496G) identified from four isolates. The prevalence of Pfcrt mutation at codon 74–76 decreased year-by-year, while the prevalence of pfmdr1 86Y also decreased significantly with time. The prevalence of Pfdhfr and Pfdhps mutants was high. Combined mutations of Pfdhfr and Pfdhps had a high prevalence of the quadruple mutant I51R59N108-G437 (39.0%), followed by the octal mutant I51R59N108-V431A436G437G581S613 (17.0%). These molecular findings update the known data on antimalarial drug-resistance genes and provide supplemental information for Nigeria.
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Affiliation(s)
- Dongyang Zhao
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Hongwei Zhang
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Penghui Ji
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Suhua Li
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Chengyun Yang
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Ying Liu
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Dan Qian
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Yan Deng
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Hao Wang
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Deling Lu
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Ruimin Zhou
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
| | - Yuling Zhao
- Department of Parasite Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Henan Key Laboratory of Infectious Disease Microbiology, Zhengzhou, China
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14
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Ebel ER, Reis F, Petrov DA, Beleza S. Historical trends and new surveillance of Plasmodium falciparum drug resistance markers in Angola. Malar J 2021; 20:175. [PMID: 33827587 PMCID: PMC8028775 DOI: 10.1186/s12936-021-03713-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Plasmodium falciparum resistance to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) has historically posed a major threat to malaria control throughout the world. The country of Angola officially replaced CQ with artemisinin-based combination therapy (ACT) as a first-line treatment in 2006, but malaria cases and deaths have recently been rising. Many classic resistance mutations are relevant for the efficacy of currently available drugs, making it important to continue monitoring their frequency in Angola. METHODS Plasmodium falciparum DNA was sampled from the blood of 50 hospital patients in Cabinda, Angola from October-December of 2018. Each infection was genotyped for 13 alleles in the genes crt, mdr1, dhps, dhfr, and kelch13, which are collectively involved in resistance to six common anti-malarials. To compare frequency patterns over time, P. falciparum genotype data were also collated from studies published from across Angola in the last two decades. RESULTS The two most important alleles for CQ resistance, crt 76T and mdr1 86Y, were found at respective frequencies of 71.4% and 6.5%. Historical data suggest that mdr1 N86 has been steadily replacing 86Y throughout Angola in the last decade, while the frequency of crt 76T has been more variable across studies. Over a third of new samples from Cabinda were 'quintuple mutants' for SP resistance in dhfr/dhps, with a sixth mutation at dhps A581G present at 9.6% frequency. The markers dhfr 51I, dhfr 108N, and dhps 437G have been nearly fixed in Angola since the early 2000s, whereas dhfr 59R may have risen to high frequency more recently. Finally, no non-synonymous polymorphisms were detected in kelch13, which is involved in artemisinin resistance in Southeast Asia. CONCLUSIONS Genetic markers of P. falciparum resistance to CQ are likely declining in frequency in Angola, consistent with the official discontinuation of CQ in 2006. The high frequency of multiple genetic markers of SP resistance is consistent with the continued public and private use of SP. In the future, more complete haplotype data from mdr1, dhfr, and dhps will be critical for understanding the changing efficacy of multiple anti-malarial drugs. These data can be used to support effective drug policy decisions in Angola.
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Affiliation(s)
- Emily R Ebel
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
- Department of Pediatrics, Infectious Disease, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Fátima Reis
- Hospital Regional de Cabinda, C5QW+XP, Cabinda, Angola
| | - Dmitri A Petrov
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Sandra Beleza
- Department of Genetics and Genome Biology, University of Leicester, Leicester, LE1 7RH, UK.
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15
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Niba PTN, Nji AM, Evehe MS, Ali IM, Netongo PM, Ngwafor R, Moyeh MN, Ngum LN, Ndum OE, Acho FA, Mbu'u CM, Fosah DA, Atogho-Tiedeu B, Achonduh-Atijegbe O, Djokam-Dadjeu R, Chedjou JPK, Bigoga JD, Moukoko CEE, Ajua A, Achidi E, Tallah E, Leke RGF, Tourgordi A, Ringwald P, Alifrangis M, Mbacham WF. Drug resistance markers within an evolving efficacy of anti-malarial drugs in Cameroon: a systematic review and meta-analysis (1998-2020). Malar J 2021; 20:32. [PMID: 33422080 PMCID: PMC7796563 DOI: 10.1186/s12936-020-03543-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/10/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Malaria remains highly endemic in Cameroon. The rapid emergence and spread of drug resistance was responsible for the change from monotherapies to artemisinin-based combinations. This systematic review and meta-analysis aimed to determine the prevalence and distribution of Plasmodium falciparum drug resistance markers within an evolving efficacy of anti-malarial drugs in Cameroon from January 1998 to August 2020. METHODS The PRISMA-P and PRISMA statements were adopted in the inclusion of studies on single nucleotide polymorphisms (SNPs) of P. falciparum anti-malarial drug resistance genes (Pfcrt, Pfmdr1, Pfdhfr, Pfdhps, Pfatp6, Pfcytb and Pfk13). The heterogeneity of the included studies was evaluated using the Cochran's Q and I2 statistics. The random effects model was used as standard in the determination of heterogeneity between studies. RESULTS Out of the 902 records screened, 48 studies were included in this aggregated meta-analysis of molecular data. A total of 18,706 SNPs of the anti-malarial drug resistance genes were genotyped from 47,382 samples which yielded a pooled prevalence of 35.4% (95% CI 29.1-42.3%). Between 1998 and 2020, there was significant decline (P < 0.0001 for all) in key mutants including Pfcrt 76 T (79.9%-43.0%), Pfmdr1 86Y (82.7%-30.5%), Pfdhfr 51I (72.2%-66.9%), Pfdhfr 59R (76.5%-67.8%), Pfdhfr 108 N (80.8%-67.6%). The only exception was Pfdhps 437G which increased over time (30.4%-46.9%, P < 0.0001) and Pfdhps 540E that remained largely unchanged (0.0%-0.4%, P = 0.201). Exploring mutant haplotypes, the study observed a significant increase in the prevalence of Pfcrt CVIET mixed quintuple haplotype from 57.1% in 1998 to 57.9% in 2020 (P < 0.0001). In addition, within the same study period, there was no significant change in the triple Pfdhfr IRN mutant haplotype (66.2% to 67.3%, P = 0.427). The Pfk13 amino acid polymorphisms associated with artemisinin resistance were not detected. CONCLUSIONS This review reported an overall decline in the prevalence of P. falciparum gene mutations conferring resistance to 4-aminoquinolines and amino alcohols for a period over two decades. Resistance to artemisinins measured by the presence of SNPs in the Pfk13 gene does not seem to be a problem in Cameroon. Systematic review registration PROSPERO CRD42020162620.
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Affiliation(s)
- Peter Thelma Ngwa Niba
- MARCAD-DELTAS Programme, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Akindeh M Nji
- MARCAD-DELTAS Programme, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Marie-Solange Evehe
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Innocent M Ali
- MARCAD-DELTAS Programme, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Palmer Masumbe Netongo
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Randolph Ngwafor
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- National Malaria Control Programme, Ministry of Public Health, Yaoundé, Cameroon
| | - Marcel N Moyeh
- MARCAD-DELTAS Programme, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Lesley Ngum Ngum
- MARCAD-DELTAS Programme, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Institute of Medical Research and Medicinal Plant Studies, Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Oliva Ebie Ndum
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Université Des Montagnes, Banganté, West Region, Cameroon
| | - Fon Abongwa Acho
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
| | - Cyrille Mbanwi Mbu'u
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Microbiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Dorothy A Fosah
- National Malaria Control Programme, Ministry of Public Health, Yaoundé, Cameroon
| | - Barbara Atogho-Tiedeu
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Rosine Djokam-Dadjeu
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Paul Kengne Chedjou
- MARCAD-DELTAS Programme, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Jude D Bigoga
- MARCAD-DELTAS Programme, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Carole Else Eboumbou Moukoko
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Malaria Research Service, Centre Pasteur Cameroon, Yaoundé, Cameroon
| | - Anthony Ajua
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Eric Achidi
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Esther Tallah
- Malaria Consortium-Cameroon Coalition Against Malaria, Yaoundé, Cameroon
| | - Rose G F Leke
- MARCAD-DELTAS Programme, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Malaria Consortium-Cameroon Coalition Against Malaria, Yaoundé, Cameroon
| | - Alexis Tourgordi
- The Cameroon Office of the World Health Organization, Yaoundé, Cameroon
| | - Pascal Ringwald
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Wilfred F Mbacham
- MARCAD-DELTAS Programme, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.
- The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon.
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon.
- Malaria Consortium-Cameroon Coalition Against Malaria, Yaoundé, Cameroon.
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16
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Fagbemi KA, Adebusuyi SA, Nderu D, Adedokun SA, Pallerla SR, Amoo AOJ, Thomas BN, Velavan TP, Ojurongbe O. Analysis of sulphadoxine-pyrimethamine resistance-associated mutations in Plasmodium falciparum isolates obtained from asymptomatic pregnant women in Ogun State, Southwest Nigeria. INFECTION GENETICS AND EVOLUTION 2020; 85:104503. [PMID: 32805431 DOI: 10.1016/j.meegid.2020.104503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022]
Abstract
Intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is one of the main strategies for protecting pregnant women, fetus, and their new-born against adverse effects of P. falciparum infection. The development of the drug resistance linked to mutations in P. falciparum dihydrofolate reductase gene (pfdhfr) and P. falciparum dihydropteroate synthase gene (pfdhps), is currently threatening the IPTp-SP approach. This study determined the prevalence of pfdhfr and pfdhps mutations in isolates obtained from pregnant women with asymptomatic P. falciparum infection in Nigerian. Additionally, P. falciparum genetic diversity and multiplicity of infection (MOI) was assessed by genotyping the P. falciparum merozoite surface Protein 1 and 2 (pfmsp-1 and pfmsp-2) genes. The pfdhfr and pfdhps were genotyped by direct sequencing, and the pfmsp-1 and pfmsp-2 fragment analysis by polymerase chain reaction was used to determine P. falciparum genetic diversity. Of the 406 pregnant women recruited, 123 had P. falciparum infection by PCR, and of these, 52 were successfully genotyped for pfdhfr and 42 for pfdhps genes. The pfdhfr triple-mutant parasites (N51I, C59R, and S108N) or the IRN haplotype were predominant (98%), whereas pfdhfr mutations C50R and I164L did not occur. For pfdhps gene, the prevalence of A437G, A581G, A436A, and A613S mutations were 98, 71, 55, and 36%, respectively. Nineteen (44%) isolates with quintuple mutations (CIRNI- SGKGA) had the highest combined pfdhfr-pfdhps haplotype. Isolates with sextuple mutants; CIRNI- AGKAS and CIRNI- AGKGA had a prevalence of 29 and 14%, respectively. High genetic diversity (7 pfmsp-1 alleles and 10 pfmsp-2 alleles) and monoclonal infection rate (76%) was observed. This study demonstrated a continuous high prevalence of pfdhfr mutation and an increase in pfdhps mutations associated with SP-resistance in southwest Nigeria. Continuous surveillance of IPTp-SP effectiveness and consideration of alternative IPTp strategies is recommended.
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Affiliation(s)
- Kaossarath A Fagbemi
- Institute of Tropical Medicine, University of Tübingen, Germany; Department of Biomedical Sciences, Laboratory of Cytogenetics and Medical Genetics, Faculty of Health Sciences, University of Abomey-Calavi, Benin
| | - Sunday A Adebusuyi
- Department of Medical Microbiology & Parasitology, Olabisi Onabanjo University, Ago-Iwoye, Nigeria
| | - David Nderu
- Institute of Tropical Medicine, University of Tübingen, Germany; School of Health Sciences, Kirinyaga University, Kirinyaga, Kenya
| | - Samuel A Adedokun
- Institute of Tropical Medicine, University of Tübingen, Germany; Department of Medical Microbiology & Parasitology, Ladoke Akintola University of Technology, Osogbo, Nigeria
| | | | - Abimbola O J Amoo
- Department of Medical Microbiology & Parasitology, Olabisi Onabanjo University, Ago-Iwoye, Nigeria
| | - Bolaji N Thomas
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, USA
| | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, University of Tübingen, Germany; Duy Tan University, Da Nang, Viet Nam
| | - Olusola Ojurongbe
- Institute of Tropical Medicine, University of Tübingen, Germany; Department of Medical Microbiology & Parasitology, Ladoke Akintola University of Technology, Osogbo, Nigeria.
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