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Wotodjo AN, Oboh MA, Doucoure S, Diagne N, Diène-Sarr F, Niang M, Trape JF, Sokhna C, Amambua-Ngwa A, D'Alessandro U. Rebound of multiple infections and prevalence of anti-malarial resistance associated markers following malaria upsurges in Dielmo village, Senegal, West Africa. Malar J 2023; 22:257. [PMID: 37670357 PMCID: PMC10478411 DOI: 10.1186/s12936-023-04694-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Thanks to the scale up of malaria control interventions, the malaria burden in Senegal has decreased substantially to the point that the National Malaria Control Programme plans to achieve malaria elimination by 2030. To guide such efforts, measuring and monitoring parasite population evolution and anti-malarial drugs resistance is extremely important. Information on the prevalence of parasite mutations related to drug resistance can provide a first signal of emergence, introduction and selection that can help with refining drug interventions. The aim of this study was to analyse the prevalence of anti-malarial drug resistance-associated markers before and after the implementation of artemisinin-based combination therapy (ACT) from 2005 to 2014 in Dielmo, a model site for malaria intervention studies in Senegal. METHODS Samples from both malaria patients and Plasmodium falciparum asymptomatic carriers were analysed with high resolution melting (HRM) technique to genotype P. falciparum chloroquine resistance transporter (Pfcrt) gene haplotypes and multidrug-resistant protein 1 (Pfmdr1) gene at codons N86 and Y184. RESULTS Among the 539 samples analysed, 474, 486, and 511 were successfully genotyped for Pfmdr1 N86, Y184, and Pfcrt, respectively. The prevalence of drug resistance markers was high, particularly during the malaria upsurges. Following the scale-up in bed net distribution, only the mutant (86F-like) variant of Pfmdr1 86 was present while during the malaria upsurges the predominance of two types 86Y-86N (43%) and 86F-like (56%) were observed. Most infections (87%) carried the wild type Y-allele at Pfmdr1 184 during the period of nets scale-up while during the malaria upsurges only 16% of infections had wild type and 79% of infections had mixed (mutant/wild) type. The frequency of the mixed genotypes SVMNT-like_CVMNK and SVMNT-like_CVIET within Pfcrt gene was particularly low during bednet scale up. Their frequency increased significantly (P < 0.001) during the malaria upsurges. CONCLUSION This data demonstrated the effect of multiple interventions on the dynamics of drug resistance-associated mutations in the main malaria parasite P. falciparum in an endemic village in Senegal. Monitoring drug resistance markers should be conducted periodically to detect threats of emergence or resurgence that could compromise the efficacy of anti-malarial drugs.
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Affiliation(s)
- Amélé Nyedzie Wotodjo
- VITROME, UMR 257 IRD, Campus UCAD-IRD, Dakar, Senegal.
- Medical Research Council Unit, London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
| | - Mary Aigbiremo Oboh
- Medical Research Council Unit, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Biological Sciences, University of Medical Sciences, Ondo, Nigeria
- Department of Biomedical Sciences, Rochester Institute of Technology, Rochester, NY, USA
| | | | | | | | - Makhtar Niang
- Institut Pasteur de Dakar, 36 Avenue Pasteur, 220, Dakar, Senegal
| | - Jean-François Trape
- UMR MIVEGEC, Laboratoire de Paludologie et Zoologie Médicale, IRD, Dakar, Senegal
| | - Cheikh Sokhna
- VITROME, UMR 257 IRD, Campus UCAD-IRD, Dakar, Senegal
| | - Alfred Amambua-Ngwa
- Medical Research Council Unit, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Njiro BJ, Mutagonda RF, Chamani AT, Mwakyandile T, Sabas D, Bwire GM. Molecular surveillance of chloroquine-resistant Plasmodium falciparum in sub-Saharan African countries after withdrawal of chloroquine for treatment of uncomplicated malaria: a systematic review. J Infect Public Health 2022; 15:550-557. [DOI: 10.1016/j.jiph.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022] Open
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Muhoza P, Tine R, Faye A, Gaye I, Zeger SL, Diaw A, Gueye AB, Kante AM, Ruff A, Marx MA. A data quality assessment of the first four years of malaria reporting in the Senegal DHIS2, 2014-2017. BMC Health Serv Res 2022; 22:18. [PMID: 34974837 PMCID: PMC8722300 DOI: 10.1186/s12913-021-07364-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background As the global burden of malaria decreases, routine health information systems (RHIS) have become invaluable for monitoring progress towards elimination. The District Health Information System, version 2 (DHIS2) has been widely adopted across countries and is expected to increase the quality of reporting of RHIS. In this study, we evaluated the quality of reporting of key indicators of childhood malaria from January 2014 through December 2017, the first 4 years of DHIS2 implementation in Senegal. Methods Monthly data on the number of confirmed and suspected malaria cases as well as tests done were extracted from the Senegal DHIS2. Reporting completeness was measured as the number of monthly reports received divided by the expected number of reports in a given year. Completeness of indicator data was measured as the percentage of non-missing indicator values. We used a quasi-Poisson model with natural cubic spline terms of month of reporting to impute values missing at the facility level. We used the imputed values to take into account the percentage of malaria cases that were missed due to lack of reporting. Consistency was measured as the absence of moderate and extreme outliers, internal consistency between related indicators, and consistency of indicators over time. Results In contrast to public facilities of which 92.7% reported data in the DHIS2 system during the study period, only 15.3% of the private facilities used the reporting system. At the national level, completeness of facility reporting increased from 84.5% in 2014 to 97.5% in 2017. The percentage of expected malaria cases reported increased from 76.5% in 2014 to 94.7% in 2017. Over the study period, the percentage of malaria cases reported across all districts was on average 7.5% higher (P < 0.01) during the rainy season relative to the dry season. Reporting completeness rates were lower among hospitals compared to health centers and health posts. The incidence of moderate and extreme outlier values was 5.2 and 2.3%, respectively. The number of confirmed malaria cases increased by 15% whereas the numbers of suspected cases and tests conducted more than doubled from 2014 to 2017 likely due to a policy shift towards universal testing of pediatric febrile cases. Conclusions The quality of reporting for malaria indicators in the Senegal DHIS2 has improved over time and the data are suitable for use to monitor progress in malaria programs, with an understanding of their limitations. Senegalese health authorities should maintain the focus on broader adoption of DHIS2 reporting by private facilities, the sustainability of district-level data quality reviews, facility-level supervision and feedback mechanisms at all levels of the health system. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07364-6.
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Affiliation(s)
- Pierre Muhoza
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Roger Tine
- Département de Parasitologie, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Adama Faye
- Institut de Santé et Développement, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Ibrahima Gaye
- Institut de Santé et Développement, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Abdoulaye Diaw
- Direction de la Planification, de la Recherche et des Statistiques/ Division du Système d'Information Sanitaire et Sociale, Ministère de la Santé et de l'Action Sociale (MSAS), Dakar, Senegal
| | - Alioune Badara Gueye
- Programme National de Lutte Contre le Paludisme, Ministère de la Santé et de l'Action Sociale (MSAS), Dakar, Senegal
| | - Almamy Malick Kante
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Andrea Ruff
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Melissa A Marx
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Roux AT, Maharaj L, Oyegoke O, Akoniyon OP, Adeleke MA, Maharaj R, Okpeku M. Chloroquine and Sulfadoxine-Pyrimethamine Resistance in Sub-Saharan Africa-A Review. Front Genet 2021; 12:668574. [PMID: 34249090 PMCID: PMC8267899 DOI: 10.3389/fgene.2021.668574] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/20/2021] [Indexed: 12/20/2022] Open
Abstract
Malaria is a great concern for global health and accounts for a large amount of morbidity and mortality, particularly in Africa, with sub-Saharan Africa carrying the greatest burden of the disease. Malaria control tools such as insecticide-treated bed nets, indoor residual spraying, and antimalarial drugs have been relatively successful in reducing the burden of malaria; however, sub-Saharan African countries encounter great challenges, the greatest being antimalarial drug resistance. Chloroquine (CQ) was the first-line drug in the 20th century until it was replaced by sulfadoxine–pyrimethamine (SP) as a consequence of resistance. The extensive use of these antimalarials intensified the spread of resistance throughout sub-Saharan Africa, thus resulting in a loss of efficacy for the treatment of malaria. SP was replaced by artemisinin-based combination therapy (ACT) after the emergence of resistance toward SP; however, the use of ACTs is now threatened by the emergence of resistant parasites. The decreased selective pressure on CQ and SP allowed for the reintroduction of sensitivity toward those antimalarials in regions of sub-Saharan Africa where they were not the primary drug for treatment. Therefore, the emergence and spread of antimalarial drug resistance should be tracked to prevent further spread of the resistant parasites, and the re-emergence of sensitivity should be monitored to detect the possible reappearance of sensitivity in sub-Saharan Africa.
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Affiliation(s)
- Alexandra T Roux
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Leah Maharaj
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Olukunle Oyegoke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Oluwasegun P Akoniyon
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Matthew Adekunle Adeleke
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
| | - Rajendra Maharaj
- Office of Malaria Research, South African Medical Research Council, Cape Town, South Africa
| | - Moses Okpeku
- Discipline of Genetics, School of Life Sciences, University of KwaZulu-Natal, Westville, South Africa
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Kayode AT, Akano K, Ajogbasile FV, Uwanibe JN, Oluniyi PE, Bankole BE, Eromon PJ, Sowunmi A, Folarin OA, Volkman SK, McInnis B, Sabeti P, Wirth DF, Happi CT. Polymorphisms in Plasmodium falciparum chloroquine resistance transporter (Pfcrt) and multidrug-resistant gene 1 (Pfmdr-1) in Nigerian children 10 years post-adoption of artemisinin-based combination treatments. Int J Parasitol 2021; 51:301-310. [PMID: 33359205 PMCID: PMC7940560 DOI: 10.1016/j.ijpara.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/08/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022]
Abstract
The emergence and spread of Plasmodium falciparum parasites resistant to artemisinin derivatives and their partners in southeastern Asia threatens malaria control and elimination efforts, and heightens the need for an alternative therapy. We have explored the distribution of P. falciparum chloroquine resistance transporter (Pfcrt) and multidrug-resistant gene 1 (Pfmdr-1) haplotypes 10 years following adoption of artemisinin-based combination therapies in a bid to investigate the possible re-emergence of Chloroquine-sensitive parasites in Nigeria, and investigated the effect of these P. falciparum haplotypes on treatment outcomes of patients treated with artemisinin-based combination therapies. A total of 271 children aged <5 years with uncomplicated falciparum malaria were included in this study. Polymorphisms on codons 72-76 of the Pfcrt gene and codon 86 and 184 of Pfmdr-1 were determined using the high resolution melting assay. Of 240 (88.6%) samples successfully genotyped with HRM for Pfcrt, wildtype C72M74N75K76 (42.9%) and mutant C72I74E75T76 (53.8%) were observed. Also, wildtype N86Y184 (62.9%) and mutant N86F184 (21.1%), Y86Y184 (6.4%), and Y86F184 (0.4%) haplotypes of Pfmdr-1 were observed. Measures of responsiveness to ACTs were similar in children infected with P. falciparum crt haplotypes (C72I74E75T76 and C72M74N75K76) and major mdr-1 haplotypes (N86Y184, N86F184 and Y86Y184). Despite a 10 year gap since the malaria treatment policy changed to ACTs, over 50% of the P. falciparum parasites investigated in this study harboured the Chloroquine-resistant C72I74E75T76 haplotype, however this did not compromise the efficacy of artemisinin-based combination therapies. Should complete artemisinin resistance emerge from or spread to Nigeria, chloroquine might not be a good alternative therapy.
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Affiliation(s)
- Adeyemi T Kayode
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Kazeem Akano
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Fehintola V Ajogbasile
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Jessica N Uwanibe
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Paul E Oluniyi
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Bolajoko E Bankole
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Philomena J Eromon
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria
| | - Akintunde Sowunmi
- Institute of Medical Research and Training, College of Medicine, University of Ibadan; Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Onikepe A Folarin
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Sarah K Volkman
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | | | - Pardis Sabeti
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Dyann F Wirth
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Christian T Happi
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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6
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Oboh MA, Diongue K, Ndiaye D. High and persistent circulation of Plasmodium falciparum drug resistant isolates in Nigeria. SCIENTIFIC AFRICAN 2019. [DOI: 10.1016/j.sciaf.2019.e00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ocan M, Akena D, Nsobya S, Kamya MR, Senono R, Kinengyere AA, Obuku EA. Persistence of chloroquine resistance alleles in malaria endemic countries: a systematic review of burden and risk factors. Malar J 2019; 18:76. [PMID: 30871535 PMCID: PMC6419488 DOI: 10.1186/s12936-019-2716-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background Chloroquine, a previous highly efficacious, easy to use and affordable anti-malarial agent was withdrawn from malaria endemic regions due to high levels of resistance. This review collated evidence from published-reviewed articles to establish prevalence of Pfcrt 76T and Pfmdr-1 86Y alleles in malaria affected countries following official discontinuation of chloroquine use. Methods A review protocol was developed, registered in PROSPERO (#CRD42018083957) and published in a peer-reviewed journal. Article search was done in PubMed, Scopus, Lilacs/Vhl and Embase databases by two experienced librarians (AK, RS) for the period 1990-to-Febuary 2018. Mesh terms and Boolean operators (AND, OR) were used. Data extraction form was designed in Excel spread sheet 2007. Data extraction was done by three reviewers (NL, BB and MO), discrepancies were resolved by discussion. Random effects analysis was done in Open Meta Analyst software. Heterogeneity was established using I2-statistic. Results A total of 4721 citations were retrieved from article search (Pubmed = 361, Lilac/vhl = 28, Science Direct = 944, Scopus = 3388). Additional targeted search resulted in three (03) eligible articles. After removal of duplicates (n = 523) and screening, 38 articles were included in the final review. Average genotyping success rate was 63.6% (18,343/28,820) for Pfcrt K76T and 93.5% (16,232/17,365) for Pfmdr-1 86Y mutations. Prevalence of Pfcrt 76T was as follows; East Africa 48.9% (2528/5242), Southern Africa 18.6% (373/2163), West Africa 58.3% (3321/6608), Asia 80.2% (1951/2436). Prevalence of Pfmdr-1 86Y was; East Africa 32.4% (1447/5722), Southern Africa 36.1% (544/1640), West Africa 52.2% (1986/4200), Asia 46.4% (1276/2217). Over half, 52.6% (20/38) of included studies reported continued unofficial chloroquine use following policy change. Studies done in Madagascar and Kenya reported re-emergence of chloroquine sensitive parasites (IC50 < 30.9 nM). The average time (years) since discontinuation of chloroquine use to data collection was 8.7 ± 7.4. There was high heterogeneity (I2 > 95%). Conclusion The prevalence of chloroquine resistance alleles among Plasmodium falciparum parasites have steadily declined since discontinuation of chloroquine use. However, Pfcrt K76T and Pfmdr-1 N86Y mutations still persist at moderate frequencies in most malaria affected countries.
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Affiliation(s)
- Moses Ocan
- Department of Pharmacology & Therapeutics, Makerere University, P.O. Box 7072, Kampala, Uganda. .,Africa Centre for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Dickens Akena
- Department of Psychiatry, Makerere University, P.O. Box 7072, Kampala, Uganda.,Infectious Disease Institute, Makerere University, P. O. Box 22418, Kampala, Uganda
| | - Sam Nsobya
- Department of Medical Microbiology, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Moses R Kamya
- Department of Medicine, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Richard Senono
- Infectious Disease Institute, Makerere University, P. O. Box 22418, Kampala, Uganda.,Africa Centre for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Alison Annet Kinengyere
- Albert Cook Library, Makerere University, P.O. Box 7072, Kampala, Uganda.,Africa Centre for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Ekwaro A Obuku
- Clinical Epidemiology Unit, Department of Medicine, Makerere University, P.O. Box 7072, Kampala, Uganda.,Africa Centre for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Konaté A, Gnagne PA, Bédia-Tanoh VA, Amiah-Droh M, Tano DK, Ignace Eby Menan H, Yavo W. Low rates of Plasmodium falciparum Pfcrt K76T mutation in three sentinel sites of malaria monitoring in Côte d'Ivoire. Acta Parasitol 2018; 63:795-801. [PMID: 30367773 DOI: 10.1515/ap-2018-0096] [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: 04/12/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022]
Abstract
Despite efforts to eliminate it, malaria remains a major public health concern, particularly in Côte d'Ivoire. Chloroquine (CQ) was one of the first drugs used for its treatment, but was officially withdrawn from the market in 2007 following reports of high levels of chloroquine resistance. The present study was carried out after the withdrawal of CQ and provides an update on the rates of CQ resistance in Côte d'Ivoire. Samples were collected between September 2013 and March 2014 in Abidjan and from January to May 2016 in Abengourou and San Pedro through cross-sectional studies. Parasitemia was assessed by microscopy, and single nucleotide polymorphism in the Pfcrt (codon 76) gene was analyzed by nested PCR and restriction fragment length polymorphism. A total of 343 samples were analyzed: 119, 106 and 118 were from Abidjan, Abengourou, and San Pedro, respectively. The sex ratio of patients was 0.92. The mean age of patients enrolled was 9.6 years (SD = 10.8). The geometric mean of parasite density was 21,337 parasites/μL (SD = 49,508; range, 2,000-200,000). Molecular analysis revealed 57 K76T mutants (16.6%): 33, 9, and 15 in Abidjan, Abengourou and in San Pedro, respectively. Most of these were found in patients aged ≤15 years (42/57) who had parasitemia greater than 10,000 parasites/μL (40/57). This is the first study conducted in Côte d'Ivoire reporting a decline in Pfcrt K76T mutation rate. Thus, our results indicate the importance of following up on the observed trend also at a national level.
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Affiliation(s)
- Abibatou Konaté
- Department of Parasitology, Mycology, Animal Biology and, Zoology, Felix Houphouët-Boigny University, BPV 34,Abidjan, Côte d'Ivoire
- Malaria Research and Control Centre/National Institute of Public Health, Abidjan, Côte d'Ivoire, BPV 47,Abidjan, Côte d'Ivoire
| | - Paterne Akpa Gnagne
- Malaria Research and Control Centre/National Institute of Public Health, Abidjan, Côte d'Ivoire, BPV 47,Abidjan, Côte d'Ivoire
| | - Valérie Akoua Bédia-Tanoh
- Department of Parasitology, Mycology, Animal Biology and, Zoology, Felix Houphouët-Boigny University, BPV 34,Abidjan, Côte d'Ivoire
- Malaria Research and Control Centre/National Institute of Public Health, Abidjan, Côte d'Ivoire, BPV 47,Abidjan, Côte d'Ivoire
| | - Mireille Amiah-Droh
- Malaria Research and Control Centre/National Institute of Public Health, Abidjan, Côte d'Ivoire, BPV 47,Abidjan, Côte d'Ivoire
| | - Dominique Konan Tano
- Malaria Research and Control Centre/National Institute of Public Health, Abidjan, Côte d'Ivoire, BPV 47,Abidjan, Côte d'Ivoire
| | - Hervé Ignace Eby Menan
- Department of Parasitology, Mycology, Animal Biology and, Zoology, Felix Houphouët-Boigny University, BPV 34,Abidjan, Côte d'Ivoire
- Parasitology and Mycology Laboratory of the Diagnosis and Research Centre on AIDS and the others infectious diseases, 01 BPV 13,Abidjan, Côte d'Ivoire
| | - William Yavo
- Department of Parasitology, Mycology, Animal Biology and, Zoology, Felix Houphouët-Boigny University, BPV 34,Abidjan, Côte d'Ivoire
- Malaria Research and Control Centre/National Institute of Public Health, Abidjan, Côte d'Ivoire, BPV 47,Abidjan, Côte d'Ivoire
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9
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Dagnogo O, Ako AB, Ouattara L, Dago ND, Coulibaly DN, Touré AO, Djaman JA. Towards a re-emergence of chloroquine sensitivity in Côte d'Ivoire? Malar J 2018; 17:413. [PMID: 30404640 PMCID: PMC6223040 DOI: 10.1186/s12936-018-2551-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resistance of Plasmodium falciparum to anti-malarial drugs has hampered efforts to eradicate malaria. Recent reports of a decline in the prevalence of chloroquine-resistant P. falciparum in several countries, including Malawi and Zambia, is raising the hope of reintroducing chloroquine in the near future, ideally in combination with another anti-malarial drug for the treatment of uncomplicated malaria. In Côte d'Ivoire, the decrease in the clinical efficacy of chloroquine, in addition to a high proportion of clinical isolates carrying the Thr-76 mutant allele of the pfcrt gene, had led to the discontinuation of the use of chloroquine in 2004. Previous studies have indicated the persistence of a high prevalence of the Thr-76 mutant allele despite the withdrawal of chloroquine as first-line anti-malarial drug. This present study is conducted to determine the prevalence of the Thr-76T mutant allele of the Pfcrt gene after a decade of the ban on the sale and use of chloroquine in Côte d'Ivoire. RESULTS Analysis of the 64 sequences from all three study sites indicated a prevalence of 15% (10/64) of the Thr-76 mutant allele against 62% (40/64) of the Lys-76 wild-type allele. No mutation of the allele Thr-76 was observed at Anonkoua Kouté while this mutant allele was in 31% (5/16) and 25% (5/20) of isolate sequences from Port-Bouët and Ayamé respectively. CONCLUSION More than a decade after the discontinuation of the use of chloroquine in Côte d'Ivoire, the proportion of parasites sensitive to this anti-malarial seems to increase in Anonkoua-kouté, Port-bouët and Ayamé.
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Affiliation(s)
- Oléfongo Dagnogo
- UFR Biosciences, Félix Houphouët-Boigny University, BP V 34, Abidjan 01, Côte d'Ivoire.,Institut Pasteur of Côte d'Ivoire, 01 BP 490, Abidjan 01, Côte d'Ivoire
| | | | - Lacinan Ouattara
- Department of Food Science and Technology, Nangui Abrogoua University, 02 BP 801, Abidjan 02, Côte d'Ivoire
| | - Noel Dougba Dago
- UFR Sciences Biologiques, Péléforo Gon Coulibaly University, BP1328, Korhogo, Côte d'Ivoire
| | | | | | - Joseph Allico Djaman
- UFR Biosciences, Félix Houphouët-Boigny University, BP V 34, Abidjan 01, Côte d'Ivoire. .,Institut Pasteur of Côte d'Ivoire, 01 BP 490, Abidjan 01, Côte d'Ivoire.
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10
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Acharya A, Bansal D, Bharti PK, Khan FY, Abusalah S, Elmalik A, ElKhalifa M, Mohapatra PK, Mahanta J, Sehgal R, Singh N, Sultan AA. Molecular surveillance of chloroquine drug resistance markers (Pfcrt and Pfmdr1) among imported Plasmodium falciparum malaria in Qatar. Pathog Glob Health 2017; 112:57-62. [PMID: 29125042 DOI: 10.1080/20477724.2017.1399234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Imported malaria has been a great challenge for public health in Qatar due to influx of large number of migrant workers. Antimalarial drug resistance has emerged as one of the greatest challenges facing malaria control today. Monitoring parasite haplotypes that predict susceptibility to major antimalarial can guide treatment policies. This study aimed to determine molecular drug resistance pattern in imported malaria cases in Qatar. Blood samples from the uncomplicated P. falciparum malaria patients were collected at Hamad General Hospital, HMC, Doha, Qatar. The samples were further confirmed by nested-polymerase chain reaction (PCR) for P. falciparum. Molecular markers of chloroquine (Pfcrt and Pfmdr1) were analyzed by using nested PCR- RFLP method to determine the key point mutations associated with chloroquine (CQ) drug resistance. A total 118 blood samples were positive for P. falciparum. Overall, by RFLP, 72% harboured wild type allele (N86) of Pfmdr1 gene. The prevalence of Pfcrt mutant (T76), WT (K76) and mixed alleles (K76T) was 63.6% (n = 75), 22.9% (n = 27) and 13.5% (n = 16), respectively. Mean parasitaemia level was higher among the wild type alleles of Pfcrt gene as compared to the mixed/mutant alleles whereas mixed alleles of Pfmdr1 gene having high parasitaemia. Molecular surveillance strategy based on imported malaria cases can be used to detect and track CQ drug-resistant malaria. The data presented here might be helpful for enrichment of molecular surveillance of antimalarial resistance and will be useful for developing and updating antimalarial guidance for non-immune imported cases in Qatar.
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Affiliation(s)
- Anushree Acharya
- a Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University , Qatar Foundation - Education City , Doha , Qatar
| | - Devendra Bansal
- a Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University , Qatar Foundation - Education City , Doha , Qatar
| | - Praveen K Bharti
- b National Institute for Research in Tribal Health, Indian Council of Medical Research , Jabalpur , India
| | - Fahmi Y Khan
- c Department of Medicine , Hamad General Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Salem Abusalah
- d Department of Emergency Medicine , Hamad General Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Ashraf Elmalik
- d Department of Emergency Medicine , Hamad General Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Mohammed ElKhalifa
- e Department of Laboratory Medicine and Pathology , Hamad General Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Pradyumna K Mohapatra
- f Regional Medical Research Centre, NE , Indian Council of Medical Research , Dibrugarh , India
| | - Jagadish Mahanta
- f Regional Medical Research Centre, NE , Indian Council of Medical Research , Dibrugarh , India
| | - Rakesh Sehgal
- g Department of Parasitology , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Neeru Singh
- b National Institute for Research in Tribal Health, Indian Council of Medical Research , Jabalpur , India
| | - Ali A Sultan
- a Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Cornell University , Qatar Foundation - Education City , Doha , Qatar
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11
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Ndiaye M, Sow D, Nag S, Sylla K, Tine RC, Ndiaye JL, Lo AC, Gaye O, Faye B, Alifrangis M. Country-Wide Surveillance of Molecular Markers of Antimalarial Drug Resistance in Senegal by Use of Positive Malaria Rapid Diagnostic Tests. Am J Trop Med Hyg 2017; 97:1593-1596. [PMID: 29140232 PMCID: PMC5817740 DOI: 10.4269/ajtmh.17-0021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/16/2017] [Indexed: 11/22/2022] Open
Abstract
In Senegal, antimalarial drugs used in treatment and prevention of malaria are one of the main reasons for the current success in controlling malaria. However, the successful control of malaria is highly dependent on continued effectiveness of these drugs which may be compromised by the spread of drug resistance. Therefore, surveillance of drug resistance in the malaria parasites is essential. The objective of this pilot study was to test the feasibility of routinely sampled malaria rapid diagnostic tests (RDTs) at a national scale to assess the temporal changes in the molecular profiles of antimalarial drug resistance markers of Plasmodium falciparum parasites. Overall, 9,549 positive malaria RDTs were collected from 14 health facilities across the country. A limited random set of RDTs were analyzed regarding Pfcrt gene polymorphisms at codon 72-76. Overall, a high but varied prevalence (> 50%) of the wild-type CVMNK haplotype was observed including a higher CVMNK prevalence in the northern part (75%) compared with the southern part of the country (59%). With caution, the study provides a proof of concept that reuse of discarded P. falciparum positive RDTs can be applied in large-scale surveillance of antimalarial drug resistance.
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Affiliation(s)
- Magatte Ndiaye
- Service de Parasitologie–Mycologie, Faculté de Médecine, Université Cheikh Anta DIOP, Dakar, Sénégal
| | - Doudou Sow
- Service de Parasitologie–Mycologie, Faculté de Médecine, Université Cheikh Anta DIOP, Dakar, Sénégal
| | - Sidsel Nag
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Disease, Copenhagen University Hospital, Copenhagen, Denmark
| | - Khadime Sylla
- Service de Parasitologie–Mycologie, Faculté de Médecine, Université Cheikh Anta DIOP, Dakar, Sénégal
| | - Roger Clement Tine
- Service de Parasitologie–Mycologie, Faculté de Médecine, Université Cheikh Anta DIOP, Dakar, Sénégal
| | - Jean Louis Ndiaye
- Service de Parasitologie–Mycologie, Faculté de Médecine, Université Cheikh Anta DIOP, Dakar, Sénégal
| | - Aminata Collé Lo
- Service de Parasitologie–Mycologie, Faculté de Médecine, Université Cheikh Anta DIOP, Dakar, Sénégal
| | - Oumar Gaye
- Service de Parasitologie–Mycologie, Faculté de Médecine, Université Cheikh Anta DIOP, Dakar, Sénégal
| | - Babacar Faye
- Service de Parasitologie–Mycologie, Faculté de Médecine, Université Cheikh Anta DIOP, Dakar, Sénégal
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Disease, Copenhagen University Hospital, Copenhagen, Denmark
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12
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Baruah UK, Gowthamarajan K, Ravisankar V, Karri VVSR, Simhadri PK, Singh V. Optimisation of chloroquine phosphate loaded nanostructured lipid carriers using Box–Behnken design and its antimalarial efficacy. J Drug Target 2017; 26:576-591. [DOI: 10.1080/1061186x.2017.1390671] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Uday Krishna Baruah
- Department of Pharmaceutics, JSS College of Pharmacy, Affiliated to Jagadguru Sri Shivarathreeswara University-Mysuru, Ootacamund, Tamil Nadu, India
| | - Kuppusamy Gowthamarajan
- Department of Pharmaceutics, JSS College of Pharmacy, Affiliated to Jagadguru Sri Shivarathreeswara University-Mysuru, Ootacamund, Tamil Nadu, India
| | - Vanka Ravisankar
- Department of Pharmaceutics, JSS College of Pharmacy, Affiliated to Jagadguru Sri Shivarathreeswara University-Mysuru, Ootacamund, Tamil Nadu, India
| | | | - Praveen Kumar Simhadri
- Department of Biotechnology and Bioinformatics, School of life Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - Vineeta Singh
- National Institute of Malaria Research (ICMR), Dwarka, New Delhi, India
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13
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Reteng P, Vrisca V, Sukarno I, Djarkoni IH, Kalangi JA, Jacobs GE, Runtuwene LR, Eshita Y, Maeda R, Suzuki Y, Mongan AE, Warouw SM, Yamagishi J, Tuda J. Genetic polymorphisms in Plasmodium falciparum chloroquine resistance genes, pfcrt and pfmdr1, in North Sulawesi, Indonesia. BMC Res Notes 2017; 10:147. [PMID: 28376874 PMCID: PMC5379540 DOI: 10.1186/s13104-017-2468-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 03/24/2017] [Indexed: 01/25/2023] Open
Abstract
Background Malaria still poses one of the major threats to human health. Development of effective antimalarial drugs has decreased this threat; however, the emergence of drug-resistant Plasmodium falciparum, a cause of Malaria, is disconcerting. The antimalarial drug chloroquine has been effectively used, but resistant parasites have spread worldwide. Interestingly, the withdrawal of the drug reportedly leads to an increased population of susceptible parasites in some cases. We examined the prevalence of genomic polymorphisms in a malaria parasite P. falciparum, associated with resistance to an antimalarial drug chloroquine, after the withdrawal of the drug from Indonesia. Results Blood samples were collected from 95 malaria patients in North Sulawesi, Indonesia, in 2010. Parasite DNA was extracted and analyzed by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) for pfcrt and pfmdr1. In parallel, multiplex amplicon sequencing for the same genes was carried out with Illumina MiSeq. Of the 59 cases diagnosed as P. falciparum infection by microscopy, PCR–RFLP analysis clearly identified the genotype 76T in pfcrt in 44 cases. Sequencing analysis validated the identified genotypes in the 44 cases and demonstrated that the haplotype in the surrounding genomic region was exclusively SVMNT. Results of pfmdr1 were successfully obtained for 51 samples, where the genotyping results obtained by the two methods were completely consistent. In pfmdr1, the 86Y mutant genotype was observed in 45 cases (88.2%). Conclusions Our results suggest that the prevalence of the mutated genotypes remained dominant even 6 years after the withdrawal of chloroquine from this region. Diversified haplotype of the resistance-related locus, potentially involved in fitness costs, unauthorized usage of chloroquine, and/or a short post-withdrawal period may account for the observed high persistence of prevalence. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2468-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick Reteng
- Department of Medicine, Sam Ratulangi University, Kampus Unsrat, Bahu, Manado, 95115, Indonesia
| | - Visia Vrisca
- Department of Medicine, Sam Ratulangi University, Kampus Unsrat, Bahu, Manado, 95115, Indonesia
| | - Inka Sukarno
- Department of Medicine, Sam Ratulangi University, Kampus Unsrat, Bahu, Manado, 95115, Indonesia
| | - Ilham Habib Djarkoni
- Department of Medicine, Sam Ratulangi University, Kampus Unsrat, Bahu, Manado, 95115, Indonesia
| | - Jane Angela Kalangi
- Department of Medicine, Sam Ratulangi University, Kampus Unsrat, Bahu, Manado, 95115, Indonesia
| | - George Eduardo Jacobs
- Department of Medicine, Sam Ratulangi University, Kampus Unsrat, Bahu, Manado, 95115, Indonesia
| | - Lucky Ronald Runtuwene
- Department of Medical Genome Sciences, University of Tokyo, Kashiwa, Chiba, 277-8562, Japan
| | - Yuki Eshita
- Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan.,Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.,Research Center for Zoonosis Control, Hokkaido University, North 20, West 10 Kita-ku, Sapporo, Hokkaido, 001-0020, Japan
| | - Ryuichiro Maeda
- Department of Human Sciences, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, 080-8555, Japan
| | - Yutaka Suzuki
- Department of Medical Genome Sciences, University of Tokyo, Kashiwa, Chiba, 277-8562, Japan
| | - Arthur Elia Mongan
- Department of Medicine, Sam Ratulangi University, Kampus Unsrat, Bahu, Manado, 95115, Indonesia
| | - Sarah Maria Warouw
- Department of Medicine, Sam Ratulangi University, Kampus Unsrat, Bahu, Manado, 95115, Indonesia
| | - Junya Yamagishi
- Research Center for Zoonosis Control, Hokkaido University, North 20, West 10 Kita-ku, Sapporo, Hokkaido, 001-0020, Japan. .,Global Station for Zoonosis Control, GI-CoRE, Hokkaido University, North 20, West 10 Kita-ku, Sapporo, Hokkaido, 001-0020, Japan.
| | - Josef Tuda
- Department of Medicine, Sam Ratulangi University, Kampus Unsrat, Bahu, Manado, 95115, Indonesia
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14
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Kateera F, Nsobya SL, Tukwasibwe S, Hakizimana E, Mutesa L, Mens PF, Grobusch MP, van Vugt M, Kumar N. Molecular surveillance of Plasmodium falciparum drug resistance markers reveals partial recovery of chloroquine susceptibility but sustained sulfadoxine-pyrimethamine resistance at two sites of different malaria transmission intensities in Rwanda. Acta Trop 2016; 164:329-336. [PMID: 27647575 PMCID: PMC10600949 DOI: 10.1016/j.actatropica.2016.09.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 09/01/2016] [Accepted: 09/05/2016] [Indexed: 12/23/2022]
Abstract
Faced with intense levels of chloroquine (CQ) resistance in Plasmodium falciparum malaria, Rwanda replaced CQ with amodiaquine (AQ)+sulfadoxine-pyrimethamine (SP) in 2001, and subsequently with artemether-lumefantrine (AL) in 2006, as first-line treatments for uncomplicated malaria. Following years of discontinuation of CQ use, re-emergence of CQ-susceptible parasites has been reported in countries including Malawi, Kenya and Tanzania. In contrast, high levels of SP resistant mutant parasites continue to be reported even in countries of presumed reduced SP drug selection pressure. The prevalence and distributions of genetic polymorphisms linked with CQ and SP resistance at two sites of different malaria transmission intensities are described here to better understand drug-related genomic adaptations over time and exposure to varying drug pressures in Rwanda. Using filter paper blood isolates collected from P. falciparum infected patients, DNA was extracted and a nested PCR performed to identify resistance-mediating polymorphisms in the pfcrt, pfmdr1, pfdhps and pfdhfr genes. Amplicons from a total of 399 genotyped samples were analysed by ligase detection reaction fluorescent microsphere assay. CQ susceptible pfcrt 76K and pfmdr1 86N wild-type parasites were found in about 50% and 81% of isolates, respectively. Concurrently, SP susceptible pfdhps double (437G-540E), pfdhfr triple (108N-51I-59R), quintuple pfdhps 437G-540E/pfdhfr 51I-59R-108N and sextuple haplotypes were found in about 84%, 85%, 74% and 18% of isolates, respectively. High-level SP resistance associated pfdhfr 164L and pfdhps 581G mutant prevalences were noted to decline. Mutations pfcrt 76T, pfdhfr 59R and pfdhfr 164L were found differentially distributed between the two study sites with the pfdhfr 164L mutants found only at Ruhuha site, eastern Rwanda. Overall, sustained intense levels of SP resistance mutations and a recovery of CQ susceptible parasites were found in this study following 7 years and 14 years of drug withdrawal from use, respectively. Most likely, the sustained high prevalence of resistant parasites is due to the use of DHFR/DHPS inhibitors like trimethoprim-sulfamethoxazole (TS) for the treatment of and prophylaxis against bacterial infections among HIV infected individuals as well as the continued use of IPTp-SP within the East and Central African regions for malaria prevention among pregnant women. With regard to CQ, the slow recovery of CQ susceptible parasites may have been caused partly by the continued use of CQ and/or CQ mimicking antimalarial drugs like AQ in spite of policies to withdraw it from Rwanda and the neighbouring countries of Uganda and Tanzania. Continued surveillance of P. falciparum CQ and SP associated polymorphisms is recommended for guiding future rational drug policy-making and mitigation of future risk of anti-malaria drug resistance development.
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Affiliation(s)
- Fredrick Kateera
- Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda; Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
| | - Sam L Nsobya
- Molecular Research Laboratory, Infectious Disease Research Collaboration (IDRC), New Mulago Hospital Complex, PO Box 7051, Kampala, Uganda; School of Biomedical Science, College of Medicine, Makerere University, Uganda.
| | - Steven Tukwasibwe
- Molecular Research Laboratory, Infectious Disease Research Collaboration (IDRC), New Mulago Hospital Complex, PO Box 7051, Kampala, Uganda.
| | - Emmanuel Hakizimana
- Medical Research Centre Division, Rwanda Biomedical Centre, PO Box 7162, Kigali, Rwanda; Malaria & Other Parasitic Diseases Division, Rwanda Biomedical Centre, Kigali, Rwanda.
| | - Leon Mutesa
- College of Medicine & Health Sciences, University of Rwanda, PO Box 3286, Kigali, Rwanda.
| | - Petra F Mens
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands; Royal Tropical Institute/Koninklijk Instituutvoor de Tropen, KIT Biomedical Research, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands.
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
| | - Michèle van Vugt
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
| | - Nirbhay Kumar
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Vector-Borne Infectious Disease Research Centre, Tulane University, 333S Liberty Street, Mail code 8317, New Orleans, LA 70112, United States.
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15
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Mbaye A, Dieye B, Ndiaye YD, Bei AK, Muna A, Deme AB, Yade MS, Diongue K, Gaye A, Ndiaye IM, Ndiaye T, Sy M, Diallo MA, Badiane AS, Ndiaye M, Seck MC, Sy N, Koita O, Krogstad DJ, Nwakanma D, Ndiaye D. Selection of N86F184D1246 haplotype of Pfmrd1 gene by artemether-lumefantrine drug pressure on Plasmodium falciparum populations in Senegal. Malar J 2016; 15:433. [PMID: 27562216 PMCID: PMC5000460 DOI: 10.1186/s12936-016-1490-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/16/2016] [Indexed: 01/06/2023] Open
Abstract
Background The use of artemisinin as a monotherapy resulted in the emergence of artemisinin resistance in 2005 in Southeast Asia. Monitoring of artemisinin combination therapy (ACT) is critical in order to detect and prevent the spread of resistance in endemic areas. Ex vivo studies and genotyping of molecular markers of resistance can be used as part of this routine monitoring strategy. One gene that has been associated in some ACT partner drug resistance is the Plasmodium falciparum multidrug resistance protein 1 (pfmdr1) gene. The purpose of this study was to assess the drug susceptibility of P. falciparum populations from Thiès, Senegal by ex vivo assay and typing molecular markers of resistance to drug components of ACT currently used for treatment. Methods The ex vivo susceptibility of 170 P. falciparum isolates to chloroquine, amodiaquine, lumefantrine, artesunate, and artemether was determined using the DAPI ex vivo assay. The high resolution melting technique was used to genotype the pfmdr1 gene at codons 86, 184 and 1246. Results A significant decrease in IC50 values was observed between 2012 and 2013: from 13.84 to 6.484 for amodiaquine, 173.4 to 113.2 for lumefantrine, and 39.72 to 18.29 for chloroquine, respectively. Increase of the wild haplotype NYD and the decrease of the mutant haplotype NFD (79 and 62.26 %) was also observed. A correlation was observed between the wild type allele Y184 in pfmdr1 and higher IC50 for all drugs, except amodiaquine. Conclusion This study has shown an increase in sensitivity over the span of two transmission seasons, marked by an increase in the WT alleles at pfmdr1. Continuous the monitoring of the ACT used for treatment of uncomplicated malaria will be helpful.
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Affiliation(s)
- Aminata Mbaye
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal.
| | - Baba Dieye
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Yaye D Ndiaye
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Amy K Bei
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal.,Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | | | - Awa B Deme
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Mamadou S Yade
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Khadim Diongue
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Amy Gaye
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Ibrahima M Ndiaye
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Tolla Ndiaye
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Mouhamad Sy
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Mamadou A Diallo
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Aida S Badiane
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Mouhamadou Ndiaye
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Mame C Seck
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | - Ngayo Sy
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal
| | | | | | | | - Daouda Ndiaye
- Laboratory of Parasitology/Mycology HALD, Cheikh Anta Diop University of Dakar, PO Box 5005, Dakar, Senegal.,Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
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16
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Dieye B, Affara M, Sangare L, Joof F, Ndiaye YD, Gomis JF, Ndiaye M, Mbaye A, Diakite M, Sy N, Mbengue B, Deme AB, Daniels R, Ahouidi AD, Dieye T, Abdullahi A, Doumbia S, Ndiaye JL, Diarra A, Ismaela A, Coulibaly M, Welty C, Ngwa AA, Shaffer J, D'Alessandro U, Volkman SK, Wirth DF, Krogstad DJ, Koita O, Nwakanma D, Ndiaye D. West Africa International Centers of Excellence for Malaria Research: Drug Resistance Patterns to Artemether-Lumefantrine in Senegal, Mali, and The Gambia. Am J Trop Med Hyg 2016; 95:1054-1060. [PMID: 27549635 DOI: 10.4269/ajtmh.16-0053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/29/2016] [Indexed: 01/09/2023] Open
Abstract
In 2006, artemether-lumefantrine (AL) became the first-line treatment of uncomplicated malaria in Senegal, Mali, and the Gambia. To monitor its efficacy, between August 2011 and November 2014, children with uncomplicated Plasmodium falciparum malaria were treated with AL and followed up for 42 days. A total of 463 subjects were enrolled in three sites (246 in Senegal, 97 in Mali, and 120 in Gambia). No early treatment failure was observed and malaria infection cleared in all patients by day 3. Polymerase chain reaction (PCR)-adjusted adequate clinical and parasitological response (ACPR) was 100% in Mali, and the Gambia, and 98.8% in Senegal. However, without PCR adjustment, ACPR was 89.4% overall; 91.5% in Mali, 98.8% in Senegal, and 64.3% in the Gambia (the lower value in the Gambia attributed to poor compliance of the full antimalarial course). However, pfmdr1 mutations were prevalent in Senegal and a decrease in parasite sensitivity to artesunate and lumefantrine (as measured by ex vivo drug assay) was observed at all sites. Recrudescent parasites did not show Kelch 13 (K13) mutations and AL remains highly efficacious in these west African sites.
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Affiliation(s)
- Baba Dieye
- Cheikh Anta Diop University, Dakar, Senegal
| | | | | | | | | | | | | | | | | | - Ngayo Sy
- Cheikh Anta Diop University, Dakar, Senegal
| | | | - Awa B Deme
- Cheikh Anta Diop University, Dakar, Senegal
| | - Rachel Daniels
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | - Umberto D'Alessandro
- Medical Research Council, The Gambia.,London School of Hygiene and Tropical Medicine, London, United Kingdom.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Sarah K Volkman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Simmons College School of Nursing and Health Sciences, Boston, Massachusetts
| | - Dyann F Wirth
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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17
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Thelingwani R, Leandersson C, Bonn B, Smith P, Chibale K, Masimirembwa C. Characterisation of artemisinin–chloroquinoline hybrids for potential metabolic liabilities. Xenobiotica 2015; 46:234-40. [DOI: 10.3109/00498254.2015.1070975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Cui L, Mharakurwa S, Ndiaye D, Rathod PK, Rosenthal PJ. Antimalarial Drug Resistance: Literature Review and Activities and Findings of the ICEMR Network. Am J Trop Med Hyg 2015; 93:57-68. [PMID: 26259943 PMCID: PMC4574275 DOI: 10.4269/ajtmh.15-0007] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 04/27/2015] [Indexed: 11/07/2022] Open
Abstract
Antimalarial drugs are key tools for the control and elimination of malaria. Recent decreases in the global malaria burden are likely due, in part, to the deployment of artemisinin-based combination therapies. Therefore, the emergence and potential spread of artemisinin-resistant parasites in southeast Asia and changes in sensitivities to artemisinin partner drugs have raised concerns. In recognition of this urgent threat, the International Centers of Excellence for Malaria Research (ICEMRs) are closely monitoring antimalarial drug efficacy and studying the mechanisms underlying drug resistance. At multiple sentinel sites of the global ICEMR network, research activities include clinical studies to track the efficacies of antimalarial drugs, ex vivo/in vitro assays to measure drug susceptibilities of parasite isolates, and characterization of resistance-mediating parasite polymorphisms. Taken together, these efforts offer an increasingly comprehensive assessment of the efficacies of antimalarial therapies, and enable us to predict the emergence of drug resistance and to guide local antimalarial drug policies. Here we briefly review worldwide antimalarial drug resistance concerns, summarize research activities of the ICEMRs related to drug resistance, and assess the global impacts of the ICEMR programs.
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Affiliation(s)
- Liwang Cui
- *Address correspondence to Liwang Cui, Department of Entomology, Pennsylvania State University, 501 ASI Building, University Park, PA 16802, E-mail: or Philip J. Rosenthal, Department of Medicine, Box 0811, University of California, San Francisco, CA 94110. E-mail:
| | | | | | | | - Philip J. Rosenthal
- *Address correspondence to Liwang Cui, Department of Entomology, Pennsylvania State University, 501 ASI Building, University Park, PA 16802, E-mail: or Philip J. Rosenthal, Department of Medicine, Box 0811, University of California, San Francisco, CA 94110. E-mail:
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Morris U, Xu W, Msellem MI, Schwartz A, Abass A, Shakely D, Cook J, Bhattarai A, Petzold M, Greenhouse B, Ali AS, Björkman A, Fröberg G, Mårtensson A. Characterising temporal trends in asymptomatic Plasmodium infections and transporter polymorphisms during transition from high to low transmission in Zanzibar, 2005-2013. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2015; 33:110-7. [PMID: 25917493 PMCID: PMC10445533 DOI: 10.1016/j.meegid.2015.04.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/14/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Improved understanding of the asymptomatic malaria parasite reservoir is a prerequisite to pursue malaria elimination efforts. We therefore characterised temporal trends and transporter polymorphisms in asymptomatic Plasmodium infections during the transition from high to low transmission in Zanzibar. METHODS Healthy individuals participating in cross-sectional surveys conducted 2005-2013 were screened for asymptomatic malaria by PCR. Complexity/diversity of infection and transporter polymorphisms were assessed in Plasmodium falciparum positive samples. Symptomatic samples were included for comparison of polymorphisms in 2013. RESULTS PCR-determined parasite prevalence declined from 21.1% (CI95% 17.4-24.9) to 2.3% (CI95% 1.7-2.9) from 2005 to 2013. P. falciparum remained the predominant species; prevalence was highest in children and young adults aged 5-25 years. Parasite densities and complexity of infection, but not population genetic diversity of P. falciparum, decreased from 2005-2009. pfcrt 76T (99.2-64.7%, p < 0.001) and pfmdr1 86Y frequencies (89.4-66.7%, p = 0.03) decreased over time. Pfmdr1 (a.a.86,184,1246) YYY and YYD haplotypes were more frequent in asymptomatic than symptomatic infections in 2013 (p < 0.001). CONCLUSIONS There is a declining, albeit persistent, reservoir of parasites present at low-densities in asymptomatic individuals in Zanzibar. This study revealed important characteristics of the remaining parasite population, including intriguing temporal trends in molecular markers associated with antimalarial resistance, which need to be further investigated.
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Affiliation(s)
- Ulrika Morris
- Malaria Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
| | - Weiping Xu
- Malaria Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Mwinyi I Msellem
- Zanzibar Malaria Elimination Programme (ZAMEP), Ministry of Health, Zanzibar, Tanzania
| | - Alanna Schwartz
- Department of Medicine, University of California San Francisco, CA, USA
| | - Ali Abass
- Zanzibar Malaria Elimination Programme (ZAMEP), Ministry of Health, Zanzibar, Tanzania
| | - Delér Shakely
- Malaria Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Kungälv Hospital, Kungälv, Sweden
| | - Jackie Cook
- Malaria Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Zanzibar Malaria Elimination Programme (ZAMEP), Ministry of Health, Zanzibar, Tanzania
| | - Achuyt Bhattarai
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Max Petzold
- Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, CA, USA
| | - Abdullah S Ali
- Zanzibar Malaria Elimination Programme (ZAMEP), Ministry of Health, Zanzibar, Tanzania
| | - Anders Björkman
- Malaria Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Gabrielle Fröberg
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Mårtensson
- Malaria Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Sweden
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Temporal trends in prevalence of Plasmodium falciparum drug resistance alleles over two decades of changing antimalarial policy in coastal Kenya. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2014; 4:152-63. [PMID: 25516825 PMCID: PMC4266795 DOI: 10.1016/j.ijpddr.2014.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 12/17/2022]
Abstract
Genomic changes in malaria parasites over 2 decades of drug pressure were assessed. Chloroquine-sensitive and antifolate-resistant parasite populations rose over time. Steady increases in pfmdr1_N86 and D1246 alleles noted after chloroquine removal. Chloroquine-sensitive parasites 15 years after its removal are highly heterogeneous. Temporal genomic data helps audit the efficacy of withdrawn drugs and those in use.
Molecular surveillance of drug resistance markers through time provides crucial information on genomic adaptations, especially in parasite populations exposed to changing drug pressures. To assess temporal trends of established genotypes associated with tolerance to clinically important antimalarials used in Kenya over the last two decades, we sequenced a region of the pfcrt locus encompassing codons 72–76 of the Plasmodium falciparum chloroquine resistance transporter, full-length pfmdr1 – encoding multi-drug resistance protein, P-glycoprotein homolog (Pgh1) and pfdhfr encoding dihydrofolate reductase, in 485 archived Plasmodium falciparum positive blood samples collected in coastal Kenya at four different time points between 1995 and 2013. Microsatellite loci were also analyzed to compare the genetic backgrounds of parasite populations circulating before and after the withdrawal of chloroquine and sulfadoxine/pyrimethamine. Our results reveal a significant increase in the prevalence of the pfcrt K76 wild-type allele between 1995 and 2013 from 38% to 81.7% (p < 0.0001). In contrast, we noted a significant decline in wild-type pfdhfr S108 allele (p < 0.0001) culminating in complete absence of this allele in 2013. We also observed a significant increase in the prevalence of the wild-type pfmdr1 N86/Y184/D1246 haplotype from 14.6% in 1995 to 66.0% in 2013 (p < 0.0001) and a corresponding decline of the mutant pfmdr1 86Y/184Y/1246Y allele from 36.4% to 0% in 19 years (p < 0.0001). We also show extensive genetic heterogeneity among the chloroquine-sensitive parasites before and after the withdrawal of the drug in contrast to a selective sweep around the triple mutant pfdhfr allele, leading to a mono-allelic population at this locus. These findings highlight the importance of continual surveillance and characterization of parasite genotypes as indicators of the therapeutic efficacy of antimalarials, particularly in the context of changes in malaria treatment policy.
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Ursing J, Eksborg S, Rombo L, Bergqvist Y, Blessborn D, Rodrigues A, Kofoed PE. Chloroquine is grossly under dosed in young children with malaria: implications for drug resistance. PLoS One 2014; 9:e86801. [PMID: 24466245 PMCID: PMC3900653 DOI: 10.1371/journal.pone.0086801] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/13/2013] [Indexed: 01/09/2023] Open
Abstract
Background Plasmodium falciparum malaria is treated with 25 mg/kg of chloroquine (CQ) irrespective of age. Theoretically, CQ should be dosed according to body surface area (BSA). The effect of dosing CQ according to BSA has not been determined but doubling the dose per kg doubled the efficacy of CQ in children aged <15 years infected with P. falciparum carrying CQ resistance causing genes typical for Africa. The study aim was to determine the effect of age on CQ concentrations. Methods and Findings Day 7 whole blood CQ concentrations were determined in 150 and 302 children treated with 25 and 50 mg/kg, respectively, in previously conducted clinical trials. CQ concentrations normalised for the dose taken in mg/kg of CQ decreased with decreasing age (p<0.001). CQ concentrations normalised for dose taken in mg/m2 were unaffected by age. The median CQ concentration in children aged <2 years taking 50 mg/kg and in children aged 10–14 years taking 25 mg/kg were 825 (95% confidence interval [CI] 662–988) and 758 (95% CI 640–876) nmol/l, respectively (p = 0.67). The median CQ concentration in children aged 10–14 taking 50 mg/kg and children aged 0–2 taking 25 mg/kg were 1521 and 549 nmol/l. Adverse events were not age/concentration dependent. Conclusions CQ is under-dosed in children and should ideally be dosed according to BSA. Children aged <2 years need approximately double the dose per kg to attain CQ concentrations found in children aged 10–14 years. Clinical trials assessing the efficacy of CQ in Africa are typically performed in children aged <5 years. Thus the efficacy of CQ is typically assessed in children in whom CQ is under dosed. Approximately 3 fold higher drug concentrations can probably be safely given to the youngest children. As CQ resistance is concentration dependent an alternative dosing of CQ may overcome resistance in Africa.
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Affiliation(s)
- Johan Ursing
- Projecto de Saúde de Bandim, Indepth Network, Bissau, Guinea-Bissau
- Malaria Research Laboratory, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Staffan Eksborg
- Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rombo
- Malaria Research Laboratory, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research, Sörmland, Uppsala University, Sweden
| | | | - Daniel Blessborn
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Poul-Erik Kofoed
- Projecto de Saúde de Bandim, Indepth Network, Bissau, Guinea-Bissau
- Department of Paediatrics, Kolding Hospital, Kolding, Denmark
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Mharakurwa S, Sialumano M, Liu K, Scott A, Thuma P. Selection for chloroquine-sensitive Plasmodium falciparum by wild Anopheles arabiensis in Southern Zambia. Malar J 2013; 12:453. [PMID: 24354640 PMCID: PMC3878239 DOI: 10.1186/1475-2875-12-453] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/17/2013] [Indexed: 11/20/2022] Open
Abstract
Background The emergence of parasite drug resistance, especially Plasmodium falciparum, persists as a major obstacle for malaria control and elimination. To develop effective public health containment strategies, a clear understanding of factors that govern the emergence and spread of resistant parasites in the field is important. The current study documents selection for chloroquine-sensitive malaria parasites by wild Anopheles arabiensis in southern Zambia. Methods In a 2,000-sq km region, mosquitoes were collected from human sleeping rooms using pyrethrum spray catches during the 2006 malaria transmission season. After morphological examination and molecular confirmation, vector mosquitoes were dissected to separate head and thorax from the abdominal section, followed by PCR screening for P. falciparum infection. Human residents of all ages were tested for P. falciparum parasitaemia by microscopy and PCR. Plasmodium falciparum infections were genotyped at the chloroquine resistance-conferring amino acid codon 76 of the PfCRT gene, using PCR and restriction enzyme digestion. Results In the human population there was nearly 90% prevalence of the chloroquine-resistant PfCRT K76T mutant, with no significant differences in polymorphism among smear-positive and smear-negative (submicroscopic) infections (p = 0.323, n = 128). However, infections in both abdominal and salivary gland phases of the An. arabiensis vector exhibited wild type K76-bearing parasites with up to 9X higher odds (OR (95% CI): 9 (3.7-20.2), p < 0.0005, n = 125), despite having been acquired from humans within a few weeks. Conclusions Anopheles arabiensis selects for wild-type K76-bearing P. falciparum during both abdominal and salivary gland phases of parasite development. The rapid vectorial selection, also recently seen with antifolate resistance, is evidence for parasite fitness cost in the mosquito, and may underpin regional heterogeneity in the emergence, spread and waning of drug resistance. Understanding the nature and direction of vector selection could be instrumental for rational curtailment of the spread of drug resistance in integrated malaria control and elimination programmes.
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Van Tyne D, Dieye B, Valim C, Daniels RF, Sène PD, Lukens AK, Ndiaye M, Bei AK, Ndiaye YD, Hamilton EJ, Ndir O, Mboup S, Volkman SK, Wirth DF, Ndiaye D. Changes in drug sensitivity and anti-malarial drug resistance mutations over time among Plasmodium falciparum parasites in Senegal. Malar J 2013; 12:441. [PMID: 24314037 PMCID: PMC3924193 DOI: 10.1186/1475-2875-12-441] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria treatment efforts are hindered by the rapid emergence and spread of drug resistant parasites. Simple assays to monitor parasite drug response in direct patient samples (ex vivo) can detect drug resistance before it becomes clinically apparent, and can inform changes in treatment policy to prevent the spread of resistance. METHODS Parasite drug responses to amodiaquine, artemisinin, chloroquine and mefloquine were tested in approximately 400 Plasmodium falciparum malaria infections in Thiès, Senegal between 2008 and 2011 using a DAPI-based ex vivo drug resistance assay. Drug resistance-associated mutations were also genotyped in pfcrt and pfmdr1. RESULTS Parasite drug responses changed between 2008 and 2011, as parasites became less sensitive to amodiaquine, artemisinin and chloroquine over time. The prevalence of known resistance-associated mutations also changed over time. Decreased amodiaquine sensitivity was associated with sustained, highly prevalent mutations in pfcrt, and one mutation in pfmdr1 - Y184F - was associated with decreased parasite sensitivity to artemisinin. CONCLUSIONS Directly measuring ex vivo parasite drug response and resistance mutation genotyping over time are useful tools for monitoring parasite drug responses in field samples. Furthermore, these data suggest that the use of amodiaquine and artemisinin derivatives in combination therapies is selecting for increased drug tolerance within this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Dyann F Wirth
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston 02115, USA.
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Gharbi M, Flegg JA, Pradines B, Berenger A, Ndiaye M, Djimdé AA, Roper C, Hubert V, Kendjo E, Venkatesan M, Brasseur P, Gaye O, Offianan AT, Penali L, Le Bras J, Guérin PJ, Study MOTFNRCFIM. Surveillance of travellers: an additional tool for tracking antimalarial drug resistance in endemic countries. PLoS One 2013; 8:e77775. [PMID: 24204960 PMCID: PMC3813754 DOI: 10.1371/journal.pone.0077775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/04/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There are growing concerns about the emergence of resistance to artemisinin-based combination therapies (ACTs). Since the widespread adoption of ACTs, there has been a decrease in the systematic surveillance of antimalarial drug resistance in many malaria-endemic countries. The aim of this work was to test whether data on travellers returning from Africa with malaria could serve as an additional surveillance system of local information sources for the emergence of drug resistance in endemic-countries. METHODOLOGY Data were collected from travellers with symptomatic Plasmodium falciparum malaria returning from Senegal (n = 1,993), Mali (n = 2,372), Cote d'Ivoire (n = 4,778) or Cameroon (n = 3,272) and recorded in the French Malaria Reference Centre during the period 1996-2011. Temporal trends of the proportion of parasite isolates that carried the mutant genotype, pfcrt 76T, a marker of resistance to chloroquine (CQ) and pfdhfr 108N, a marker of resistance to pyrimethamine, were compared for travellers and within-country surveys that were identified through a literature review in PubMed. The in vitro response to CQ was also compared between these two groups for parasites from Senegal. RESULTS The trends in the proportion of parasites that carried pfcrt 76T, and pfdhfr 108N, were compared for parasites from travellers and patients within-country using the slopes of the curves over time; no significant differences in the trends were found for any of the 4 countries. These results were supported by in vitro analysis of parasites from the field in Senegal and travellers returning to France, where the trends were also not significantly different. CONCLUSION The results have not shown different trends in resistance between parasites derived from travellers or from parasites within-country. This work highlights the value of an international database of drug responses in travellers as an additional tool to assess the emergence of drug resistance in endemic areas where information is limited.
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Affiliation(s)
- Myriam Gharbi
- Unité Mixte de Recherche 216, Institut de Recherche et de Développement, Paris, France
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Paris, France
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Ecole des Hautes Etudes en Santé Publique, Sorbonne Paris Cité, Rennes, France
| | - Jennifer A. Flegg
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Centre for Tropical Medicine & Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Bruno Pradines
- Département d’Infectiologie de Terrain, Institut de Recherche Biomédicale des Armées, Marseille, France
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Aix Marseille Université, Marseille, France
- Centre National de Référence du Paludisme, Marseille, France
| | - Ako Berenger
- Malariology Department, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Magatte Ndiaye
- Service de parasitologie, Faculté de Médecine et Pharmacie Université Cheikh Anta Diop, Dakar, Sénégal
| | - Abdoulaye A. Djimdé
- Malaria Research and Training Center & Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Cally Roper
- Pathogen Molecular Biology Department of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Véronique Hubert
- Centre National de Référence du Paludisme & Service de Parasitologie Mycologie, CHU Bichat-Claude Bernard APHP, Paris, France
| | - Eric Kendjo
- Centre National de Référence du Paludisme and Service de Parasitologie Mycologie, CHU Pitié-Salpétrière APHP, Paris, France
| | - Meera Venkatesan
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Philippe Brasseur
- UMR 198, Institut de Recherche pour le Développement, Dakar, Sénégal
| | - Oumar Gaye
- Service de parasitologie, Faculté de Médecine et Pharmacie Université Cheikh Anta Diop, Dakar, Sénégal
| | - André T. Offianan
- Malariology Department, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Louis Penali
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
| | - Jacques Le Bras
- Unité Mixte de Recherche 216, Institut de Recherche et de Développement, Paris, France
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Paris, France
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Centre National de Référence du Paludisme & Service de Parasitologie Mycologie, CHU Bichat-Claude Bernard APHP, Paris, France
| | - Philippe J. Guérin
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Ecole des Hautes Etudes en Santé Publique, Sorbonne Paris Cité, Rennes, France
- Centre for Tropical Medicine & Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- UMR S 707: Epidemiology Information Systems Modeling, INSERM and Université Pierre et Marie-Curie-Paris6, Paris, France
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Lödige M, Lewis MD, Paulsen ES, Esch HL, Pradel G, Lehmann L, Brun R, Bringmann G, Mueller AK. A primaquine-chloroquine hybrid with dual activity against Plasmodium liver and blood stages. Int J Med Microbiol 2013; 303:539-47. [PMID: 23992634 DOI: 10.1016/j.ijmm.2013.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 07/01/2013] [Accepted: 07/14/2013] [Indexed: 10/26/2022] Open
Abstract
We present a new class of hybrid molecules consisting of the established antiplasmodial drugs primaquine and chloroquine. No drug is known to date that acts comparably against all stages of Plasmodium in its life cycle. Starting from available precursors, we designed and synthesized a new-generation compound consisting of both primaquine and chloroquine components, with the intent to produce agents that exhibit bioactivity against different stages of the parasite's life cycle. In vitro, the hybrid molecule 3 displays activity against both asexual and sexual P. falciparum blood stages as well as P. berghei sporozoites and liver stages. In vivo, the hybrid elicits activity against P. berghei liver and blood stages. Our results successfully validate the concept of utilizing one compound to combine different modes of action that attack different Plasmodium stages in the mammalian host. It is our hope that the novel design of such compounds will outwit the pathogen in the spread of drug resistance. Based on the optimized synthetic pathway, the compound is accessible in a smooth and versatile way and open for potential further molecular modification.
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Affiliation(s)
- Melanie Lödige
- Institute of Organic Chemistry, University of Wuerzburg, Am Hubland, D-97074 Wuerzburg, Germany
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Chloroquine: modes of action of an undervalued drug. Immunol Lett 2013; 153:50-7. [PMID: 23891850 DOI: 10.1016/j.imlet.2013.07.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 12/30/2022]
Abstract
For more than two decades, chloroquine (CQ) was largely and deliberately used as first choice drug for malaria treatment. However, worldwide increasing cases of resistant strains of Plasmodium have hampered its use. Nevertheless, CQ has recently been tested as adjunct therapy in several inflammatory situations, such as rheumatoid arthritis and transplantation procedures, presenting intriguing and promising results. In this review, we discuss recent findings and CQ mechanisms of action vis-à-vis its use as a broad adjunct therapy.
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Gadalla NB, Abdallah TM, Atwal S, Sutherland CJ, Adam I. Selection of pfdhfr/pfdhps alleles and declining artesunate/sulphadoxine-pyrimethamine efficacy against Plasmodium falciparum eight years after deployment in eastern Sudan. Malar J 2013; 12:255. [PMID: 23870667 PMCID: PMC3720549 DOI: 10.1186/1475-2875-12-255] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 07/16/2013] [Indexed: 12/20/2022] Open
Abstract
Background Artesunate/sulphadoxine-pyrimethamine (AS/SP) has been the first-line treatment for falciparum malaria in Sudan since 2004. The impact of this combination on anti-malarial resistance-associated molecular markers has not been investigated. In this study, an evaluation of the efficacy and prevalence of drug resistance alleles (pfcrt, pfmdr1, pfdhfr and pfdhps) eight years after the adoption of AS/SP in eastern Sudan is reported. Methods A 28-day follow-up efficacy trial of AS/SP was conducted in eastern Sudan during the 2012 transmission season. Blood smears were collected from patients on days 0, 1, 2, 3, 7, 14, 21 and 28. Blood spots on filter paper were obtained pre-treatment and on the day the patient was parasite positive by microscopy. Genotyping of alleles was performed by qPCR (pfcrt 72–76 and pfmdr1 copy number) and direct sequencing of pfmdr1, pfdhfr and pfdhps. Results Sixty-three patients out of 68 (93%) completed the 28-day follow-up, adequate clinical, and parasitological response occurred in 90.5% and 85.3% of the patients in the per-protocol and intent-to-treat analyses, respectively. PCR corrected per-protocol efficacy was 93.7%. The enrolment prevalence of pfcrt-CVMNK was 30.2% and pfmdr1-N86 was 40.3%. The pfmdr1 haplotype NFD occurred in 32.8% of pre-treatment samples and was significantly higher than previous reports (Fisher’s exact p = 0.0001). The pfdhfr-51I/108N combination occurred in all sequenced isolates and 59R was observed in a single individual. pfdhps substitutions 436A, 437G, 540E, 581G and 613S were observed at 7.8, 77.3, 76.9%, 33.8% and 0.0%, respectively. Treatment failures were associated with the pfdhps haplotype SGEGA at these five codons (OR 7.3; 95% CI 0.65 - 368; p = 0.048). Conclusion The decrease of CQR associated genotypes reflects the formal policy of complete removal of CQ in Sudan. However, the frequency of markers associated with SP failure is increasing in this study area and may be contributing to the treatment efficacy falling below 90%. Further monitoring of AS/SP efficacy and of post-treatment selection of pfdhfr and pfdhps alleles in vivo is required to inform future treatment guidelines.
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Affiliation(s)
- Nahla B Gadalla
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK.
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Fall B, Pascual A, Sarr FD, Wurtz N, Richard V, Baret E, Diémé Y, Briolant S, Bercion R, Wade B, Tall A, Pradines B. Plasmodium falciparum susceptibility to anti-malarial drugs in Dakar, Senegal, in 2010: an ex vivo and drug resistance molecular markers study. Malar J 2013; 12:107. [PMID: 23510258 PMCID: PMC3606842 DOI: 10.1186/1475-2875-12-107] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 03/10/2013] [Indexed: 11/18/2022] Open
Abstract
Background In 2006, the Senegalese National Malaria Control Programme recommended artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. Since the introduction of ACT, there have been very few reports on the level of resistance of P. falciparum to anti-malarial drugs. To determine whether parasite susceptibility has been affected by the new anti-malarial policies, an ex vivo susceptibility and drug resistance molecular marker study was conducted on local isolates obtained from the Centre de santé Elizabeth Diouf (Médina, Dakar, Senegal). Methods The prevalence of genetic polymorphisms in genes associated with anti-malarial drug resistance, i.e., pfcrt, pfdhfr, pfdhps and pfmdr1, were evaluated for a panel of 165 isolates collected from patients recruited from 17 August 2010 to 6 January 2011. The malaria isolates were assessed for susceptibility to chloroquine (CQ); quinine (QN); monodesethylamodiaquine (MDAQ), the active metabolite of amodiaquine; mefloquine (MQ); lumefantrine (LMF); dihydroartemisinin (DHA), the active metabolite of artemisinin derivatives; and doxycycline (DOX) using the Plasmodium lactate dehydrogenase (pLDH) ELISA. Results The prevalence of the in vitro resistant isolates, or isolates with reduced susceptibility, was 62.1% for MQ, 24.2% for CQ, 10.3% for DOX, 11.8% MDAQ, 9.7% for QN, 2.9% for LMF and 0% for DHA. The Pfcrt 76T mutation was identified in 43.6% of the samples. The pfmdr1 86Y, 184F and 1246Y mutations were found in 16.2%, 50.0% and 1.6% of the samples, respectively. The pfdhfr 108N, 51I and 59R mutations were identified in 81.9%, 77.4% and 79.4% of the samples, respectively. The double mutant (108N and 51I) was detected in 75.5% of the isolates, and the triple mutant (108N, 51I and 59R) was detected in 73.6% of the isolates. The pfdhps 437G, 436A and 613S mutations were found in 54.4%, 38.6% and 1.2% of the samples, respectively. There was only one double mutant, 437G and 540E, and one quintuple mutant, pfdhfr 108N, 51I and 59R and pfdhps 437G and 540E. The prevalence of the quadruple mutant (pfdhfr 108N, 51I and 59R and pfdhps 437G) was 36.7%. Conclusions The results of this study indicate that an intensive surveillance of the in vitro P. falciparum susceptibility to anti-malarial drugs must be conducted in Senegal.
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Affiliation(s)
- Bécaye Fall
- Laboratoire d'étude de la chimiosensibilité du paludisme, Fédération des laboratoires, Hôpital Principal de Dakar, Dakar, Sénégal
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Thomsen TT, Madsen LB, Hansson HH, Tomás EVE, Charlwood D, Bygbjerg IC, Alifrangis M. Rapid selection of Plasmodium falciparum chloroquine resistance transporter gene and multidrug resistance gene-1 haplotypes associated with past chloroquine and present artemether-lumefantrine use in Inhambane District, southern Mozambique. Am J Trop Med Hyg 2013; 88:536-41. [PMID: 23382159 DOI: 10.4269/ajtmh.12-0525] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Chloroquine (CQ) use in Mozambique was stopped in 2002 and artemether-lumefantrine (AL) was implemented in 2008. In light of no use of CQ and extensive use of AL, we determined the frequency of molecular markers of Plasmodium falciparum drug resistance/tolerance to CQ and AL in persons living in Linga-Linga, an isolated peninsula and in Furvela village, which is located 8 km inland. The P. falciparum chloroquine resistance transporter gene CVMNK wild type increased in frequency from 43.9% in 2009 to 66.4% in 2010 (P ≤ 0.001), and combined P. falciparum multidrug resistance gene 1 N86-184F-D1246 haplotype increased significantly between years (P = 0.039). The combination of P. falciparum chloroquine resistance transporter gene CVMNK and P. falciparum multidrug resistance gene NFD increased from 24.3% (2009) to 45.3% in (2010, P = 0.017). The rapid changes observed may largely be caused by decreased use of CQ and large-scale use of AL. In the absence of a clear AL-resistance marker and the (almost) continent-wide use of AL in sub-Saharan Africa, and when considering CQ reintroduction, continued monitoring of these markers is needed.
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Affiliation(s)
- Thomas T Thomsen
- Section for Functional Genomics, Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, 2200 Copenhagen N, Denmark.
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Gharbi M, Flegg JA, Hubert V, Kendjo E, Metcalf JE, Bertaux L, Guérin PJ, Le Bras J, Aboubaca A, Agnamey P, Angoulvant A, Barbut P, Basset D, Belkadi G, Bellanger AP, Bemba D, Benoit-Vica F, Berry A, Bigel ML, Bonhomme J, Botterel F, Bouchaud O, Bougnoux ME, Bourée P, Bourgeois N, Branger C, Bret L, Buret B, Casalino E, Chevrier S, Conquere de Monbrison F, Cuisenier B, Danis M, Darde ML, De Gentile L, Delarbre JM, Delaunay P, Delaval A, Desoubeaux G, Develoux M, Dunand J, Durand R, Eloy O, Fauchet N, Faugere B, Faye A, Fenneteau O, Flori P, Fontrouge M, Garabedian C, Gayandrieu F, Godineau N, Houzé P, Houzé S, Hurst JP, Ichou H, Lachaud L, Lebuisson A, Lefevre M, LeGuern AS, Le Moal G, Lusina D, Machouart MC, Malvy D, Matheron S, Maubon D, Mechali D, Megarbane B, Menard G, Millon L, Aiach MM, Minodier P, Morelle C, Nevez G, Parola P, Parzy D, Patey O, Patoz P, Penn P, Perignon A, Picot S, Pilo JE, Poilane I, Pons D, Poupart M, Pradines B, Raffenot D, Rapp C, Receveur MC, Sarfati C, Senghor Y, Simon F, Siriez JY, Taudon N, Thellier M, Thouvenin M, Toubas D. Longitudinal study assessing the return of chloroquine susceptibility of Plasmodium falciparum in isolates from travellers returning from West and Central Africa, 2000-2011. Malar J 2013; 12:35. [PMID: 23351608 PMCID: PMC3583707 DOI: 10.1186/1475-2875-12-35] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/19/2013] [Indexed: 11/10/2022] Open
Abstract
Background Chloroquine (CQ) was the main malaria therapy worldwide from the 1940s until the 1990s. Following the emergence of CQ-resistant Plasmodium falciparum, most African countries discontinued the use of CQ, and now promote artemisinin-based combination therapy as the first-line treatment. This change was generally initiated during the last decade in West and Central Africa. The aim of this study is to describe the changes in CQ susceptibility in this African region, using travellers returning from this region as a sentinel system. Methods The study was conducted by the Malaria National Reference Centre, France. The database collated the pfcrtK76T molecular marker for CQ susceptibility and the in vitro response to CQ of parasites from travellers’ isolates returning from Senegal, Mali, Ivory Coast or Cameroon. As a proxy of drug pressure, data regarding CQ intake in febrile children were collated for the study period. Logistic regression models were used to detect trends in the proportions of CQ resistant isolates. Results A total of 2874 parasite isolates were genotyped between 2000–2011. The prevalence of the pfcrt76T mutant genotype significantly decreased for Senegal (from 78% to 47%), Ivory Coast (from 63% to 37%), Cameroon (from 90% to 59%) and remained stable for Mali. The geometric mean of the 50% inhibitory concentration (IC50) of CQ in vitro susceptibility and the proportion of resistant isolates (defining resistance as an IC50 value > 100 nM) significantly decreased for Senegal (from 86 nM (59%) to 39 nM (25%)), Mali (from 84 nM (50%) to 51 nM (31%)), Ivory Coast (from 75 nM (59%) to 29 nM (16%)) and Cameroon (from 181 nM (75%) to 51 nM (37%)). Both analyses (molecular and in vitro susceptibility) were performed for the 2004–2011 period, after the four countries had officially discontinued CQ and showed an accelerated decline of the resistant isolates for the four countries. Meanwhile, CQ use among children significantly deceased in this region (fixed effects slope = −0.3, p < 10-3). Conclusions An increase in CQ susceptibility following official withdrawal of the drug was observed in travellers returning from West and Central African countries. The same trends were observed for molecular and in vitro analysis between 2004-2011and they correlated to the decrease of the drug pressure.
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Affiliation(s)
- Myriam Gharbi
- Mère et enfant face aux infections tropicales, IRD unité mixte de recherche 216, Université Paris Descartes-Paris V, 4 avenue de l'Observatoire, Paris Cedex 06 75270, France.
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