1
|
Antinori S, Giacomelli A, Casalini G, Ridolfo AL. How to manage adult patients with malaria in the non-endemic setting. Clin Microbiol Infect 2024; 30:1374-1383. [PMID: 38960312 DOI: 10.1016/j.cmi.2024.06.021] [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: 02/11/2024] [Revised: 06/16/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The diagnosis and management of malaria in non-endemic countries presents a continuing challenge. Plasmodium falciparum, which is capable of rapidly inducing severe and life-threatening multiorgan disease, is the species most frequently diagnosed in Europe and North America. OBJECTIVES To summarise the more relevant diagnostic findings and clinical features of malaria observed in non-endemic settings and to provide an update of the key management decision points using three illustrative clinical scenarios of uncomplicated and severe malaria. SOURCES The discussion is based on a relevant literature search spanning the last 20 years. Recommendations are based on available clinical guidelines including those of the WHO, observational studies conducted in non-endemic settings, and, when available, extrapolation from randomised studies from malaria-endemic settings. CONTENT The following topics are covered: diagnosis, including the use of molecular biology; clinical characteristics; management with a specific focus on complicated (severe) and uncomplicated malaria; and areas of resistance to available antimalarial drugs. IMPLICATIONS Malaria imported to non-endemic settings, especially P. falciparum malaria, is sometimes initially overlooked and the delayed diagnosis is responsible for every year of preventable deaths. This review aims to raise awareness of malaria outside endemic countries and to provide clinicians with a practical guide for efficient diagnosis and targeted therapy for the different species involved.
Collapse
Affiliation(s)
- Spinello Antinori
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy.
| | - Andrea Giacomelli
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Giacomo Casalini
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| |
Collapse
|
2
|
Ribeiro GDJG, Rei Yan SL, Palmisano G, Wrenger C. Plant Extracts as a Source of Natural Products with Potential Antimalarial Effects: An Update from 2018 to 2022. Pharmaceutics 2023; 15:1638. [PMID: 37376086 DOI: 10.3390/pharmaceutics15061638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 06/29/2023] Open
Abstract
Malaria kills more than 500,000 people yearly, mainly affecting Africa and Southeast Asia. The disease is caused by the protozoan parasite from the genus Plasmodium, with Plasmodium vivax and Plasmodium falciparum being the main species that cause the disease in humans. Although substantial progress has been observed in malaria research in the last years, the threat of the spread of Plasmodium parasites persists. Artemisinin-resistant strains of this parasite have been reported mainly in Southeast Asia, highlighting the urgent need to develop more effective and safe antimalarial drugs. In this context, natural sources, mainly from flora, remain underexplored antimalarial spaces. The present mini-review explores this space focusing on plant extracts and some of their isolated natural products with at least in vitro antiplasmodial effects reported in the literature comprising the last five years (2018-2022).
Collapse
Affiliation(s)
- Giovane de Jesus Gomes Ribeiro
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Sun Liu Rei Yan
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Giuseppe Palmisano
- GlycoProteomics Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Carsten Wrenger
- Unit for Drug Discovery, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| |
Collapse
|
3
|
Motta V, Verdenelli S, Sparavelli R, L'Episcopia M, Severini C, Bruschi F, Fabiani S, Mangano V. Artesunate and dihydroartemisinin-piperaquine treatment failure in a severe Plasmodium falciparum malaria case imported from Republic of Côte d'Ivoire. Int J Infect Dis 2022; 122:352-355. [PMID: 35691551 DOI: 10.1016/j.ijid.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
A 68-year-old man returning from Republic of Côte d'Ivoire (Ivory Coast) was diagnosed with severe Plasmodium falciparum malaria and treated with intravenous artesunate followed by oral dihydroartemisinin-piperaquine (DHA-PPQ). A month later the patient experienced a new P. falciparum episode; analysis of pfmsp-1 and pfmsp-2 revealed that the infection was caused by a genetic strain identical to the strain that caused the initial episode, indicating resurgence of the previous infection. No mutations in genes associated with resistance to artemisinin derivatives (pfk13) or piperaquine (pfexonuclease, pfplasmepsin 2/3) were detected, suggesting that treatment failure could have been caused by drug malabsorption or poor drug manufacturing practices. A second treatment with atovaquone-proguanil was successful in eliminating the infection, with no further relapses. To our knowledge, this is the first description of a treatment failure with both artesunate and DHA-PPQ in a traveler returning from a malaria-endemic region. Analysis of molecular markers of resistance to antimalarial drugs revealed mutations associated with resistance to sulfadoxine (pfdhps) and pyrimethamine (pfdhfr), highlighting the important contribution of surveillance of imported malaria cases to the monitoring of drug resistance globally.
Collapse
Affiliation(s)
- Vincenzo Motta
- Dipartimento di Ricerca Traslazionale e Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
| | - Stefano Verdenelli
- Unità Operativa Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Rebecca Sparavelli
- Dipartimento di Ricerca Traslazionale e Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
| | | | - Carlo Severini
- Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Roma, Italy
| | - Fabrizio Bruschi
- Dipartimento di Ricerca Traslazionale e Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy; Programma Monitoraggio delle Parassitosi, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Silvia Fabiani
- Unità Operativa Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
| | - Valentina Mangano
- Dipartimento di Ricerca Traslazionale e Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy; Sezione Dipartimentale di Microbiologia Universitaria, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
| |
Collapse
|
4
|
Marwa K, Kapesa A, Baraka V, Konje E, Kidenya B, Mukonzo J, Kamugisha E, Swedberg G. Therapeutic efficacy of artemether-lumefantrine, artesunate-amodiaquine and dihydroartemisinin-piperaquine in the treatment of uncomplicated Plasmodium falciparum malaria in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2022; 17:e0264339. [PMID: 35271592 PMCID: PMC8912261 DOI: 10.1371/journal.pone.0264339] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa has the highest burden of malaria in the world. Artemisinin-based combination therapies (ACTs) have been the cornerstone in the efforts to reduce the global burden of malaria. In the effort to facilitate early detection of resistance for artemisinin derivatives and partner drugs, WHO recommends monitoring of ACT's efficacy in the malaria endemic countries. The present systematic meta-analysis study summarises the evidence of therapeutic efficacy of the commonly used artemisinin-based combinations for the treatment of uncomplicated P. falciparum malaria in Sub-Saharan Africa after more than a decade since the introduction of the drugs. METHODS Fifty two studies carried out from 2010 to 2020 on the efficacy of artemether-lumefantrine or dihydro-artemisinin piperaquine or artesunate amodiaquine in patients with uncomplicated P. falciparum malaria in Sub-Saharan Africa were searched for using the Google Scholar, Cochrane Central Register of controlled trials (CENTRAL), PubMed, Medline, LILACS, and EMBASE online data bases. Data was extracted by two independent reviewers. Random analysis effect was performed in STATA 13. Heterogeneity was established using I2 statistics. RESULTS Based on per protocol analysis, unadjusted cure rates in malaria infected patients treated with artemether-lumefantrine (ALU), artesunate-amodiaquine (ASAQ) and dihydroartemisinin-piperaquine (DHP) were 89%, 94% and 91% respectively. However, the cure rates after PCR correction were 98% for ALU, 99% for ASAQ and 99% for DHP. CONCLUSION The present meta-analysis reports the overall high malaria treatment success for artemether-lumefantrine, artesunate-amodiaquine and dihydroartemisinin-piperaquine above the WHO threshold value in Sub-Saharan Africa.
Collapse
Affiliation(s)
- Karol Marwa
- Department of Pharmacology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Anthony Kapesa
- Department of Community Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Vito Baraka
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Evelyne Konje
- Department of Epidemiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson Kidenya
- Department of Biochemistry, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Jackson Mukonzo
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda
| | - Erasmus Kamugisha
- Department of Biochemistry, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Gote Swedberg
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
5
|
Delandre O, Gendrot M, Fonta I, Mosnier J, Benoit N, Amalvict R, Gomez N, Madamet M, Pradines B. Prevalence of Mutations in the pfcoronin Gene and Association with Ex Vivo Susceptibility to Common Quinoline Drugs against Plasmodium falciparum. Pharmaceutics 2021; 13:pharmaceutics13081273. [PMID: 34452235 PMCID: PMC8400718 DOI: 10.3390/pharmaceutics13081273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/10/2021] [Accepted: 08/15/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Artemisinin-based combination therapy (ACT) was recommended to treat uncomplicated falciparum malaria. Unlike the situation in Asia where resistance to ACT has been reported, artemisinin resistance has not yet emerged in Africa. However, some rare failures with ACT or patients continuing to be parasitaemic on day 3 after ACT treatment have been reported in Africa or in travellers returning from Africa. Three mutations (G50E, R100K, and E107V) in the pfcoronin gene could be responsible for artemisinin resistance in Africa. Methods: The aims of this study were first to determine the prevalence of mutations in the pfcoronin gene in African P. falciparum isolates by Sanger sequencing, by targeting the 874 samples collected from patients hospitalised in France after returning from endemic areas in Africa between 2018 and 2019, and secondly to evaluate their association with in vitro reduced susceptibility to standard quinoline antimalarial drugs, including chloroquine, quinine, mefloquine, desethylamodiaquine, lumefantrine, piperaquine, and pyronaridine. Results: The three mutations in the pfcoronin gene (50E, 100K, and 107V) were not detected in the 874 P. falciparum isolates. Current data show that another polymorphism (P76S) is present in many countries of West Africa (mean prevalence of 20.7%) and Central Africa (11.9%) and, rarely, in East Africa (4.2%). This mutation does not appear to be predictive of in vitro reduced susceptibility to quinolines, including artemisinin derivative partners in ACT such as amodiaquine, lumefantrine, piperaquine, pyronaridine, and mefloquine. Another mutation (V62M) was identified at low prevalence (overall prevalence of 1%). Conclusions: The 76S mutation is present in many African countries with a prevalence above 10%. It is reassuring that this mutation does not confer in vitro resistance to ACT partners.
Collapse
Affiliation(s)
- Océane Delandre
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 13005 Marseille, France; (O.D.); (M.G.); (I.F.); (J.M.); (N.B.); (R.A.); (N.G.); (M.M.)
- Aix Marseille University, IRD, SSA, AP-HM, VITROME, 13005 Marseille, France
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Mathieu Gendrot
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 13005 Marseille, France; (O.D.); (M.G.); (I.F.); (J.M.); (N.B.); (R.A.); (N.G.); (M.M.)
- Aix Marseille University, IRD, SSA, AP-HM, VITROME, 13005 Marseille, France
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Isabelle Fonta
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 13005 Marseille, France; (O.D.); (M.G.); (I.F.); (J.M.); (N.B.); (R.A.); (N.G.); (M.M.)
- Aix Marseille University, IRD, SSA, AP-HM, VITROME, 13005 Marseille, France
- IHU Méditerranée Infection, 13005 Marseille, France
- Centre National de Référence du Paludisme, 13005 Marseille, France
| | - Joel Mosnier
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 13005 Marseille, France; (O.D.); (M.G.); (I.F.); (J.M.); (N.B.); (R.A.); (N.G.); (M.M.)
- Aix Marseille University, IRD, SSA, AP-HM, VITROME, 13005 Marseille, France
- IHU Méditerranée Infection, 13005 Marseille, France
- Centre National de Référence du Paludisme, 13005 Marseille, France
| | - Nicolas Benoit
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 13005 Marseille, France; (O.D.); (M.G.); (I.F.); (J.M.); (N.B.); (R.A.); (N.G.); (M.M.)
- Aix Marseille University, IRD, SSA, AP-HM, VITROME, 13005 Marseille, France
- IHU Méditerranée Infection, 13005 Marseille, France
- Centre National de Référence du Paludisme, 13005 Marseille, France
| | - Rémy Amalvict
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 13005 Marseille, France; (O.D.); (M.G.); (I.F.); (J.M.); (N.B.); (R.A.); (N.G.); (M.M.)
- Aix Marseille University, IRD, SSA, AP-HM, VITROME, 13005 Marseille, France
- IHU Méditerranée Infection, 13005 Marseille, France
- Centre National de Référence du Paludisme, 13005 Marseille, France
| | - Nicolas Gomez
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 13005 Marseille, France; (O.D.); (M.G.); (I.F.); (J.M.); (N.B.); (R.A.); (N.G.); (M.M.)
- Aix Marseille University, IRD, SSA, AP-HM, VITROME, 13005 Marseille, France
- IHU Méditerranée Infection, 13005 Marseille, France
| | - Marylin Madamet
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 13005 Marseille, France; (O.D.); (M.G.); (I.F.); (J.M.); (N.B.); (R.A.); (N.G.); (M.M.)
- Aix Marseille University, IRD, SSA, AP-HM, VITROME, 13005 Marseille, France
- IHU Méditerranée Infection, 13005 Marseille, France
- Centre National de Référence du Paludisme, 13005 Marseille, France
| | - Bruno Pradines
- Unité Parasitologie et Entomologie, Département Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, 13005 Marseille, France; (O.D.); (M.G.); (I.F.); (J.M.); (N.B.); (R.A.); (N.G.); (M.M.)
- Aix Marseille University, IRD, SSA, AP-HM, VITROME, 13005 Marseille, France
- IHU Méditerranée Infection, 13005 Marseille, France
- Centre National de Référence du Paludisme, 13005 Marseille, France
- Correspondence: ; Tel.: +33-4-13-73-22-31
| |
Collapse
|
6
|
L'Episcopia M, Bartoli TA, Corpolongo A, Mariano A, D'Abramo A, Vulcano A, Paglia MG, Perrotti E, Menegon M, Nicastri E, Severini C. Artemisinin resistance surveillance in African Plasmodium falciparum isolates from imported malaria cases to Italy. J Travel Med 2021; 28:6028740. [PMID: 33295621 DOI: 10.1093/jtm/taaa231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Plasmodium falciparum (P. falciparum) malaria is a significant public health problem in returning travellers, and artemisinin combination therapy (ACT) remains the first choice for treatment. Several single nucleotide polymorphisms (SNPs) in the P. falciparum kelch 13 (Pfk13) gene have been associated with artemisinin (ART) resistance. Moreover, the increase in the P. falciparum plasmepsin 2 (Pfpm2) gene copy number was shown to be linked with reduced susceptibility of P. falciparum to piperaquine (PPQ), a partner drug in an ACT regimen. Active molecular surveillance for imported drug-resistant malaria parasites is a pivotal activity to provide adequate chemoprophylaxis and treatment guidelines. METHODS A retrospective study to review imported P. falciparum malaria in patients admitted to Spallanzani Institute between 2014 and 2015 was conducted. Information collected included clinic and epidemiological characteristics such as age, gender, country of origin, time since arrival to our country, travel history. All P.falciparum isolates were analysed for SNPs in the Pfk13 gene and for copy number variations in the Pfpm2 gene. RESULTS P. falciparum malaria was identified in 54 travellers. The mean age was 37 years, 44 were males. All cases were imported from non-EU countries. In the Pfk13 gene two mutations (R561R and F673L) were detected. Six P. falciparum isolates carried two copies of Pfpm2 gene, and one three copies, representing ≈16% of the analysed isolates. CONCLUSIONS None of the SNPs known to be associated with ART resistance were detected in the examined parasites. Our results provide evidence that Pfpm2 duplications (associated with piperaquine resistance) occur in Africa, emphasizing the necessity to better decode the genetic background associated with PPQ resistance. Further epidemiological investigations in Pfpm2 amplification along with mutations in the Pfk13 gene will be useful for developing and updating anti-malarial guidance in travellers.
Collapse
Affiliation(s)
- Mariangela L'Episcopia
- Department of Infectious Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy
| | - Tommaso Ascoli Bartoli
- National Institute for Infectious Diseases, IRCCS "Lazzaro Spallanzani", Via Portuense 292, 00149 Rome, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases, IRCCS "Lazzaro Spallanzani", Via Portuense 292, 00149 Rome, Italy
| | - Andrea Mariano
- National Institute for Infectious Diseases, IRCCS "Lazzaro Spallanzani", Via Portuense 292, 00149 Rome, Italy
| | - Alessandra D'Abramo
- National Institute for Infectious Diseases, IRCCS "Lazzaro Spallanzani", Via Portuense 292, 00149 Rome, Italy
| | - Antonella Vulcano
- National Institute for Infectious Diseases, IRCCS "Lazzaro Spallanzani", Via Portuense 292, 00149 Rome, Italy
| | - Maria G Paglia
- National Institute for Infectious Diseases, IRCCS "Lazzaro Spallanzani", Via Portuense 292, 00149 Rome, Italy
| | - Edvige Perrotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy
| | - Michela Menegon
- Department of Infectious Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, IRCCS "Lazzaro Spallanzani", Via Portuense 292, 00149 Rome, Italy
| | - Carlo Severini
- Department of Infectious Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy
| |
Collapse
|
7
|
K13-Mediated Reduced Susceptibility to Artemisinin in Plasmodium falciparum Is Overlaid on a Trait of Enhanced DNA Damage Repair. Cell Rep 2021; 32:107996. [PMID: 32755588 PMCID: PMC7408483 DOI: 10.1016/j.celrep.2020.107996] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/21/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022] Open
Abstract
Southeast Asia has been the hotbed for the development of drug-resistant malaria parasites, including those with resistance to artemisinin combination therapy. While mutations in the kelch propeller domain (K13 mutations) are associated with artemisinin resistance, a range of evidence suggests that other factors are critical for the establishment and subsequent transmission of resistance in the field. Here, we perform a quantitative analysis of DNA damage and repair in the malaria parasite Plasmodium falciparum and find a strong link between enhanced DNA damage repair and artemisinin resistance. This experimental observation is further supported when variations in seven known DNA repair genes are found in resistant parasites, with six of these mutations being associated with K13 mutations. Our data provide important insights on confounding factors that are important for the establishment and spread of artemisinin resistance and may explain why resistance has not yet arisen in Africa. High-throughput MalariaCometChip to measure DNA damage level in P. falciparum Subpopulation of Cambodian isolates possess enhanced DNA damage repair Important link between enhanced DNA damage repair and artemisinin resistance
Collapse
|
8
|
Ippolito MM, Moser KA, Kabuya JBB, Cunningham C, Juliano JJ. Antimalarial Drug Resistance and Implications for the WHO Global Technical Strategy. CURR EPIDEMIOL REP 2021; 8:46-62. [PMID: 33747712 PMCID: PMC7955901 DOI: 10.1007/s40471-021-00266-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Five years have passed since the World Health Organization released its Global Technical Strategy for Malaria (GTS). In that time, progress against malaria has plateaued. This review focuses on the implications of antimalarial drug resistance for the GTS and how interim progress in parasite genomics and antimalarial pharmacology offer a bulwark against it. RECENT FINDINGS For the first time, drug resistance-conferring genes have been identified and validated before their global expansion in malaria parasite populations. More efficient methods for their detection and elaboration have been developed, although low-density infections and polyclonality remain a nuisance to be solved. Clinical trials of alternative regimens for multidrug-resistant malaria have delivered promising results. New agents continue down the development pipeline, while a nascent infrastructure in sub-Saharan Africa for conducting phase I trials and trials of transmission-blocking agents has come to fruition after years of preparation. SUMMARY These and other developments can help inform the GTS as the world looks ahead to the next two decades of its implementation. To remain ahead of the threat that drug resistance poses, wider application of genomic-based surveillance and optimization of existing and forthcoming antimalarial drugs are essential.
Collapse
Affiliation(s)
- Matthew M. Ippolito
- Divisions of Clinical Pharmacology and Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
- The Johns Hopkins Malaria Research Institute, Johns Hopkins University School of Public Health, Baltimore, MD USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Kara A. Moser
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC USA
| | | | - Clark Cunningham
- School of Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Jonathan J. Juliano
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, CB#7030, 130 Mason Farm Rd, Chapel Hill, NC 27599 USA
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina, Chapel Hill, NC USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| |
Collapse
|
9
|
Delandre O, Daffe SM, Gendrot M, Diallo MN, Madamet M, Kounta MB, Diop MN, Bercion R, Sow A, Ngom PM, Lo G, Benoit N, Amalvict R, Fonta I, Mosnier J, Diawara S, Wade KA, Fall M, Fall KB, Fall B, Pradines B. Absence of association between polymorphisms in the pfcoronin and pfk13 genes and the presence of Plasmodium falciparum parasites after treatment with artemisinin derivatives in Senegal. Int J Antimicrob Agents 2020; 56:106190. [PMID: 33045351 DOI: 10.1016/j.ijantimicag.2020.106190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/04/2020] [Indexed: 01/12/2023]
Abstract
Due to resistance to chloroquine and sulfadoxine/pyrimethamine, treatment for uncomplicated Plasmodium falciparum malaria switched to artemisinin-based combination therapy (ACT) in 2006 in Senegal. Several mutations in the gene encoding the kelch13 helix (pfk13-propeller) have been identified as associated with in vitro and in vivo artemisinin resistance in Southeast Asia. Additionally, three mutations in the pfcoronin gene (G50E, R100K and E107V) have been identified in two culture-adapted Senegalese field isolates that became resistant in vitro to artemisinin after 4 years of intermittent selection with dihydroartemisinin. The aims of this study were to assess the prevalence of pfcoronin and pfk13 mutations in Senegalese field isolates from Dakar and to investigate their association with artemisinin derivative clinical failures. A total of 348 samples of P. falciparum from 327 patients, collected from 2015-2019 in Dakar, were successfully analysed. All sequences had wild-type pfk13 allele. The three mutations (G50E, R100K and E107V), previously identified in parasites with reduced susceptibility to artemisinin, were not found in this study, but a new mutation (P76S) was detected (mean prevalence 16.2%). The P76S mutation was identified in 5 (31.3%) of 16 isolates collected from patients still parasitaemic on Day 3 after ACT treatment and in 31 samples (15.3%) among 203 patients considered successfully cured. There was no significant association between in vivo reduced efficacy to artemisinin derivatives and the P76S mutation (P = 0.151, Fisher's exact test). These data suggest that polymorphisms in pfk13 and pfcoronin are not the best predictive markers for artemisinin resistance in Senegal.
Collapse
Affiliation(s)
- Océane Delandre
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de recherche biomédicale des armées, Marseille, France; Aix-Marseille Université, IRD, SSA, AP-HM, VITROME, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - Sokhna M Daffe
- Fédération des laboratoires, Hôpital Principal de Dakar, Dakar, Senegal
| | - Mathieu Gendrot
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de recherche biomédicale des armées, Marseille, France; Aix-Marseille Université, IRD, SSA, AP-HM, VITROME, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - Maguette N Diallo
- Fédération des laboratoires, Hôpital Principal de Dakar, Dakar, Senegal
| | - Marylin Madamet
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de recherche biomédicale des armées, Marseille, France; Aix-Marseille Université, IRD, SSA, AP-HM, VITROME, Marseille, France; IHU Méditerranée Infection, Marseille, France; Centre national de reference du paludisme, Marseille, France
| | - Mame B Kounta
- Service des urgences, Hôpital Principal de Dakar, Dakar, Senegal
| | - Moustapha N Diop
- Service de réanimation médicale, Hôpital Principal de Dakar, Dakar, Senegal
| | - Raymond Bercion
- Laboratoire d'analyses médicales, Institut Pasteur de Dakar, Dakar, Senegal
| | - Abdou Sow
- Service de maternité, Hôpital Principal de Dakar, Dakar, Senegal
| | - Papa M Ngom
- Service de maternité, Hôpital Principal de Dakar, Dakar, Senegal
| | - Gora Lo
- Centre medical inter-armées Lemonier, Dakar, Senegal; Institut de recherche en santé, de surveillance épidémiologique et de formation (IRESSEF), Dakar, Senegal
| | - Nicolas Benoit
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de recherche biomédicale des armées, Marseille, France; Aix-Marseille Université, IRD, SSA, AP-HM, VITROME, Marseille, France; IHU Méditerranée Infection, Marseille, France; Centre national de reference du paludisme, Marseille, France
| | - Rémy Amalvict
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de recherche biomédicale des armées, Marseille, France; Aix-Marseille Université, IRD, SSA, AP-HM, VITROME, Marseille, France; IHU Méditerranée Infection, Marseille, France; Centre national de reference du paludisme, Marseille, France
| | - Isabelle Fonta
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de recherche biomédicale des armées, Marseille, France; Aix-Marseille Université, IRD, SSA, AP-HM, VITROME, Marseille, France; IHU Méditerranée Infection, Marseille, France; Centre national de reference du paludisme, Marseille, France
| | - Joel Mosnier
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de recherche biomédicale des armées, Marseille, France; Aix-Marseille Université, IRD, SSA, AP-HM, VITROME, Marseille, France; IHU Méditerranée Infection, Marseille, France; Centre national de reference du paludisme, Marseille, France
| | - Silman Diawara
- Fédération des laboratoires, Hôpital Principal de Dakar, Dakar, Senegal
| | - Khalifa A Wade
- Service des urgences, Hôpital Principal de Dakar, Dakar, Senegal
| | - Mansour Fall
- Service de réanimation médicale, Hôpital Principal de Dakar, Dakar, Senegal
| | - Khadidiatou B Fall
- Service de pathologies infectieuses, Hôpital Principal de Dakar, Dakar, Senegal
| | - Bécaye Fall
- Fédération des laboratoires, Hôpital Principal de Dakar, Dakar, Senegal
| | - Bruno Pradines
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de recherche biomédicale des armées, Marseille, France; Aix-Marseille Université, IRD, SSA, AP-HM, VITROME, Marseille, France; IHU Méditerranée Infection, Marseille, France; Centre national de reference du paludisme, Marseille, France.
| |
Collapse
|
10
|
Misganaw D, Amare GG, Mengistu G. Chemo Suppressive and Curative Potential of Hypoestes forskalei Against Plasmodium berghei: Evidence for in vivo Antimalarial Activity. J Exp Pharmacol 2020; 12:313-323. [PMID: 32982487 PMCID: PMC7498819 DOI: 10.2147/jep.s262026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/07/2020] [Indexed: 12/31/2022] Open
Abstract
Background The emergence of drug resistance together with the global burden of malaria triggers the necessity for the searching of new antimalarial agents. This study, therefore, was initiated to investigate the in vivo antimalarial activity of Hypoestes forskalei in mice based on the strong supported evidence from the ethnobotanical claims and the in vitro anti-plasmodial activity of the plant. Methods The 4-day suppressive (crude extract and fractions) and the Rane’s (n-butanol fraction) tests were used to evaluate the antimalarial activity of the plant. A cold maceration technique with 80% methanol was used for the crude extraction of the plant. The crude extract was then fractionated using solvents of different polarity (chloroform, n-butanol, and water). Results All the test doses of the crude extract as well as the fractions reduced parasitemia and prolonged mean survival time significantly (P<0.001) as compared to their negative control groups. Maximum parasitemia suppression effect (56%) was observed at the highest dose (600 mg/kg) of the crude extract during the 4-day suppressive test. Likewise, the n-butanol, chloroform, and aqueous fractions showed a percentage suppression of about 50, 38, and 19, respectively, at the dose of 600 mg/kg. Therefore, the n-butanol fraction showed the highest parasitemia suppression followed by the chloroform fraction and then the aqueous fraction. Moreover, the n-butanol fraction showed a significant curative effect (P<0.001) in Rane’s test with a percentage suppression of about 49 at a dose of 600 mg/kg. Conclusion The study has revealed that the plant has a promising antimalarial activity, the activity being more in the crude extract than the fractions. The highest antimalarial activity of the n-butanol fraction suggests that non-polar and medium polar principles could be responsible for the observed activity.
Collapse
Affiliation(s)
- Desye Misganaw
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Gedefaw Getnet Amare
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Getnet Mengistu
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| |
Collapse
|
11
|
Huang F, Shrestha B, Liu H, Tang LH, Zhou SS, Zhou XN, Takala-Harrison S, Ringwald P, Nyunt MM, Plowe CV. No evidence of amplified Plasmodium falciparum plasmepsin II gene copy number in an area with artemisinin-resistant malaria along the China-Myanmar border. Malar J 2020; 19:334. [PMID: 32928233 PMCID: PMC7488220 DOI: 10.1186/s12936-020-03410-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background The emergence and spread of artemisinin resistance in Plasmodium falciparum poses a threat to malaria eradication, including China’s plan to eliminate malaria by 2020. Piperaquine (PPQ) resistance has emerged in Cambodia, compromising an important partner drug that is widely used in China in the form of dihydroartemisinin (DHA)-PPQ. Several mutations in a P. falciparum gene encoding a kelch protein on chromosome 13 (k13) are associated with artemisinin resistance and have arisen spread in the Great Mekong subregion, including the China–Myanmar border. Multiple copies of the plasmepsin II/III (pm2/3) genes, located on chromosome 14, have been shown to be associated with PPQ resistance. Methods The therapeutic efficacy of DHA-PPQ for the treatment of uncomplicated P. falciparum was evaluated along the China–Myanmar border from 2010 to 2014. The dry blood spots samples collected in the efficacy study prior DHA-PPQ treatment and from the local hospital by passive detection were used to amplify k13 and pm2. Polymorphisms within k13 were genotyped by capillary sequencing and pm2 copy number was quantified by relative-quantitative real-time polymerase chain reaction. Treatment outcome was evaluated with the World Health Organization protocol. A linear regression model was used to estimate the association between the day 3 positive rate and k13 mutation and the relationship of the pm2 copy number variants and k13 mutations. Results DHA-PPQ was effective for uncomplicated P. falciparum infection in Yunnan Province with cure rates > 95%. Twelve non synonymous mutations in the k13 domain were observed among the 268 samples with the prevalence of 44.0% and the predominant mutation was F446I with a prevalence of 32.8%. Only one sample was observed with multi-copies of pm2, including parasites with and without k13 mutations. The therapeutic efficacy of DHA-PPQ was > 95% along the China–Myanmar border, consistent with the lack of amplification of pm2. Conclusion DHA-PPQ for uncomplicated P. falciparum infection still showed efficacy in an area with artemisinin-resistant malaria along the China–Myanmar border. There was no evidence to show PPQ resistance by clinical study and molecular markers survey. Continued monitoring of the parasite population using molecular markers will be important to track emergence and spread of resistance in this region.
Collapse
Affiliation(s)
- Fang Huang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China.
| | - Biraj Shrestha
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hui Liu
- Yunnan Institute of Parasitic Diseases, Puer, People's Republic of China
| | - Lin-Hua Tang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Shui-Sen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Shannon Takala-Harrison
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pascal Ringwald
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Myaing M Nyunt
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | |
Collapse
|
12
|
Foguim FT, Bogreau H, Gendrot M, Mosnier J, Fonta I, Benoit N, Amalvict R, Madamet M, Wein S, Pradines B. Prevalence of mutations in the Plasmodium falciparum chloroquine resistance transporter, PfCRT, and association with ex vivo susceptibility to common anti-malarial drugs against African Plasmodium falciparum isolates. Malar J 2020; 19:201. [PMID: 32503540 PMCID: PMC7275453 DOI: 10.1186/s12936-020-03281-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background The Plasmodium falciparum chloroquine transporter gene (pfcrt) is known to be involved in chloroquine and amodiaquine resistance, and more particularly the mutations on the loci 72 to 76 localized within the second exon. Additionally, new mutations (T93S, H97Y, C101F, F145I, M343L, C350R and G353V) were recently shown to be associated with in vitro reduced susceptibility to piperaquine in Asian or South American P. falciparum strains. However, very few data are available on the prevalence of these mutations and their effect on parasite susceptibility to anti-malarial drugs, and more particularly piperaquine in Africa. Methods A molecular investigation of these mutations was performed in 602 African P. falciparum parasites collected between 2017 and 2018 on malaria patients hospitalized in France after a travel in African countries. Associations between genotypes and in vitro susceptibilities to piperaquine and standard antimalarial drugs were assessed. Results None of the mutations, previously described as associated with piperaquine resistance, was found in the 602 P. falciparum African isolates. The K76T mutation is associated with resistance to chloroquine (p < 0.0002) and desethylamodiaquine (p < 0.002) in Africa. The K76T mutation is not associated with in vitro reduced susceptibility to piperaquine. The mutation I356T, identified in 54.7% (n = 326) of the African isolates, was significantly associated with reduced susceptibility to quinine (p < 0.02) and increased susceptibility to mefloquine (p < 0.04). The K76T and I356T mutations were significantly associated in West African isolates (p = 0.008). Conclusion None of the mutations in pfcrt found to be associated with piperaquine reduced susceptibility in Asia or South America (T93S, H97Y, C101F, F145I, M343L C350R and G353V) were found in the 602 African isolates including the three isolates with reduced susceptibility to piperaquine. The K76T mutation, involved in resistance to chloroquine and amodiaquine, and the I356T mutation were not associated with in vitro reduced susceptibility to piperaquine. Differences in mefloquine susceptibility between I356 and 356T isolates were, while statistically different, minimal. Further analyses are needed with a more important sample size from the same geographic area to confirm the role of the I356T mutation on quinine susceptibility.
Collapse
Affiliation(s)
- Francis Tsombeng Foguim
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Hervé Bogreau
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Mathieu Gendrot
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Joel Mosnier
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France.,Centre National de Référence du Paludisme, Marseille, France
| | - Isabelle Fonta
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France.,Centre National de Référence du Paludisme, Marseille, France
| | - Nicolas Benoit
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France.,Centre National de Référence du Paludisme, Marseille, France
| | - Rémy Amalvict
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France.,Centre National de Référence du Paludisme, Marseille, France
| | - Marylin Madamet
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France.,Centre National de Référence du Paludisme, Marseille, France
| | - Sharon Wein
- Laboratory of Pathogen Host Interactions, UMR 5235, CNRS-Université de Montpellier, Montpellier, France
| | - Bruno Pradines
- Unité Parasitologie et entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France. .,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France. .,IHU Méditerranée Infection, Marseille, France. .,Centre National de Référence du Paludisme, Marseille, France.
| | | |
Collapse
|
13
|
A Computer Modelling Approach To Evaluate the Accuracy of Microsatellite Markers for Classification of Recurrent Infections during Routine Monitoring of Antimalarial Drug Efficacy. Antimicrob Agents Chemother 2020; 64:AAC.01517-19. [PMID: 31932376 DOI: 10.1128/aac.01517-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/06/2020] [Indexed: 12/23/2022] Open
Abstract
Antimalarial drugs have long half-lives, so clinical trials to monitor their efficacy require long periods of follow-up to capture drug failure that may become patent only weeks after treatment. Reinfections often occur during follow-up, so robust methods of distinguishing drug failures (recrudescence) from emerging new infections are needed to produce accurate failure rate estimates. Molecular correction aims to achieve this by comparing the genotype of a patient's pretreatment (initial) blood sample with that of any infection that occurs during follow-up, with matching genotypes indicating drug failure. We use an in silico approach to show that the widely used match-counting method of molecular correction with microsatellite markers is likely to be highly unreliable and may lead to gross under- or overestimates of the true failure rates, depending on the choice of matching criterion. A Bayesian algorithm for molecular correction was previously developed and utilized for analysis of in vivo efficacy trials. We validated this algorithm using in silico data and showed it had high specificity and generated accurate failure rate estimates. This conclusion was robust for multiple drugs, different levels of drug failure rates, different levels of transmission intensity in the study sites, and microsatellite genetic diversity. The Bayesian algorithm was inherently unable to accurately identify low-density recrudescence that occurred in a small number of patients, but this did not appear to compromise its utility as a highly effective molecular correction method for analyzing microsatellite genotypes. Strong consideration should be given to using Bayesian methodology to obtain accurate failure rate estimates during routine monitoring trials of antimalarial efficacy that use microsatellite markers.
Collapse
|
14
|
L'Episcopia M, Kelley J, Patel D, Schmedes S, Ravishankar S, Menegon M, Perrotti E, Nurahmed AM, Talha AA, Nour BY, Lucchi N, Severini C, Talundzic E. Targeted deep amplicon sequencing of kelch 13 and cytochrome b in Plasmodium falciparum isolates from an endemic African country using the Malaria Resistance Surveillance (MaRS) protocol. Parasit Vectors 2020; 13:137. [PMID: 32171330 PMCID: PMC7071742 DOI: 10.1186/s13071-020-4005-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Routine molecular surveillance for imported drug-resistant malaria parasites to the USA and European Union is an important public health activity. The obtained molecular data are used to help keep chemoprophylaxis and treatment guidelines up to date for persons traveling to malaria endemic countries. Recent advances in next-generation sequencing (NGS) technologies provide a new and effective way of tracking malaria drug-resistant parasites. Methods As part of a technology transfer arrangement between the CDC Malaria Branch and the Istituto Superiore di Sanità (ISS), Rome, Italy, the recently described Malaria Resistance Surveillance (MaRS) protocol was used to genotype 148 Plasmodium falciparum isolates from Eritrea for kelch 13 (k13) and cytochrome b (cytb) genes, molecular markers associated with resistance to artemisinin (ART) and atovaquone/proguanil (AP), respectively. Results Spanning the full-length k13 gene, seven non-synonymous single nucleotide polymorphisms (SNPs) were found (K189N, K189T, E208K, D281V, E401Q, R622I and T535M), of which none have been associated with artemisinin resistance. No mutations were found in cytochrome b. Conclusion All patients successfully genotyped carried parasites susceptible to ART and AP treatment. Future studies between CDC Malaria Branch and ISS are planned to expand the MaRS system, including data sharing, in an effort to maintain up to date treatment guidelines for travelers to malaria endemic countries. ![]()
Collapse
Affiliation(s)
| | - Julia Kelley
- Atlanta Research and Education Foundation, VAMC, Atlanta, Georgia, USA
| | - Dhruviben Patel
- Atlanta Research and Education Foundation, VAMC, Atlanta, Georgia, USA
| | - Sarah Schmedes
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | | | - Michela Menegon
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Edvige Perrotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Albadawi A Talha
- Faculty of Medical Laboratory Science, University of Gezira, Gezira, Sudan.,Department of clinical laboratory Sciences, College of Applied Medical Sciences, Juof University, Sakaka, Saudi Arabia
| | - Bakri Y Nour
- Blue Nile Research National Institute for Communicable Diseases, University of Gezira, Wad Medani, Sudan
| | - Naomi Lucchi
- Centers for Disease Control and Prevention, CGH, DPDM, Atlanta, GA, USA
| | - Carlo Severini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Eldin Talundzic
- Centers for Disease Control and Prevention, CGH, DPDM, Atlanta, GA, USA
| |
Collapse
|
15
|
Pull L, Lupoglazoff JM, Beardmore M, Michel JF, Buffet P, Bouchaud O, Siriez JY. Artenimol-piperaquine in children with uncomplicated imported falciparum malaria: experience from a prospective cohort. Malar J 2019; 18:419. [PMID: 31843017 PMCID: PMC6915931 DOI: 10.1186/s12936-019-3047-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/30/2019] [Indexed: 11/25/2022] Open
Abstract
Background Although malaria remains one of the major public health threats in inter-tropical areas, there is limited understanding of imported malaria in children by paediatricians and emergency practitioners in non-endemic countries, often resulting in misdiagnosis and inadequate treatment. Moreover, classical treatments (atovaquone-proguanil, quinine, mefloquine) are limited either by lengthy treatment courses or by side effects. Since 2010, the World Health Organization (WHO) has recommended the use of oral artemisinin-based combination therapy for the treatment of uncomplicated Plasmodium falciparum malaria worldwide. The benefits of artenimol–piperaquine in children have been validated in endemic countries but experience remains limited in cases of imported malaria. Methods This prospective observational study in routine paediatric care took place at the Emergency Department, Robert-Debré Hospital (Paris, France) from September 2012 to December 2014. Tolerance and efficacy of artenimol–piperaquine in children presenting with the following inclusion criteria were assessed: P. falciparum positive on thin or thick blood smear; and the absence of WHO-defined features of severity. Results Among 83 children included in this study, treatment with artenimol–piperaquine was successful in 82 children (98.8%). None of the adverse events were severe and all were considered mild with no significant clinical impact. This also applied to cardiological adverse events despite a significant increase of the mean post-treatment QTc interval. Conclusion Artenimol–piperaquine displays a satisfying efficacy and tolerance profile as a first-line treatment for children with imported uncomplicated falciparum malaria and only necessitates three once-daily oral intakes of the medication. Comparative studies versus artemether-lumefantrine or atovaquone-proguanil would be useful to confirm the results of this study.
Collapse
Affiliation(s)
- Lauren Pull
- Service D'Accueil Des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 48 Boulevard Sérurier, 75019, Paris, France
| | - Jean-Marc Lupoglazoff
- Service D'Accueil Des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 48 Boulevard Sérurier, 75019, Paris, France
| | | | - Jean-François Michel
- Service D'Accueil Des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 48 Boulevard Sérurier, 75019, Paris, France
| | - Pierre Buffet
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France
| | - Olivier Bouchaud
- Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris 13, 93000, Bobigny, France
| | - Jean-Yves Siriez
- Service D'Accueil Des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 48 Boulevard Sérurier, 75019, Paris, France.
| |
Collapse
|
16
|
Conrad MD, Rosenthal PJ. Antimalarial drug resistance in Africa: the calm before the storm? THE LANCET. INFECTIOUS DISEASES 2019; 19:e338-e351. [DOI: 10.1016/s1473-3099(19)30261-0] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/09/2019] [Accepted: 05/09/2019] [Indexed: 11/26/2022]
|
17
|
Foguim Tsombeng F, Gendrot M, Robert MG, Madamet M, Pradines B. Are k13 and plasmepsin II genes, involved in Plasmodium falciparum resistance to artemisinin derivatives and piperaquine in Southeast Asia, reliable to monitor resistance surveillance in Africa? Malar J 2019; 18:285. [PMID: 31443646 PMCID: PMC6708145 DOI: 10.1186/s12936-019-2916-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/17/2019] [Indexed: 11/17/2022] Open
Abstract
Mutations in the propeller domain of Plasmodium falciparum kelch 13 (Pfk13) gene are associated with artemisinin resistance in Southeast Asia. Artemisinin resistance is defined by increased ring survival rate and delayed parasite clearance half-life in patients. Additionally, an amplification of the Plasmodium falciparum plasmepsin II gene (pfpm2), encoding a protease involved in hemoglobin degradation, has been found to be associated with reduced in vitro susceptibility to piperaquine in Cambodian P. falciparum parasites and with dihydroartemisinin–piperaquine failures in Cambodia. The World Health Organization (WHO) has recommended the use of these two genes to track the emergence and the spread of the resistance to dihydroartemisinin–piperaquine in malaria endemic areas. Although the resistance to dihydroartemisinin–piperaquine has not yet emerged in Africa, few reports on clinical failures suggest that k13 and pfpm2 would not be the only genes involved in artemisinin and piperaquine resistance. It is imperative to identify molecular markers or drug resistance genes that associate with artemisinin and piperaquine in Africa. K13 polymorphisms and Pfpm2 copy number variation analysis may not be sufficient for monitoring the emergence of dihydroartemisinin–piperaquine resistance in Africa. But, these markers should not be ruled out for tracking the emergence of resistance.
Collapse
Affiliation(s)
- Francis Foguim Tsombeng
- Unité Parasitologie et Entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Mathieu Gendrot
- Unité Parasitologie et Entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Marie Gladys Robert
- Unité Parasitologie et Entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France
| | - Marylin Madamet
- Unité Parasitologie et Entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France.,IHU Méditerranée Infection, Marseille, France.,Centre National de Référence du Paludisme, Institut de Recherche Biomédicale des Armées, Marseille, France
| | - Bruno Pradines
- Unité Parasitologie et Entomologie, Département Microbiologie et maladies infectieuses, Institut de Recherche Biomédicale des Armées, 19-21 Boulevard Jean Moulin, 13005, Marseille, France. .,Aix Marseille Univ, IRD, SSA, AP-HM, VITROME, Marseille, France. .,IHU Méditerranée Infection, Marseille, France. .,Centre National de Référence du Paludisme, Institut de Recherche Biomédicale des Armées, Marseille, France.
| |
Collapse
|
18
|
Baseline Ex Vivo and Molecular Responses of Plasmodium falciparum Isolates to Piperaquine before Implementation of Dihydroartemisinin-Piperaquine in Senegal. Antimicrob Agents Chemother 2019; 63:AAC.02445-18. [PMID: 30782997 DOI: 10.1128/aac.02445-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/10/2019] [Indexed: 02/07/2023] Open
Abstract
Dihydroartemisinin-piperaquine, which was registered in 2017 in Senegal, is not currently used as the first-line treatment against uncomplicated malaria. A total of 6.6% to 17.1% of P. falciparum isolates collected in Dakar in 2013 to 2015 showed ex vivo-reduced susceptibility to piperaquine. Neither the exonuclease E415G mutation nor the copy number variation of the plasmepsin II gene (Pfpm2), associated with piperaquine resistance in Cambodia, was detected in Senegalese parasites.
Collapse
|
19
|
Corpolongo A, Pisapia R, Oliva A, Giancola ML, Mencarini P, Bevilacqua N, Ghirga P, Mariano A, Vulcano A, Paglia MG, Nicastri E. Five cases of Plasmodium vivax malaria treated with artemisinin derivatives: the advantages of a unified approach to treatment. Infection 2019; 47:655-659. [PMID: 30809760 DOI: 10.1007/s15010-019-01286-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/19/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In endemic countries with a high level of chloroquine resistance, Plasmodium vivax malaria is associated with high morbidity and mortality. In these areas, the dihydroartemisinin-piperaquine combination resulted in clinical response, a more rapid clearance of parasitaemia, compared to chloroquine therapies, and reduction of recrudescence or reinfection. METHODS We describe five cases of Plasmodium vivax malaria in returning travelers treated with dihydroartemisinin-piperaquine. RESULTS All patients showed the early parasite clearance and no side effects. Our preliminary results suggest that the dihydroartemisinin-piperaquine combination is effective and safe even in imported cases. CONCLUSIONS A unified treatment policy using the artemisinin combination therapy should be adopted even in non-endemic countries and larger studies are underway to support this strategy.
Collapse
Affiliation(s)
- Angela Corpolongo
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Raffaella Pisapia
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy.
| | - Alessandra Oliva
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Maria Letizia Giancola
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Paola Mencarini
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Nazario Bevilacqua
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Piero Ghirga
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Andrea Mariano
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Antonella Vulcano
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Maria Grazia Paglia
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Via Portuense, 292, 00149, Rome, Italy
| |
Collapse
|