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Schreidah C, Giesbrecht D, Gashema P, Young NW, Munyaneza T, Muvunyi CM, Thwai K, Mazarati JB, Bailey JA, Juliano JJ, Karema C. Expansion of artemisinin partial resistance mutations and lack of histidine rich protein-2 and -3 deletions in Plasmodium falciparum infections from Rukara, Rwanda. Malar J 2024; 23:150. [PMID: 38755607 PMCID: PMC11100144 DOI: 10.1186/s12936-024-04981-4] [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: 12/17/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Emerging artemisinin partial resistance and diagnostic resistance are a threat to malaria control in Africa. Plasmodium falciparum kelch13 (k13) propeller-domain mutations that confer artemisinin partial resistance have emerged in Africa. k13-561H was initially described at a frequency of 7.4% from Masaka in 2014-2015, but not present in nearby Rukara. By 2018, 19.6% of isolates in Masaka and 22% of isolates in Rukara contained the mutation. Longitudinal monitoring is essential to inform control efforts. In Rukara, an assessment was conducted to evaluate recent k13-561H prevalence changes, as well as other key mutations. Prevalence of hrp2/3 deletions was also assessed. METHODS Samples collected in Rukara in 2021 were genotyped for key artemisinin and partner drug resistance mutations using molecular inversion probe assays and for hrp2/3 deletions using qPCR. RESULTS Clinically validated k13 artemisinin partial resistance mutations continue to increase in prevalence with the overall level of mutant infections reaching 32% in Rwanda. The increase appears to be due to the rapid emergence of k13-675V (6.4%, 6/94 infections), previously not observed, rather than continued expansion of 561H (23.5% 20/85). Mutations to partner drugs and other anti-malarials were variable, with high levels of multidrug resistance 1 (mdr1) N86 (95.5%) associated with lumefantrine decreased susceptibility and dihydrofolate reductase (dhfr) 164L (24.7%) associated with a high level of antifolate resistance, but low levels of amodiaquine resistance polymorphisms with chloroquine resistance transporter (crt) 76T: at 6.1% prevalence. No hrp2 or hrp3 gene deletions associated with diagnostic resistance were found. CONCLUSIONS Increasing prevalence of artemisinin partial resistance due to k13-561H and the rapid expansion of k13-675V is concerning for the longevity of artemisinin effectiveness in the region. False negative RDT results do not appear to be an issue with no hrp2 or hpr3 deletions detected. Continued molecular surveillance in this region and surrounding areas is needed to follow artemisinin partial resistance and provide early detection of partner drug resistance, which would likely compromise control and increase malaria morbidity and mortality in East Africa.
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Affiliation(s)
| | | | | | | | | | | | - Kyaw Thwai
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | | | - Jonathan J Juliano
- University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Corine Karema
- Quality Equity Health Care, Kigali, Rwanda
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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Schreidah C, Giesbrecht D, Gashema P, Young N, Munyaneza T, Muvunyi CM, Thwai K, Mazarati JB, Bailey J, Juliano JJ, Karema C. Expansion of Artemisinin Partial Resistance Mutations and Lack of Histidine Rich Protein-2 and -3 Deletions in Plasmodium falciparum infections from Rukara, Rwanda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.17.23300081. [PMID: 38196592 PMCID: PMC10775326 DOI: 10.1101/2023.12.17.23300081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background Emerging artemisinin resistance and diagnostic resistance are a threat to malaria control in Africa. Plasmodium falciparum kelch13 (K13) propeller-domain mutations that confer artemisinin partial resistance have emerged in Africa. K13-561H was initially described at a frequency of 7.4% from Masaka in 2014-2015 but not present in nearby Rukara. By 2018, 19.6% of isolates in Masaka and 22% of isolates in Rukara contained the mutation. Longitudinal monitoring is essential to inform control efforts. In Rukara, we sought to assess recent K13-561H prevalence changes, as well as for other key mutations. Prevalence of hrp2/3 deletions was also assessed. Methods We genotyped samples collected in Rukara in 2021 for key artemisinin and partner drug resistance mutations using molecular inversion probe assays and for hrp2/3 deletions using qPCR. Results Clinically validated K13 artemisinin partial resistance mutations continue to increase in prevalence with the overall level of artemisinin resistance mutant infections reaching 32% in Rwanda. The increase appears to be due to the rapid emergence of K13-675V (6.4%, 6/94 infections), previously not observed, rather than continued expansion of 561H (23.5% 20/85). Mutations to partner drugs and other antimalarials were variable, with high levels of multidrug resistance 1 (MDR1) N86 (95.5%) associated with lumefantrine resistance and dihydrofolate reductase (DHFR) 164L (24.7%) associated with antifolate resistance, but low levels of amodiaquine resistance polymorphisms with chloroquine resistance transporter (CRT ) 76T: at 6.1% prevalence. No hrp2 or hrp3 gene deletions associated with diagnostic resistance were found. Conclusions Increasing prevalence of artemisinin partial resistance due to K13-561H and the rapid expansion of K13-675V is concerning for the longevity of artemisinin effectiveness in the region. False negative mRDT results do not appear to be an issue with no hrp2 or hpr3 deletions detected. Continued molecular surveillance in this region and surrounding areas is needed to follow artemisinin resistance and provide early detection of partner drug resistance, which would likely compromise control and increase malaria morbidity and mortality in East Africa.
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Soriano-Pérez MJ, Castillo-Fernández N, Lozano-Serrano AB, Luzón-García MP, Vázquez-Villegas J, Cabeza-Barrera MI, Borrego-Jiménez J, Giménez-López MJ, Salas-Coronas J. Estimation of parasitaemia in imported falciparum malaria using the results of a combined rapid diagnostic test. No big help from haematological parameters. Malar J 2023; 22:351. [PMID: 37974257 PMCID: PMC10655380 DOI: 10.1186/s12936-023-04781-2] [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: 06/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Microscopy continues to be the mainstay for the evaluation of parasitaemia in malaria but requires laboratory support and microbiological experience. Other fast and simple methods are necessary. METHODS A retrospective observational study of imported malaria treated from July-2007 to December-2020 was carried out to evaluate the association between the degree of parasitaemia and both rapid diagnostic tests (RDT) reactivity patterns and haematological parameters. Plasmodium falciparum monoinfections diagnosed by peripheral blood smear and/or polymerase chain reaction (PCR),which also had a positive RDT result in the same blood sample, were included in the study. RESULTS A total of 273 patients were included. Most of them were male (n = 256; 93.8%) and visiting friends and relatives (VFR) travellers (n = 252; 92.3%). Patients with plasmodial lactate dehydrogenase (pLDH) or aldolase and histidine-rich protein 2 (HRP-2) co-reactivity (Pan/Pf pattern) had a parasitaemia range between 0 and 37% while those with just HRP-2 reactivity (P. falciparum pattern) had ranges between 0 and 1%. Not a single case of P. falciparum pattern was found for parasitaemia ranges greater than 1%, showing a negative predictive value of 100% for high parasitaemia. All the correlations between haematological parameters and parasitaemia resulted to be weak, with a maximum rho coefficient of -0.35 for lymphocytes and platelets, and of 0.40 for neutrophils-to-lymphocytes count ratio. Multivariate predictive models were constructed reflecting a poor predictive capacity. CONCLUSIONS The reactivity pattern of RDT allows a rapid semi-quantitative assessment of P. falciparum parasitaemia in travellers with imported malaria, discriminating patients with lower parasite loads. Haematological parameters were not able to estimate parasitaemia with sufficient precision.
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Affiliation(s)
- Manuel Jesús Soriano-Pérez
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - Nerea Castillo-Fernández
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain.
| | - Ana Belén Lozano-Serrano
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - María Pilar Luzón-García
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - José Vázquez-Villegas
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - María Isabel Cabeza-Barrera
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | - Jaime Borrego-Jiménez
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
| | | | - Joaquín Salas-Coronas
- Tropical Medicine Unit. Hospital Universitario de Poniente, Ctra. de Almerimar, 31, 04700, El Ejido, Almería, Spain
- Department of Nursing, Physiotherapy and Medicine. Faculty of Health Sciences, University of Almeria, Almeria, Spain
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Oliveira MJ, Caetano S, Dalot A, Sabino F, Calmeiro TR, Fortunato E, Martins R, Pereira E, Prudêncio M, Byrne HJ, Franco R, Águas H. A simple polystyrene microfluidic device for sensitive and accurate SERS-based detection of infection by malaria parasites. Analyst 2023; 148:4053-4063. [PMID: 37529888 PMCID: PMC10440799 DOI: 10.1039/d3an00971h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/27/2023] [Indexed: 08/03/2023]
Abstract
Early and accurate detection of infection by pathogenic microorganisms, such as Plasmodium, the causative agent of malaria, is critical for clinical diagnosis and ultimately determines the patient's outcome. We have combined a polystyrene-based microfluidic device with an immunoassay which utilises Surface-Enhanced Raman Spectroscopy (SERS) to detect malaria. The method can be easily translated to a point-of-care testing format and shows excellent sensitivity and specificity, when compared to the gold standard for laboratorial detection of Plasmodium infections. The device can be fabricated in less than 30 min by direct patterning on shrinkable polystyrene sheets of adaptable three-dimensional microfluidic chips. To validate the microfluidic system, samples of P. falciparum-infected red blood cell cultures were used. The SERS-based immunoassay enabled the detection of 0.0012 ± 0.0001% parasitaemia in a P. falciparum-infected red blood cell culture supernatant, an ∼7-fold higher sensitivity than that attained by most rapid diagnostic tests. Our approach successfully overcomes the main challenges of the current Plasmodium detection methods, including increased reproducibility, sensitivity, and specificity. Furthermore, our system can be easily adapted for detection of other pathogens and has excellent properties for early diagnosis of infectious diseases, a decisive step towards lowering their high burden on healthcare systems worldwide.
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Affiliation(s)
- Maria João Oliveira
- CENIMAT-i3N, Departamento de Ciência dos Materiais, Faculdade de Ciências e Tecnologia, FCT, Universidade Nova de Lisboa, and CEMOP/UNINOVA, 2829-516 Caparica, Portugal.
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal.
- UCIBIO - Applied Molecular Biosciences Unit, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
| | - Soraia Caetano
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Ana Dalot
- CENIMAT-i3N, Departamento de Ciência dos Materiais, Faculdade de Ciências e Tecnologia, FCT, Universidade Nova de Lisboa, and CEMOP/UNINOVA, 2829-516 Caparica, Portugal.
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal.
- UCIBIO - Applied Molecular Biosciences Unit, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
| | - Filipe Sabino
- CENIMAT-i3N, Departamento de Ciência dos Materiais, Faculdade de Ciências e Tecnologia, FCT, Universidade Nova de Lisboa, and CEMOP/UNINOVA, 2829-516 Caparica, Portugal.
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal.
- UCIBIO - Applied Molecular Biosciences Unit, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
| | - Tomás R Calmeiro
- CENIMAT-i3N, Departamento de Ciência dos Materiais, Faculdade de Ciências e Tecnologia, FCT, Universidade Nova de Lisboa, and CEMOP/UNINOVA, 2829-516 Caparica, Portugal.
| | - Elvira Fortunato
- CENIMAT-i3N, Departamento de Ciência dos Materiais, Faculdade de Ciências e Tecnologia, FCT, Universidade Nova de Lisboa, and CEMOP/UNINOVA, 2829-516 Caparica, Portugal.
| | - Rodrigo Martins
- CENIMAT-i3N, Departamento de Ciência dos Materiais, Faculdade de Ciências e Tecnologia, FCT, Universidade Nova de Lisboa, and CEMOP/UNINOVA, 2829-516 Caparica, Portugal.
| | - Eulália Pereira
- LAQV, REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Rua do Campo Alegre, s/n, 4169-007 Porto, Portugal
| | - Miguel Prudêncio
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Hugh J Byrne
- FOCAS Research Institute, Technological University Dublin, Camden Street, Dublin 8, Ireland
| | - Ricardo Franco
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal.
- UCIBIO - Applied Molecular Biosciences Unit, Departamento de Química, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
| | - Hugo Águas
- CENIMAT-i3N, Departamento de Ciência dos Materiais, Faculdade de Ciências e Tecnologia, FCT, Universidade Nova de Lisboa, and CEMOP/UNINOVA, 2829-516 Caparica, Portugal.
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Balerdi-Sarasola L, Parolo C, Fleitas P, Cruz A, Subirà C, Rodríguez-Valero N, Almuedo-Riera A, Letona L, Álvarez-Martínez MJ, Valls ME, Vera I, Mayor A, Muñoz J, Camprubí-Ferrer D. Host biomarkers for early identification of severe imported Plasmodium falciparum malaria. Travel Med Infect Dis 2023; 54:102608. [PMID: 37348666 DOI: 10.1016/j.tmaid.2023.102608] [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: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Severe imported P. falciparum malaria is a source of morbi-mortality in non-endemic regions. WHO criteria don't accurately classify patients at risk of complications. There is a need to evaluate new tools such as biomarkers to better identify patients with severe imported malaria. METHODS A case-control study was conducted in Barcelona, from January 2011-January 2021. Adult patients with microbiologically confirmed P. falciparum malaria were classified according to WHO criteria. Patients with imported non-malarial fevers were included as controls. In each group, angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), soluble triggering receptor expressed on myeloid cells (sTREM-1), C-reactive protein (CRP) and platelets were measured and their concentrations were compared between groups. New groups were made with a modified WHO severity classification and biomarkers' performance was evaluated using multiple imputation models. RESULTS 131 participants were included: 52 severe malaria, 30 uncomplicated malaria and 49 non-malarial fever cases. All biomarkers except sTREM-1 showed significant differences between groups. Using the modified WHO severity classification, Ang-2 and CRP presented the best AUROC; 0.79 (95%CI 0.64-0.94) and 0.80(95%CI 0.67-0.93). A model combining CRP and Ang-2 showed the best AUROC, of 0.84(95%CI 0.68-0.99), with the highest sensitivity and specificity: 84.6%(95%CI 58.9-98.1) and 77.4% (95%CI 65.9-87.7), respectively. CONCLUSIONS The combination of Ang-2 and CRP may be a reliable tool for the early identification of severe imported malaria. The use of a rapid prognostic test including the mentioned biomarkers could optimize imported malaria management, with the potential to decrease the rate of complications and hospitalizations in patients with imported malaria.
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Affiliation(s)
| | - C Parolo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - P Fleitas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Cruz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - C Subirà
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - A Almuedo-Riera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - L Letona
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - M J Álvarez-Martínez
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - M Eugenia Valls
- Microbiology Department, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - I Vera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - A Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; CIBERINFEC, ISCIII - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - D Camprubí-Ferrer
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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