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Sima-Biyang YV, Ontoua SS, Longo-Pendy NM, Mbou-Boutambe C, Makouloutou-Nzassi P, Moussadji CK, Lekana-Douki JB, Boundenga L. Epidemiology of malaria in Gabon: A systematic review and meta-analysis from 1980 to 2023. J Infect Public Health 2024; 17:102459. [PMID: 38870682 DOI: 10.1016/j.jiph.2024.05.047] [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: 12/25/2023] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024] Open
Abstract
The objective of this were conducted to elucidate spatiotemporal variations in malaria epidemiology in Gabon since 1980. For that, five databases, were used to collect and identify all studies published between 1980 and 2023 on malaria prevalence, antimalarial drug resistance, markers of antimalarial drug resistance and insecticide resistance marker. The findings suggest that Gabon continues to face malaria as an urgent public health problem, with persistently high prevalence rates. Markers of resistance to CQ persist despite its withdrawal, and markers of resistance to SP have emerged with a high frequency, reaching 100 %, while ACTs remain effective. Also, recent studies have identified markers of resistance to the insecticides Kdr-w and Kdr-e at frequencies ranging from 25 % to 100 %. Ace1R mutation was reported with a frequency of 0.4 %. In conclusion, the efficacy of ACTs remains above the threshold recommended by the WHO. Organo-phosphates and carbamates could provide an alternative for vector control.
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Affiliation(s)
- Yann Vital Sima-Biyang
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Central African Regional Doctoral School in Tropical Infectiology (EDR), BP 876 Franceville, Gabon
| | - Steede Seinnat Ontoua
- Central African Regional Doctoral School in Tropical Infectiology (EDR), BP 876 Franceville, Gabon; Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon
| | - Neil Michel Longo-Pendy
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon
| | - Clark Mbou-Boutambe
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Central African Regional Doctoral School in Tropical Infectiology (EDR), BP 876 Franceville, Gabon
| | - Patrice Makouloutou-Nzassi
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Department of Animal Biology and Ecology, Tropical Ecology Research Institute (IRET/CENAREST), Libreville BP 13354, Gabon
| | - Cyr Kinga Moussadji
- Primatology Center, Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon
| | - Jean-Bernard Lekana-Douki
- Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Department of Parasitology-Mycology-Tropical Medicine, University of Health Sciences, Faculty of Medicine, BP 4009 Libreville, Gabon
| | - Larson Boundenga
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Department of Anthropology, Durham University, South Road, Durham DH1 3LE, UK.
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Dinzouna-Boutamba SD, Iroungou BA, Akombi FL, Yacka-Mouele L, Moon Z, Aung JM, Lee S, Chung DI, Hong Y, Goo YK. Assessment of genetic polymorphisms associated with malaria antifolate resistance among the population of Libreville, Gabon. Malar J 2023; 22:183. [PMID: 37312220 DOI: 10.1186/s12936-023-04615-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Gabon is a malaria-threatened country with a stable and hyperendemic transmission of Plasmodium falciparum monoinfection. Malaria drug resistance is widely spread in many endemic countries around the world, including Gabon. The molecular surveillance of drug resistance to antifolates and artemisinin-based combination therapy (ACT) is one of the strategies for combating malaria. As Plasmodium parasites continue to develop resistance to currently available anti-malarial drugs, this study evaluated the frequency of the polymorphisms and genetic diversity associated with this phenomenon among the parasites isolates in Gabon. METHODS To assess the spread of resistant haplotypes among the malaria-infected population of Libreville, single nucleotide polymorphisms linked to sulfadoxine-pyrimethamine (SP) and artemisinin drugs resistance were screened for P. falciparum dihydrofolate reductase (Pfdhfr), P. falciparum dihydropteroate synthase (Pfdhps), and P. falciparum kelch 13-propeller domain (Pfk13) point mutations. RESULTS The analysis of 70 malaria-positive patient samples screened for polymorphism showed 92.65% (n = 63) mutants vs. 7.35% (n = 5) wild parasite population in Pfdhfr, with high prevalence mutations at S108N(88.24%, n = 60), N51I(85.29%, n = 58), C59R(79.41%, n = 54); however, I164L(2.94%, n = 2) showed low frequency mutation. No wild haplotype existed for Pfdhps, and there were no mutations at the K540E, A581G, and A613T/S positions. However, the mutation rate at A437G(93.38%, n = 62) was the highest, followed by S436A/F(15.38%, n = 10). A higher frequency of quadruple IRNI-SGKAA (69.84%) than quintuple IRNI-(A/F)GKAA (7.94%) mutations was observed in the Pfdhfr-Pfdhps combination. Furthermore, none of the mutations associated with ACT resistance, especially those commonly found in Africa, were observed in Pfk13. CONCLUSIONS High polymorphism frequencies of Pfdhfr and Pfdhps genes were observed, with alternative alanine/phenylalanine mutation at S436A/F (7.69%, n = 5) for the first time. Similar to that of other areas of the country, the patterns of multiple polymorphisms were consistent with selection owing to drug pressure. Although there was no evidence of a medication failure haplotype in the studied population, ACT drug efficacy should be regularly monitored in Libreville, Gabon.
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Affiliation(s)
| | - Berthe Amélie Iroungou
- Unité Mixte de Recherche Centre International de Recherches Médicales de Franceville et le Service de Santé Militaire, Libreville, 20404, Gabon
| | - Falone Larissa Akombi
- Unité Mixte de Recherche Centre International de Recherches Médicales de Franceville et le Service de Santé Militaire, Libreville, 20404, Gabon
| | - Lauriane Yacka-Mouele
- Unité Mixte de Recherche Centre International de Recherches Médicales de Franceville et le Service de Santé Militaire, Libreville, 20404, Gabon
| | - Zin Moon
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
| | - Ja Moon Aung
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
| | - Sanghyun Lee
- Division of Bio Bigdata, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, 28159, Korea
| | - Dong-Il Chung
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
| | - Yeonchul Hong
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea
| | - Youn-Kyoung Goo
- Department of Parasitology and Tropical Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Korea.
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Ali IM, Kom Tchuenkam PV, Tagomo SS, Hornela M, Moyeh MN, Nfor EN, Nji AM, Fomboh CT, Nana WD, Chedjou Kengne JP, Ngwa Niba PT, Ekoyol GE, Achu DF, Bigoga JD, Mbacham WF. Allelic Frequencies of Mutants of the Plasmodium falciparum, Quinoline and Folate Metabolizing genes in the West Region of Cameroon. Heliyon 2022; 8:e11861. [DOI: 10.1016/j.heliyon.2022.e11861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/03/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
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Wang X, Zhang X, Chen H, Lu Q, Ruan W, Chen Z. Molecular Determinants of Sulfadoxine-Pyrimethamine Resistance in Plasmodium falciparum Isolates from Central Africa between 2016 and 2021: Wide Geographic Spread of Highly Mutated Pfdhfr and Pfdhps Alleles. Microbiol Spectr 2022; 10:e0200522. [PMID: 36121226 PMCID: PMC9602997 DOI: 10.1128/spectrum.02005-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/27/2022] [Indexed: 12/31/2022] Open
Abstract
Sulfadoxine-pyrimethamine (SP) resistance impairs the efficacy of antimalarial drugs. Monitoring molecular markers in exported malaria infections provides an efficient way to trace the emergence of drug resistance in countries where malaria is endemic. Molecular markers in Pfdhfr and Pfdhps of 237 Plasmodium falciparum infections imported from central Africa between 2016 and 2021 were detected. The spatial and temporal distributions of Pfdhfr and Pfdhps mutations were analyzed. A high prevalence of Pfdhfr single-nucleotide polymorphisms (SNPs) (~92.34% to 99.10%) and a high frequency of the triple mutation haplotype I51R59N108 were observed. Cameroon, Equatorial Guinea, and Gabon showed a higher frequency (~96.61% to 100.00%) of I51R59N108 than other countries (~71.11% to 88.10%). The prevalence of C59R and I51R59N108 increased while that of other SNPs or haplotypes did not fluctuate greatly from 2016 to 2021. Large proportions of Pfdhps SNPs (A437G and K540E) were demonstrated. The SNP distribution of Pfdhps differed between countries, with S436A dominating in northern countries and A437G dominating in others. The proportions of I431V, A437G, and the triple mutant haplotype declined between 2016 and 2021, whereas the prevalence of the single mutant haplotype rose from 61.60% to 73.68%. Combinations of Pfdhfr-Pfdhps alleles conferring partial resistance, full resistance, and superresistance to SP, as defined in the text, were detected in 63.64%, 8.64%, and 0.91% of the samples, respectively. The octuple Pfdhfr-Pfdhps allele (I51R59N108-V431A436G437K540G581S613) was seen in 5.00% of the samples. We demonstrated the wide geographic spread and increasing trends in highly SP-resistant Pfdhfr genes and varying spatial patterns of Pfdhps mutants across countries in central Africa. The high prevalences of partially resistant, fully resistant, and superresistant Pfdhfr-Pfdhps combinations observed here indicated impaired SP efficacy. Increased molecular surveillance is required to monitor the changing status of the Pfdhfr and Pfdhps genes. IMPORTANCE Monitoring drug resistance is important for malaria control because its early detection enables timely action to prevent its spread and mitigate its impact. The wide geographic spread and the increasing trend of highly resistant Pfdhfr genes between 2016 and 2021 found in our study are worrisome and emphasize the urgency to monitor their updated status in central Africa. This study also illustrated the wide spread of the novel mutant Pfdhps I431V as well as the high prevalence of "partially resistant," "fully resistant," and "superresistant" Pfdhfr-Pfdhps combinations, indicating the urgent concern for SP efficacy in central Africa. These findings are alarming in central African countries where malaria is endemic, where SP was is widely used for the intermittent preventive treatment of malaria in pregnancy (IPTp) and the intermittent preventive treatment of malaria in infants below 5 years of age (IPTi), and urge enhanced molecular surveillance and responses to the threat of drug resistance.
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Affiliation(s)
- Xiaoxiao Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Xuan Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Hualiang Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Qiaoyi Lu
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Wei Ruan
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Zhiping Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
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Chaturvedi R, Chhibber-Goel J, Verma I, Gopinathan S, Parvez S, Sharma A. Geographical spread and structural basis of sulfadoxine-pyrimethamine drug-resistant malaria parasites. Int J Parasitol 2021; 51:505-525. [PMID: 33775670 DOI: 10.1016/j.ijpara.2020.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 12/22/2022]
Abstract
The global spread of sulfadoxine (Sdx, S) and pyrimethamine (Pyr, P) resistance is attributed to increasing number of mutations in DHPS and DHFR enzymes encoded by malaria parasites. The association between drug resistance mutations and SP efficacy is complex. Here we provide an overview of the geographical spread of SP resistance mutations in Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) encoded dhps and dhfr genes. In addition, we have collated the mutation data and mapped it on to the three-dimensional structures of DHPS and DHFR which have become available. Data from genomic databases and 286 studies were collated to provide a comprehensive landscape of mutational data from 2005 to 2019. Our analyses show that the Pyr-resistant double mutations are widespread in Pf/PvDHFR (P. falciparum ∼61% in Asia and the Middle East, and in the Indian sub-continent; in P. vivax ∼33% globally) with triple mutations prevailing in Africa (∼66%) and South America (∼33%). For PfDHPS, triple mutations dominate South America (∼44%), Asia and the Middle East (∼34%) and the Indian sub-continent (∼27%), while single mutations are widespread in Africa (∼45%). Contrary to the status for P. falciparum, Sdx-resistant single point mutations in PvDHPS dominate globally. Alarmingly, highly resistant quintuple and sextuple mutations are rising in Africa (PfDHFR-DHPS) and Asia (Pf/PvDHFR-DHPS). Structural analyses of DHFR and DHPS proteins in complexes with substrates/drugs have revealed that resistance mutations map proximal to Sdx and Pyr binding sites. Thus new studies can focus on discovery of novel inhibitors that target the non-substrate binding grooves in these two validated malaria parasite drug targets.
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Affiliation(s)
- Rini Chaturvedi
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India; Department of Toxicology, Jamia Hamdard, New Delhi, India
| | - Jyoti Chhibber-Goel
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ishika Verma
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Sreehari Gopinathan
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Suhel Parvez
- Department of Toxicology, Jamia Hamdard, New Delhi, India
| | - Amit Sharma
- Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India; National Institute of Malaria Research, Dwarka, New Delhi, India.
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Myers-Hansen JL, Abuaku B, Oyebola MK, Mensah BA, Ahorlu C, Wilson MD, Awandare G, Koram KA, Ngwa AA, Ghansah A. Assessment of antimalarial drug resistant markers in asymptomatic Plasmodium falciparum infections after 4 years of indoor residual spraying in Northern Ghana. PLoS One 2020; 15:e0233478. [PMID: 33284800 PMCID: PMC7721464 DOI: 10.1371/journal.pone.0233478] [Citation(s) in RCA: 5] [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: 05/02/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Drug resistance remains a concern for malaria control and elimination. The effect of interventions on its prevalence needs to be monitored to pre-empt further selection. We assessed the prevalence of Plasmodium falciparum gene mutations associated with resistance to the antimalarial drugs: sulfadoxine-pyrimethamine (SP), chloroquine (CQ) and artemisinin combination therapy (ACTs) after the scale-up of a vector control activity that reduced transmission. METHODS A total of 400 P. falciparum isolates from children under five years were genotyped for seventeen single nucleotide polymorphisms (SNPs) in pfcrt, pfmdr1, pfdhfr, pfdhps and pfk13 genes using polymerase chain reaction (PCR) and high resolution melting (HRM) analysis. These included 80 isolates, each randomly selected from cross-sectional surveys of asymptomatic infections across 2010 (baseline), 2011, 2012, 2013 (midline: post-IRS) and 2014 (endline: post-IRS) during the peak transmission season, when IRS intervention was rolled out in Bunkpurugu Yunyoo (BY) District, Ghana. The proportions of isolates with drug resistant alleles were assessed over this period. RESULTS There were significant decreases in the prevalence of pfdhfr- I51R59N108 haplotype from 2010 to 2014, while the decline in pfdhfr/pfdhps- I51R59N108G437 during the same period was not significant. The prevalence of lumefantrine (LM), mefloquine (MQ) and amodiaquine (AQ) resistance-associated haplotypes pfmdr1-N86F184D1246 and pfmdr1-Y86Y184Y1246 showed decreasing trends (z = -2.86, P = 0.004 and z = -2.71, P = 0.007, respectively). Each of pfcrt-T76 and pfmdr1-Y86 mutant alleles also showed a declining trend in the asymptomatic reservoir, after the IRS rollout in 2014 (z = -2.87, P = 0.004 and z = -2.65, P = 0.008, respectively). Similarly, Pyrimethamine resistance mediating polymorphisms pfdhfr-N108, pfdhfr-I51 and pfdhfr-R59 also declined (z = -2.03, P = 0.042, z = -3.54, P<0.001 and z = -4.63, P<0.001, respectively), but not the sulphadoxine resistance mediating pfdhps-G437 and pfdhps-F436 (z = -0.36, P = 0.715 and z = 0.41, P = 0.684, respectively). No mutant pfk13-Y580 were detected during the study period. CONCLUSION The study demonstrated declining trends in the prevalence of drug resistant mutations in asymptomatic P. falciparum infections following transmission reduction after an enhanced IRS intervention in Northern Ghana.
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Affiliation(s)
| | - Benjamin Abuaku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Muyiwa K. Oyebola
- West African Center for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Ghana
| | - Benedicta A. Mensah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Michael D. Wilson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Gordon Awandare
- West African Center for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Ghana
| | - Kwadwo A. Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - Anita Ghansah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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Gikunju SW, Agola EL, Ondondo RO, Kinyua J, Kimani F, LaBeaud AD, Malhotra I, King C, Thiong'o K, Mutuku F. Prevalence of pfdhfr and pfdhps mutations in Plasmodium falciparum associated with drug resistance among pregnant women receiving IPTp-SP at Msambweni County Referral Hospital, Kwale County, Kenya. Malar J 2020; 19:190. [PMID: 32448228 PMCID: PMC7247205 DOI: 10.1186/s12936-020-03263-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevention and treatment of malaria during pregnancy is crucial in dealing with maternal mortality and adverse fetal outcomes. The World Health Organization recommendation to treat all pregnant women with sulfadoxine-pyrimethamine (SP) through antenatal care structures was implemented in Kenya in the year 1998, but concerns about its effectiveness in preventing malaria in pregnancy has arisen due to the spread of SP resistant parasites. This study aimed to determine the prevalence of SP resistance markers in Plasmodium falciparum parasites isolated from pregnant women seeking antenatal care at Msambweni County Referral Hospital, located in coastal Kenya, between the year 2013 and 2015. METHODS This hospital-based study included 106 malaria positive whole blood samples for analysis of SP resistance markers within the Pfdhfr gene (codons 51, 59 and 108) and Pfdhps gene (codons 437 and 540). The venous blood collected from all pregnant women was tested for malaria via light microscopy, then the malaria positive samples were separated into plasma and red cells and stored in a - 86° freezer for further studies. Archived red blood cells were processed for molecular characterization of SP resistance markers within the Pfdhfr and Pfdhps genes using real time PCR platform and Sanger sequencing. RESULTS All samples had at least one mutation in the genes associated with drug resistance; polymorphism prevalence of Pfdhfr51I, 59R and 108N was at 88.7%, 78.3% and 93.4%, respectively, while Pfdhps polymorphism accounted for 94.3% and 91.5% at 437G and 540E, respectively. Quintuple mutations (at all the five codons) conferring total SP resistance had the highest prevalence of 85.8%. Quadruple mutations were observed at a frequency of 10.4%, and 24.5% had a mixed outcome of both wildtype and mutant genotypes in the genes of interest. CONCLUSION The data suggest a high prevalence of P. falciparum genetic variations conferring resistance to SP among pregnant women, which may explain reduced efficacy of IPTp treatment in Kenya. There is need for extensive SP resistance profiling in Kenya to inform IPTp drug choices for successful malaria prevention during pregnancy.
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Affiliation(s)
- Stella Wanjiku Gikunju
- Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya. .,Kenya Medical Research Institute (KEMRI), Centre for Biotechnology Research and Development (CBRD), Nairobi, Kenya.
| | - Eric L Agola
- Kenya Medical Research Institute (KEMRI), Centre for Biotechnology Research and Development (CBRD), Nairobi, Kenya.,Technical University of Kenya, Nairobi, Kenya
| | | | - Johnson Kinyua
- Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
| | - Francis Kimani
- Kenya Medical Research Institute (KEMRI), Centre for Biotechnology Research and Development (CBRD), Nairobi, Kenya
| | - Angelle Desiree LaBeaud
- Department of Pediatrics, Division of Infectious Disease, Stanford University School of Medicine, Stanford, CA, USA
| | - Indu Malhotra
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - Charles King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - Kelvin Thiong'o
- Kenya Medical Research Institute (KEMRI), Centre for Biotechnology Research and Development (CBRD), Nairobi, Kenya
| | - Francis Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
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Koumba Lengongo JV, Ndiaye YD, Tshibola Mbuyi ML, Ndong Ngomo JM, Ndiaye D, Bouyou Akotet MK, Mawili-Mboumba DP. Increased Frequency of Pfdhps A581G Mutation in Plasmodium falciparum Isolates from Gabonese HIV-Infected Individuals. Malar Res Treat 2019; 2019:9523259. [PMID: 31210925 PMCID: PMC6532279 DOI: 10.1155/2019/9523259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/08/2019] [Accepted: 04/14/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studying malaria parasites cross resistance to sulfadoxine-pyrimethamine (SP) and trimethoprim-sulfamethoxazole (cotrimoxazole, CTX) is necessary in areas coendemic for malaria and HIV. Polymorphism and frequency of drug resistance molecular markers, Pfdhfr and Pfdhps genes have been assessed in Plasmodium falciparum isolates from HIV-infected adults, in Gabon. MATERIEL AND METHODS A cross-sectional study was conducted in three HIV care and treatment centers, at Libreville, the capital city of Gabon and at Oyem and Koulamoutou, two rural cities between March 2015 and June 2016. P. falciparum-infected HIV adults were selected. Analysis of Pfdhfr and Pfdhps genes was performed using high resolution melting (HRM) technique. RESULTS Pfdhps A581G mutation was found in 23.5% (8/34) of the isolates. Triple Pfdhfr mutation (51I-59R-108N) was predominant (29.4%; n=10) while 17.6% (n=6) of the isolates carried a quadruple mutation (Pfdhfr 51I-59R-108N + Pfdhps 437G; Pfdhfr 51I-108N + Pfdhps 437G-Pfdhps581G; Pfdhfr 51I-59R-108N + Pfdhps 581G). Highly resistant genotype was detected in around 10% (n=3) of the isolates. The quintuple mutation (triple Pfdhfr 51I-59R-108N and double Pfdhps437-581) was only found in isolates from two patients who did not use CTX. The most frequent haplotypes were those with a single mutation (NCNIAKA) (36%) and a quadruple mutation (NCIIGKG, NRIIGKA, and NRIIAKG). Mixed unknown genotypes were found at codon 164 in three isolates. Mixed genotypes were more frequent at codons 51 (23.5%; n=8) and 59 (20.5%; n=7) (p<0.01). CONCLUSION Pfdhps A581G mutation as well as new combination of quintuple mutations is found for the first time in isolates from HIV-infected patients in Gabon in comparison to a previous study. The detection of these genotypes at a nonnegligible frequency underlines the need of a regular surveillance of antifolates drug resistance.
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Affiliation(s)
| | - Yaye Dié Ndiaye
- Laboratory of Parasitology Mycology, Aristide le Dantec Hospital, Faculty of Medicine and Pharmacy, Cheikh Anta Diop University, 5005 Dakar, Senegal
- The International Centers of Excellence for Malaria Research (ICEMR) Program, Dakar, Senegal
| | - Marie Louise Tshibola Mbuyi
- Department of Parasitology Mycology, Faculty of Medicine, Université des Sciences de la Santé, Libreville BP4009, Gabon
| | - Jacques Mari Ndong Ngomo
- Department of Parasitology Mycology, Faculty of Medicine, Université des Sciences de la Santé, Libreville BP4009, Gabon
| | - Daouda Ndiaye
- Laboratory of Parasitology Mycology, Aristide le Dantec Hospital, Faculty of Medicine and Pharmacy, Cheikh Anta Diop University, 5005 Dakar, Senegal
- The International Centers of Excellence for Malaria Research (ICEMR) Program, Dakar, Senegal
| | - Marielle Karine Bouyou Akotet
- Department of Parasitology Mycology, Faculty of Medicine, Université des Sciences de la Santé, Libreville BP4009, Gabon
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Jiang T, Chen J, Fu H, Wu K, Yao Y, Eyi JUM, Matesa RA, Obono MMO, Du W, Tan H, Lin M, Li J. High prevalence of Pfdhfr-Pfdhps quadruple mutations associated with sulfadoxine-pyrimethamine resistance in Plasmodium falciparum isolates from Bioko Island, Equatorial Guinea. Malar J 2019; 18:101. [PMID: 30914041 PMCID: PMC6434785 DOI: 10.1186/s12936-019-2734-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/18/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sulfadoxine-pyrimethamine (SP) is recommended for intermittent preventive treatment of malaria in Africa. However, increasing SP resistance (SPR) affects the therapeutic efficacy of the SP. As molecular markers, Pfdhfr (dihydrofolate reductase) and Pfdhps (dihydropteroate synthase) genes are widely used for SPR surveillance. This study aimed to assess the prevalence of Pfdhfr and Pfdhps genes mutations and haplotypes in Plasmodium falciparum isolates collected from Bioko Island, Equatorial Guinea (EG). METHODS In total, 180 samples were collected in 2013-2014. The single nucleotide polymorphisms (SNPs) of the Pfdhfr and Pfdhps genes were identified with nested PCR and Sanger sequencing. The genotypes and linkage disequilibrium (LD) tests were also analysed. RESULTS Sequences of Pfdhfr and Pfdhps genes were obtained from 92.78% (167/180) and 87.78% (158/180) of the samples, respectively. For Pfdhfr, 97.60% (163/167), 87.43% (146/167) and 97.01% (162/167) of the samples carried N51I, C59R and S108N mutant alleles, respectively. The prevalence of the Pfdhps S436A, A437G, K540E, A581G, and A613S mutations were observed in 20.25% (32/158), 90.51% (143/158), 5.06% (8/158), 0.63% (1/158), and 3.16% (5/158) of the samples, respectively. In total, 3 unique haplotypes at the Pfdhfr locus and 8 haplotypes at the Pfdhps locus were identified. A triple mutation (CIRNI) in Pfdhfr was the most prevalent haplotype (86.83%), and a single mutant haplotype (SGKAA; 62.66%) was predominant in Pfdhps. A total of 130 isolates with 12 unique haplotypes were found in the Pfdhfr and Pfdhps combined haplotypes, 65.38% (85/130) of them carried quadruple allele combinations (CIRNI-SGKAA), whereas only one isolate (0.77%, 1/130) was found to carry the wild-type (CNCSI-SAKAA). For LD analysis, the Pfdhfr N51I was significantly associated with the Pfdhps A437G (P < 0.05). CONCLUSION Bioko Island possesses a high prevalence of the Pfdhfr triple mutation (CIRNI) and Pfdhps single mutation (SGKAA), which will undermine the pharmaceutical effect of SP for malaria treatment strategies. To avoid an increase in SPR, continuous molecular monitoring and additional control efforts are urgently needed in Bioko Island, Equatorial Guinea.
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Affiliation(s)
- Tingting Jiang
- Department of Human Parasitology, School of Basic Medical Sciences, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Jiangtao Chen
- The Chinese Medical Aid Team To the Republic of Equatorial Guinea; Laboratory Medical Center, Huizhou Municipal Central Hospital, Huizhou, 516001, People's Republic of China
| | - Hongxia Fu
- Clinical Laboratory, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Kai Wu
- Department of Schistosomiasis and Endemic Diseases, Wuhan City Center for Disease Prevention and Control, Wuhan, People's Republic of China
| | - Yi Yao
- Department of Human Parasitology, School of Basic Medical Sciences, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | | | - Rocio Apicante Matesa
- Department of Medical Laboratory, Malabo Regional Hospital, Malabo, Equatorial Guinea
| | | | - Weixing Du
- Department of Human Parasitology, School of Basic Medical Sciences, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Huabing Tan
- Department of Human Parasitology, School of Basic Medical Sciences, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Min Lin
- Department of Histology and Embryology, Shantou University Medical College, Shantou, People's Republic of China.
| | - Jian Li
- Department of Human Parasitology, School of Basic Medical Sciences, Department of Infectious Diseases, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.
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Voumbo-Matoumona DF, Kouna LC, Madamet M, Maghendji-Nzondo S, Pradines B, Lekana-Douki JB. Prevalence of Plasmodium falciparum antimalarial drug resistance genes in Southeastern Gabon from 2011 to 2014. Infect Drug Resist 2018; 11:1329-1338. [PMID: 30214253 PMCID: PMC6118251 DOI: 10.2147/idr.s160164] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The introduction of artemisinin-based combination therapies (ACTs) in treating uncomplicated malaria and sulfadoxine-pyrimethamine (SP) as intermittent preventive treatment during pregnancy drastically decreased the burden of malarial disease around the world. However, ACTs are known to select for drug resistance markers. In Gabon, artemether-lumefantrine induced an increase in the prevalence of N86-Pfmdr1, which is associated with treatment failure. However, little data are available regarding resistance markers in Southeastern Gabon. This study aimed to evaluate the evolution of resistance haplotypes in the Pfcrt, Pfdhps, Pfdhfr, and PfK13 genes from 2011 to 2014 in Southeastern Gabon. METHODS A total of 233 Plasmodium falciparum DNA samples were collected from febrile pediatric patients in South Gabon: Franceville, an urban area; Koulamoutou, a semi-urban area; and Lastourville, a rural area. Pfcrt, Pfdhps, Pfdhfr, and the propeller domain of PfK13 were sequenced for all isolates. RESULTS The overall prevalence (3.7%-11.5%) of the wild-type haplotype Pfcrt 72-76 CVMNK was not significantly different between 2011 and 2014 in Southeast Gabon. For Pfdhfr (codons 51, 59, 108, 164), the IRNI triple-mutant haplotype was the most prevalent (>89.0%). The ICNI and NCNI mutant haplotypes and the NCSI wild-type haplotype showed a minor prevalence. There were no differences in the distributions of these haplotypes across the 4 years and the three study sites. For Pfdhps, the AAKAA and SGKAA mutant haplotypes and the SAKAA wild-type haplotype were similarly present in the three areas during the study period. The AGKAA double mutant was first observed in 2013 in Franceville and in 2014 in Koulamoutou and Lastourville. Interestingly, only the A578S mutation (0.4%) and two new A494V (0.4%) and V504A (0.9%) mutations were found in PfK13. CONCLUSION Despite the withdrawal of chloroquine, the frequency of the resistant allele 76T remained high in the south of Gabon. Moreover, a high level of resistant haplotypes against IPTp-SP was found.
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Affiliation(s)
- Dominique Fatima Voumbo-Matoumona
- Unit of Evolution, Epidemiology and Parasitic Resistances (UNEEREP), International Medical Research Center of Franceville (CIRMF), Franceville, Gabon,
- Parasitology and Entomology Unit, Department of Infectious Diseases, Biomedical Research Institute of Army, Marseille, France
- Regional Doctoral School of Central Africa in Tropical Infectiology, Franceville, Gabon
| | - Lady Charlène Kouna
- Department of Parasitology, Mycology and Tropical Medicine, University of Health Sciences, Libreville, Gabon,
| | - Marylin Madamet
- Parasitology and Entomology Unit, Department of Infectious Diseases, Biomedical Research Institute of Army, Marseille, France
- Research Unit on Infectious and Tropical Emerging Diseases, Aix Marseille University, Marseille, France
- National Malaria Reference Center, Marseille, France
| | - Sydney Maghendji-Nzondo
- Department of Parasitology, Mycology and Tropical Medicine, University of Health Sciences, Libreville, Gabon,
| | - Bruno Pradines
- Parasitology and Entomology Unit, Department of Infectious Diseases, Biomedical Research Institute of Army, Marseille, France
- Research Unit on Infectious and Tropical Emerging Diseases, Aix Marseille University, Marseille, France
- National Malaria Reference Center, Marseille, France
| | - Jean Bernard Lekana-Douki
- Unit of Evolution, Epidemiology and Parasitic Resistances (UNEEREP), International Medical Research Center of Franceville (CIRMF), Franceville, Gabon,
- Department of Parasitology, Mycology and Tropical Medicine, University of Health Sciences, Libreville, Gabon,
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