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Sridapan T, Rattanakoch P, Kijprasong K, Srisutham S. Drug resistance markers in Plasmodium vivax isolates from a Kanchanaburi province, Thailand between January to May 2023. PLoS One 2024; 19:e0304337. [PMID: 38968216 PMCID: PMC11226124 DOI: 10.1371/journal.pone.0304337] [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: 08/27/2023] [Accepted: 05/10/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Plasmodium vivax has become the predominant species in the border regions of Thailand. The emergence and spread of antimalarial drug resistance in P. vivax is one of the significant challenges for malaria control. Continuous surveillance of drug resistance is therefore necessary for monitoring the development of drug resistance in the region. This study aims to investigate the prevalence of the mutation in the P. vivax multidrug resistant 1 (Pvmdr1), dihydrofolate reductase (Pvdhfr), and dihydropteroate synthetase (Pvdhps) genes conferred resistance to chloroquine (CQ), pyrimethamine (P) and sulfadoxine (S), respectively. METHOD 100 P. vivax isolates were obtained between January to May 2023 from a Kanchanaburi province, western Thailand. Nucleotide sequences of Pvmdr1, Pvdhfr, and Pvdhps genes were amplified and sequenced. The frequency of single nucleotide polymorphisms (SNPs)-haplotypes of drug-resistant alleles was assessed. The linkage disequilibrium (LD) tests were also analyzed. RESULTS In Pvmdr1, T958M, Y976F, and F1076L, mutations were detected in 100%, 21%, and 23% of the isolates, respectively. In Pvdhfr, the quadruple mutant allele (I57R58M61T117) prevailed in 84% of the samples, followed by (L57R58M61T117) in 11%. For Pvdhps, the double mutant allele (G383G553) was detected (48%), followed by the triple mutant allele (G383M512G553) (47%) of the isolates. The most prevalent combination of Pvdhfr (I57R58M61T117) and Pvdhps (G383G553) alleles was sextuple mutated haplotypes (48%). For LD analysis, the association in the SNPs pairs was found between the intragenic and intergenic regions of the Pvdhfr and Pvdhps genes. CONCLUSION The study has recently updated the high prevalence of three gene mutations associated with CQ and SP resistance. Genetic monitoring is therefore important to intensify in the regions to further assess the spread of drug resistant. Our data also provide evidence on the distribution of drug resistance for the early warning system, thereby threatening P. vivax malaria treatment policy decisions at the national level.
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Affiliation(s)
- Thanawat Sridapan
- Department of Clinical Microscopy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Paweesuda Rattanakoch
- Department of Clinical Microscopy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | - Suttipat Srisutham
- Department of Clinical Microscopy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Nallapati VT, Gupta N, Hande MH, Saravu K. A systematic review of CQ-resistant Plasmodium vivax malaria infections in India. Pathog Glob Health 2024; 118:295-304. [PMID: 37994442 PMCID: PMC11234910 DOI: 10.1080/20477724.2023.2285179] [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] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Chloroquine (CQ) is the drug of choice for treating uncomplicated Plasmodium vivax (P. vivax) malaria in India. The knowledge about the exact burden of CQ resistance in P. vivax in India is scarce. Therefore, this systematic review aimed to assess the prevalence of CQ resistance in reported P. vivax cases from India. METHODS PubMed, EMBASE, and Web of Science, were searched using the search string: 'Malaria AND vivax AND chloroquine AND (resistance OR resistant) AND India'. We systematically reviewed in-vivo and in-vitro drug efficacy studies that investigated the CQ efficacy of P. vivax malaria between January 1995 and December 2022. Those studies where patients were followed up for at least 28 days after initiation of treatment were included. RESULTS We identified 12 eligible CQ therapeutic efficacy studies involving 2470 patients, Of these 2329 patients were assessed by in-vivo therapeutic efficacy methods and the remaining 141 were assessed by in-vitro methods. CQ resistance was found in 25/1787 (1.39%) patients from in-vivo and in 11/141 (7.8%) patients from in-vitro drug efficacy studies. CONCLUSION Based on the available studies, the prevalence of CQ resistance in P. vivax was found to be relatively lower in India. However, continued surveillance and monitoring are crucial to identify the emergence of CQ resistance.
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Affiliation(s)
- Vishnu Teja Nallapati
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Manjunath H Hande
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Karnataka, Manipal, India
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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3
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Kaur D, Sinha S, Sehgal R. Global scenario of Plasmodium vivax occurrence and resistance pattern. J Basic Microbiol 2022; 62:1417-1428. [PMID: 36125207 DOI: 10.1002/jobm.202200316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/20/2022] [Accepted: 09/04/2022] [Indexed: 11/06/2022]
Abstract
Malaria caused by Plasmodium vivax is comparatively less virulent than Plasmodium falciparum, which can also lead to severe disease and death. It shows a wide geographical distribution. Chloroquine serves as a drug of choice, with primaquine as a radical cure. However, with the appearance of resistance to chloroquine and treatment has been shifted to artemisinin combination therapy followed by primaquine as a radical cure. Sulphadoxine-pyrimethamine, mefloquine, and atovaquone-proguanil are other drugs of choice in chloroquine-resistant areas, and later resistance was soon reported for these drugs also. The emergence of drug resistance serves as a major hurdle to controlling and eliminating malaria. The discovery of robust molecular markers and regular surveillance for the presence of mutations in malaria-endemic areas would serve as a helpful tool to combat drug resistance. Here, in this review, we will discuss the endemicity of P. vivax, a historical overview of antimalarial drugs, the appearance of drug resistance and molecular markers with their global distribution along with different measures taken to reduce malaria burden due to P. vivax infection and their resistance.
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Affiliation(s)
- Davinder Kaur
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shweta Sinha
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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4
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Zeng W, Zhao H, Zhao W, Yang Q, Li X, Li X, Duan M, Wang X, Li C, Xiang Z, Chen X, Cui L, Yang Z. Molecular Surveillance and Ex Vivo Drug Susceptibilities of Plasmodium vivax Isolates From the China-Myanmar Border. Front Cell Infect Microbiol 2021; 11:738075. [PMID: 34790586 PMCID: PMC8591282 DOI: 10.3389/fcimb.2021.738075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
Drug resistance in Plasmodium vivax may pose a challenge to malaria elimination. Previous studies have found that P. vivax has a decreased sensitivity to antimalarial drugs in some areas of the Greater Mekong Sub-region. This study aims to investigate the ex vivo drug susceptibilities of P. vivax isolates from the China–Myanmar border and genetic variations of resistance-related genes. A total of 46 P. vivax clinical isolates were assessed for ex vivo susceptibility to seven antimalarial drugs using the schizont maturation assay. The medians of IC50 (half-maximum inhibitory concentrations) for chloroquine, artesunate, and dihydroartemisinin from 46 parasite isolates were 96.48, 1.95, and 1.63 nM, respectively, while the medians of IC50 values for piperaquine, pyronaridine, mefloquine, and quinine from 39 parasite isolates were 19.60, 15.53, 16.38, and 26.04 nM, respectively. Sequence polymorphisms in pvmdr1 (P. vivax multidrug resistance-1), pvmrp1 (P. vivax multidrug resistance protein 1), pvdhfr (P. vivax dihydrofolate reductase), and pvdhps (P. vivax dihydropteroate synthase) were determined by PCR and sequencing. Pvmdr1 had 13 non-synonymous substitutions, of which, T908S and T958M were fixed, G698S (97.8%) and F1076L (93.5%) were highly prevalent, and other substitutions had relatively low prevalences. Pvmrp1 had three non-synonymous substitutions, with Y1393D being fixed, G1419A approaching fixation (97.8%), and V1478I being rare (2.2%). Several pvdhfr and pvdhps mutations were relatively frequent in the studied parasite population. The pvmdr1 G698S substitution was associated with a reduced sensitivity to chloroquine, artesunate, and dihydroartemisinin. This study suggests the possible emergence of P. vivax isolates resistant to certain antimalarial drugs at the China–Myanmar border, which demands continuous surveillance for drug resistance.
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Affiliation(s)
- Weilin Zeng
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Hui Zhao
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Wei Zhao
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Qi Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Xinxin Li
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Xiaosong Li
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Mengxi Duan
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Xun Wang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Cuiying Li
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Zheng Xiang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Xi Chen
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
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5
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Nadeem MF, Khattak AA, Zeeshan N, Zahid H, Awan UA, Yaqoob A, Ashraf NM, Gul S, Alam S, Ahmed W. Surveillance of molecular markers of antimalarial drug resistance in Plasmodium falciparum and Plasmodium vivax in Federally Administered Tribal Area (FATA), Pakistan. Rev Inst Med Trop Sao Paulo 2021; 63:e59. [PMID: 34407160 PMCID: PMC8323834 DOI: 10.1590/s1678-9946202163059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022] Open
Abstract
This molecular epidemiological study was designed to determine the antimalarial
drug resistance pattern, and the genetic diversity of malaria isolates collected
from a war-altered Federally Administered Tribal Area (FATA), in Pakistan.
Clinical isolates were collected from Bajaur, Mohmand, Khyber, Orakzai and
Kurram agencies of FATA region between May 2017 and May 2018, and they underwent
DNA extraction and amplification. The investigation of gene polymorphisms in
drug resistance genes (dhfr, dhps, crt, and
mdr1) of Plasmodium falciparum and
Plasmodium vivax was carried out by pyrosequencing and
Sanger sequencing, respectively. Out of 679 PCR-confirmed malaria samples, 523
(77%) were P. vivax, 121 (18%) P. falciparum,
and 35 (5%) had mixed-species infections. All P. falciparum
isolates had pfdhfr double mutants (C59R+S108N), while
pfdhfr/pfdhps triple mutants (C59R+S108N+A437G) were
detected in 11.5% of the samples. About 97.4% of P. falciparum
isolates contained pfcrt K76T mutation, while
pfmdr1 N86Y and Y184F mutations were present in 18.2% and
10.2% of the samples. P. vivax pvdhfr S58R mutation was present
in 24.9% of isolates and the S117N mutation in 36.2%, while no mutation in the
pvdhps gene was found. Pvmdr1 F1076L
mutation was found in nearly all samples, as it was observed in 98.9% of
isolates. No significant anti-folate and chloroquine resistance was observed in
P. vivax; however, mutations associated with
antifolate-resistance were found, and the chloroquine-resistant gene has been
observed in 100% of P. falciparum isolates. Chloroquine and
sulphadoxine-pyrimethamine resistance were found to be high in P.
falciparum and low in P. vivax. Chloroquine could
still be used for P. vivax infection but need to be tested
in vivo, whereas a replacement of the artemisinin
combination therapy for P. falciparum appears to be
justified.
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Affiliation(s)
- Muhammad Faisal Nadeem
- University of Gujrat, Department of Biochemistry & Biotechnology, Gujrat, Punjab, Pakistan
| | - Aamer Ali Khattak
- The University of Haripur, Department of Medical Laboratory Technology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Nadia Zeeshan
- University of Gujrat, Department of Biochemistry & Biotechnology, Gujrat, Punjab, Pakistan
| | - Hamza Zahid
- Sandeman Provincial Hospital, Department of Surgery, Quetta, Balochistan, Pakistan
| | - Usman Ayub Awan
- The University of Haripur, Department of Medical Laboratory Technology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Adnan Yaqoob
- University of Gujrat, Department of Biochemistry & Biotechnology, Gujrat, Punjab, Pakistan
| | - Naeem Mahmood Ashraf
- University of Gujrat, Department of Biochemistry & Biotechnology, Gujrat, Punjab, Pakistan
| | - Sana Gul
- National University of Medical Sciences, Department of Biological Sciences, Rawalpindi, Pujab, Pakistan
| | - Sadia Alam
- The University of Haripur, Department of Microbiology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - Waqas Ahmed
- The University of Haripur, Department of Microbiology, Haripur, Khyber Pakhtunkhwa, Pakistan
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6
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Spotin A, Mahami-Oskouei M, Ahmadpour E, Parsaei M, Rostami A, Emami S, Gholipour S, Farmani M. Global assessment of genetic paradigms of Pvmdr1 mutations in chloroquine-resistant Plasmodium vivax isolates. Trans R Soc Trop Med Hyg 2021; 114:339-345. [PMID: 32100835 DOI: 10.1093/trstmh/traa002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/04/2019] [Accepted: 01/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chloroquine (CQ) is generally prescribed as the front-line antimalarial drug of choice to treat Plasmodium vivax infections; however, some clinical CQ-resistant P. vivax isolates have been indigenously reported around the world during the last decade. METHODS In this study, P. vivax isolates (n=52) were obtained from autochthonous samples in southeast Iran during 2015-2017. The genomic DNA of samples was extracted, amplified (nested PCR) and sequenced by targeting the multidrug-resistance 1 gene. To verify the global genetic diversity of CQ-resistant P. vivax strains, the sequences of Pvmdr1 originating from Asia and the Americas were retrieved. RESULTS A total of 46 haplotypes were grouped into three distinct geographical haplogroups. The haplotype diversity and occurrence rates of Pvmdr1 976F/1076L mutations indicate that the efficacy of CQ is being compromised in Mexico, China, Nicaragua, Thailand, Brazil (2016), Ethiopia, Mauritania (2012) and southwest India in the near future. The cladistic phylogenetic tree showed that Pvmdr1 sequences isolated from the southeast Asian clade has a partial sister relationship with the American clade. CONCLUSIONS The current findings will serve as a basis to develop appropriate malaria control strategies and public health policies in symptomatic imported malaria cases or plausible CQ-resistant P. vivax strains.
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Affiliation(s)
- Adel Spotin
- Department of Parasitology and Mycology, Faculty of Medicine Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Mahami-Oskouei
- Department of Parasitology and Mycology, Faculty of Medicine Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Ahmadpour
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Parsaei
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Shima Emami
- Department of Parasitology and Mycology, Faculty of Medicine Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saba Gholipour
- Department of Parasitology and Mycology, Faculty of Medicine Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farmani
- Department of Parasitology and Mycology, Faculty of Medicine Tabriz University of Medical Sciences, Tabriz, Iran
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7
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Nadeem MF, Khattak AA, Zeeshan N, Zahid H, Awan UA, Yaqoob A, Ashraf NM, Gul S, Alam S, Ahmed W. Surveillance of molecular markers of antimalarial drug resistance in Plasmodium falciparum and Plasmodium vivax in Federally Administered Tribal Area (FATA), Pakistan. Rev Inst Med Trop Sao Paulo 2021. [DOI: 10.1590/s1678-994620216305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Sana Gul
- National University of Medical Sciences, Pakistan
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8
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Ferreira MU, Nobrega de Sousa T, Rangel GW, Johansen IC, Corder RM, Ladeia-Andrade S, Gil JP. Monitoring Plasmodium vivax resistance to antimalarials: Persisting challenges and future directions. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2020; 15:9-24. [PMID: 33360105 PMCID: PMC7770540 DOI: 10.1016/j.ijpddr.2020.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022]
Abstract
Emerging antimalarial drug resistance may undermine current efforts to control and eliminate Plasmodium vivax, the most geographically widespread yet neglected human malaria parasite. Endemic countries are expected to assess regularly the therapeutic efficacy of antimalarial drugs in use in order to adjust their malaria treatment policies, but proper funding and trained human resources are often lacking to execute relatively complex and expensive clinical studies, ideally complemented by ex vivo assays of drug resistance. Here we review the challenges for assessing in vivo P. vivax responses to commonly used antimalarials, especially chloroquine and primaquine, in the presence of confounding factors such as variable drug absorption, metabolism and interaction, and the risk of new infections following successful radical cure. We introduce a simple modeling approach to quantify the relative contribution of relapses and new infections to recurring parasitemias in clinical studies of hypnozoitocides. Finally, we examine recent methodological advances that may render ex vivo assays more practical and widely used to confirm P. vivax drug resistance phenotypes in endemic settings and review current approaches to the development of robust genetic markers for monitoring chloroquine resistance in P. vivax populations. Plasmodium vivax resistance to chloroquine may undermine malaria elimination efforts. Plasmodium vivax resistance to schizontocides has been mostly monitored in therapeutic efficacy studies. In vivo studies to determine the anti-relapse efficacy of primaquine are challenging to design and execute. Ex vivo assays to determine Plasmodium vivax resistance to schizontocides remain limited to research settings. Robust molecular markers to monitor Plasmodium vivax drug resistance are currently lacking.
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Affiliation(s)
- Marcelo U Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal.
| | - Tais Nobrega de Sousa
- Molecular Biology and Malaria Immunology Research Group, René Rachou Institute, Fiocruz, Belo Horizonte, Brazil
| | - Gabriel W Rangel
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA, USA
| | - Igor C Johansen
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rodrigo M Corder
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Simone Ladeia-Andrade
- Laboratory of Parasitic Diseases, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - José Pedro Gil
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Solna, Sweden
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9
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Matlani M, Kumar A, Singh V. Assessing the in vitro sensitivity with associated drug resistance polymorphisms in Plasmodium vivax clinical isolates from Delhi, India. Exp Parasitol 2020; 220:108047. [PMID: 33221328 DOI: 10.1016/j.exppara.2020.108047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022]
Abstract
The drug resistance of Plasmodium vivax in clinical cases remains largely unknown till date because of the difficulty in diagnosing the resistant P. vivax strains. The present study was undertaken to determine the prevalence of mutant alleles in drug resistance genes viz P. vivax multi-drug resistance (pvmdr-1), chloroquine resistance transporter (pvcrt-o), dihydrofolate reductase (pvdhfr) and dihydropteroate synthase (pvdhps) along with in vitro chloroquine (CQ) sensitivity in P. vivax clinical isolates. During August-October 2017 a total of 86 samples of the febrile patients were screened and 31 samples were found to be positive for P. vivax in Safdarjung hospital, New Delhi. Sequence genotyping of the drug resistance genes was carried out in these P. vivax samples and in vitro CQ susceptibility for 23 isolates was determined by the schizont maturation assay (SMA). The CQ inhibitory concentrations (IC50) for the clinical isolates was found to be in the range of 25.6-176.7 nM. All the 31 clinical isolates analyzed for pvmdr-1 gene, showed mutant alleles and in only two isolates novel mutations at 861 and 898 codons were observed. Sequence analysis of pvcrt-o, pvdhfr and pvdhps genes revealed wild type genotypes in all the 31 studied isolates. The presence of mutations in pvmdr-1 gene and the increase in the CQ IC50 value indicates the possibility of shift in drug tolerance where CQ with primaquine (PQ) is still the first line of treatment for P. vivax malaria in the country. The regular molecular surveillance in P. vivax would provide useful information for the policy makers of the malaria control programme.
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Affiliation(s)
- Monika Matlani
- Department of Microbiology,Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Amit Kumar
- Cell Biology Laboratory and Malaria Parasite Bank, ICMR-National Institute of Malaria Research, New Delhi, India
| | - Vineeta Singh
- Cell Biology Laboratory and Malaria Parasite Bank, ICMR-National Institute of Malaria Research, New Delhi, India.
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10
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Marasinghe MM, Karunasena VM, Seneratne AS, Herath HDB, Fernando D, Wickremasinghe R, Mendis KN, Ranaweera D. Mass radical treatment of a group of foreign workers to mitigate the risk of re-establishment of malaria in Sri Lanka. Malar J 2020; 19:346. [PMID: 32977809 PMCID: PMC7517794 DOI: 10.1186/s12936-020-03419-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Following malaria elimination, Sri Lanka was free from indigenous transmission for six consecutive years, until the first introduced case was reported in December 2018. The source of transmission (index case) was a member of a group of 32 migrant workers from India and the location of transmission was their residence reporting a high prevalence of the primary vector for malaria. Despite extensive vector control the situation was highly susceptible to onward transmission if another of the group developed malaria. Therefore, Mass Radical Treatment (MRT) of the group of workers for Plasmodium vivax malaria was undertaken to mitigate this risk. Method The workers were screened for malaria by microscopy and RDT, their haemoglobin level assessed, and tested for Glucose 6 phosphate dehydrogenase deficiency (G6PD) using the Care Start RDT and Brewers test prior to treatment with chloroquine (CQ) 25 mg/kg body weight (over three days) and primaquine (PQ) (0.25 mg/kg/day bodyweight for 14 days) following informed consent. All were monitored for adverse events. Results None of the foreign workers were parasitaemic at baseline screening and their haemoglobin levels ranged from 9.7–14.7 g/dl. All 31 individuals (excluding the index case treated previously) were treated with the recommended dose of CQ. The G6PD test results were inconclusive in 45% of the RDT results and were discrepant between the two tests in 31% of the remaining test events. Seven workers who tested G6PD deficient in either test were excluded from PQ and the rest, 24 workers, received PQ. No serious adverse events occurred. Conclusions Mass treatment may be an option in prevention of reintroduction settings for groups of migrants who are likely to be carrying latent malaria infections, and resident in areas of high receptivity. However, in the case of Plasmodium vivax and Plasmodium ovale, a more reliable and affordable point-of-care test for G6PD activity would be required. Most countries which are eliminating malaria now are in the tropical zone and face considerable and similar risks of malaria re-introduction due to massive labour migration between them and neighbouring countries. Regional elimination of malaria should be the focus of global strategy if malaria elimination from countries is to be worthwhile and sustainable.
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Affiliation(s)
| | | | | | | | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
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11
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Zhao Y, Wang L, Soe MT, Aung PL, Wei H, Liu Z, Ma T, Huang Y, Menezes LJ, Wang Q, Kyaw MP, Nyunt MH, Cui L, Cao Y. Molecular surveillance for drug resistance markers in Plasmodium vivax isolates from symptomatic and asymptomatic infections at the China-Myanmar border. Malar J 2020; 19:281. [PMID: 32758218 PMCID: PMC7409419 DOI: 10.1186/s12936-020-03354-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In the Greater Mekong sub-region, Plasmodium vivax has become the predominant species and imposes a major challenge for regional malaria elimination. This study aimed to investigate the variations in genes potentially related to drug resistance in P. vivax populations from the China-Myanmar border area. In addition, this study also wanted to determine whether divergence existed between parasite populations associated with asymptomatic and acute infections. METHODS A total of 66 P. vivax isolates were obtained from patients with acute malaria who attended clinics at the Laiza area, Kachin State, Myanmar in 2015. In addition, 102 P. vivax isolates associated with asymptomatic infections were identified by screening of volunteers without signs or symptoms from surrounding villages. Slide-positive samples were verified with nested PCR detecting the 18S rRNA gene. Multiclonal infections were further excluded by genotyping at msp-3α and msp-3β genes. Parasite DNA from 60 symptomatic cases and 81 asymptomatic infections was used to amplify and sequence genes potentially associated with drug resistance, including pvmdr1, pvcrt-o, pvdhfr, pvdhps, and pvk12. RESULTS The pvmdr1 Y976F and F1076L mutations were present in 3/113 (2.7%) and 97/113 (85.5%) P. vivax isolates, respectively. The K10 insertion in pvcrt-o gene was found in 28.2% of the parasites. Four mutations in the two antifolate resistance genes reached relatively high levels of prevalence: pvdhfr S58R (53.4%), S117N/T (50.8%), pvdhps A383G (75.0%), and A553G (36.3%). Haplotypes with wild-type pvmdr1 (976Y/997K/1076F) and quadruple mutations in pvdhfr (13I/57L/58R/61M/99H/117T/173I) were significantly more prevalent in symptomatic than asymptomatic infections, whereas the pvmdr1 mutant haplotype 976Y/997K/1076L was significantly more prevalent in asymptomatic than symptomatic infections. In addition, quadruple mutations at codons 57, 58, 61 and 117 of pvdhfr and double mutations at codons 383 and 553 of pvdhps were found both in asymptomatic and symptomatic infections with similar frequencies. No mutations were found in the pvk12 gene. CONCLUSIONS Mutations in pvdhfr and pvdhps were prevalent in both symptomatic and asymptomatic P. vivax infections, suggestive of resistance to antifolate drugs. Asymptomatic carriers may act as a silent reservoir sustaining drug-resistant parasite transmission necessitating a rational strategy for malaria elimination in this region.
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Affiliation(s)
- Yan Zhao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Lin Wang
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Myat Thu Soe
- Myanmar Health Network Organization, Yangon, Myanmar
| | | | - Haichao Wei
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Ziling Liu
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Tongyu Ma
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yuanyuan Huang
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Lynette J Menezes
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA
| | - Qinghui Wang
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | | | | | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, 33612, USA.
| | - Yaming Cao
- Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China.
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12
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Li J, Zhang J, Li Q, Hu Y, Ruan Y, Tao Z, Xia H, Qiao J, Meng L, Zeng W, Li C, He X, Zhao L, Siddiqui FA, Miao J, Yang Z, Fang Q, Cui L. Ex vivo susceptibilities of Plasmodium vivax isolates from the China-Myanmar border to antimalarial drugs and association with polymorphisms in Pvmdr1 and Pvcrt-o genes. PLoS Negl Trop Dis 2020; 14:e0008255. [PMID: 32530913 PMCID: PMC7314094 DOI: 10.1371/journal.pntd.0008255] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 06/24/2020] [Accepted: 03/26/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Vivax malaria is an important public health problem in the Greater Mekong Subregion (GMS), including the China-Myanmar border. Previous studies have found that Plasmodium vivax has decreased sensitivity to antimalarial drugs in some areas of the GMS, but the sensitivity of P. vivax to antimalarial drugs is unclear in the China-Myanmar border. Here, we investigate the drug sensitivity profile and genetic variations for two drug resistance related genes in P. vivax isolates to provide baseline information for future drug studies in the China-Myanmar border. METHODOLOGY/PRINCIPAL FINDINGS A total of 64 P. vivax clinical isolates collected from the China-Myanmar border area were assessed for ex vivo susceptibility to eight antimalarial drugs by the schizont maturation assay. The medians of IC50 (half-maximum inhibitory concentrations) for chloroquine, mefloquine, pyronaridine, piperaquine, quinine, artesunate, artemether, dihydroartemisinin were 84.2 nM, 34.9 nM, 4.0 nM, 22.3 nM, 41.4 nM, 2.8 nM, 2.1 nM and 2.0 nM, respectively. Twelve P. vivax clinical isolates were found over the cut-off IC50 value (220 nM) for chloroquine resistance. In addition, sequence polymorphisms in pvmdr1 (P. vivax multidrug resistance-1), pvcrt-o (P. vivax chloroquine resistance transporter-o), and difference in pvmdr1 copy number were studied. Sequencing of the pvmdr1 gene in 52 samples identified 12 amino acid substitutions, among which two (G698S and T958M) were fixed, M908L were present in 98.1% of the isolates, while Y976F and F1076L were present in 3.8% and 78.8% of the isolates, respectively. Amplification of the pvmdr1 gene was only detected in 4.8% of the samples. Sequencing of the pvcrt-o in 59 parasite isolates identified a single lysine insertion at position 10 in 32.2% of the isolates. The pvmdr1 M908L substitutions in pvmdr1 in our samples was associated with reduced sensitivity to chloroquine, mefloquine, pyronaridine, piperaquine, quinine, artesunate and dihydroartemisinin. CONCLUSIONS Our findings depict a drug sensitivity profile and genetic variations of the P. vivax isolates from the China-Myanmar border area, and suggest possible emergence of chloroquine resistant P. vivax isolates in the region, which demands further efforts for resistance monitoring and mechanism studies.
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Affiliation(s)
- Jiangyan Li
- Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province, China
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province, China
| | - Jie Zhang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Qian Li
- Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province, China
- Xiangtan Blood Center, Xiangtan, Hunan Province, China
| | - Yue Hu
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Yonghua Ruan
- Department of Pathology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Zhiyong Tao
- Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province, China
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province, China
| | - Hui Xia
- Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province, China
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province, China
| | - Jichen Qiao
- Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province, China
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province, China
| | - Lingwen Meng
- Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province, China
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province, China
| | - Weilin Zeng
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Cuiying Li
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Xi He
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Luyi Zhao
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
| | - Faiza A. Siddiqui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Jun Miao
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan Province, China
- * E-mail: (ZY); (QF)
| | - Qiang Fang
- Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui Province, China
- Anhui Key Laboratory of Infection and Immunity, Bengbu Medical College, Bengbu, Anhui Province, China
- * E-mail: (ZY); (QF)
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
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13
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van Eijk AM, Sutton PL, Ramanathapuram L, Sullivan SA, Kanagaraj D, Priya GSL, Ravishankaran S, Asokan A, Sangeetha V, Rao PN, Wassmer SC, Tandel N, Patel A, Desai N, Choubey S, Ali SZ, Barla P, Oraon RR, Mohanty S, Mishra S, Kale S, Bandyopadhyay N, Mallick PK, Huck J, Valecha N, Singh OP, Pradhan K, Singh R, Sharma SK, Srivastava HC, Carlton JM, Eapen A. The burden of submicroscopic and asymptomatic malaria in India revealed from epidemiology studies at three varied transmission sites in India. Sci Rep 2019; 9:17095. [PMID: 31745160 PMCID: PMC6863831 DOI: 10.1038/s41598-019-53386-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/31/2019] [Indexed: 01/14/2023] Open
Abstract
Malaria in India, while decreasing, remains a serious public health problem, and the contribution of submicroscopic and asymptomatic infections to its persistence is poorly understood. We conducted community surveys and clinic studies at three sites in India differing in their eco-epidemiologies: Chennai (Tamil Nadu), Nadiad (Gujarat), and Rourkela (Odisha), during 2012-2015. A total of 6,645 subject blood samples were collected for Plasmodium diagnosis by microscopy and PCR, and an extensive clinical questionnaire completed. Malaria prevalence ranged from 3-8% by PCR in community surveys (24 infections in Chennai, 56 in Nadiad, 101 in Rourkela), with Plasmodium vivax dominating in Chennai (70.8%) and Nadiad (67.9%), and Plasmodium falciparum in Rourkela (77.3%). A proportional high burden of asymptomatic and submicroscopic infections was detected in community surveys in Chennai (71% and 71%, respectively, 17 infections for both) and Rourkela (64% and 31%, 65 and 31 infections, respectively). In clinic studies, a proportional high burden of infections was identified as submicroscopic in Rourkela (45%, 42 infections) and Chennai (19%, 42 infections). In the community surveys, anemia and fever were significantly more common among microscopic than submicroscopic infections. Exploratory spatial analysis identified a number of potential malaria hotspots at all three sites. There is a considerable burden of submicroscopic and asymptomatic malaria in malarious regions in India, which may act as a reservoir with implications for malaria elimination strategies.
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Affiliation(s)
- Anna Maria van Eijk
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Patrick L Sutton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA.,GlaxoSmithKline, 5 Moore Drive, PO Box 13398, RTP, Raleigh, NC, 27709-3398, United States
| | - Lalitha Ramanathapuram
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA.,Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Steven A Sullivan
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Deena Kanagaraj
- Indian Council of Medical Research - National Institute of Malaria Research, IDVC Field Unit, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - G Sri Lakshmi Priya
- Indian Council of Medical Research - National Institute of Malaria Research, IDVC Field Unit, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India.,Department of Zoology, Madras Christian College, University of Madras, Tambaram, Chennai, 600 059, India
| | - Sangamithra Ravishankaran
- Indian Council of Medical Research - National Institute of Malaria Research, IDVC Field Unit, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - Aswin Asokan
- Indian Council of Medical Research - National Institute of Malaria Research, IDVC Field Unit, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - V Sangeetha
- Indian Council of Medical Research - National Institute of Malaria Research, IDVC Field Unit, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - Pavitra N Rao
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Samuel C Wassmer
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA.,London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
| | - Nikunj Tandel
- Indian Council of Medical Research - National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India.,Institute of Science, Nirma University, Gujarat, 382481, India
| | - Ankita Patel
- Indian Council of Medical Research - National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Nisha Desai
- Indian Council of Medical Research - National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Sandhya Choubey
- Jigyansha, International Center of Excellence for Malaria Research, Sector 1, Rourkela, Odisha, India
| | - Syed Zeeshan Ali
- Jigyansha, International Center of Excellence for Malaria Research, Sector 1, Rourkela, Odisha, India
| | - Punam Barla
- Jigyansha, International Center of Excellence for Malaria Research, Sector 1, Rourkela, Odisha, India
| | - Rajashri Rani Oraon
- Jigyansha, International Center of Excellence for Malaria Research, Sector 1, Rourkela, Odisha, India
| | - Stuti Mohanty
- Jigyansha, International Center of Excellence for Malaria Research, Sector 1, Rourkela, Odisha, India
| | - Shobhna Mishra
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka Sector 8, New Delhi, India
| | - Sonal Kale
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka Sector 8, New Delhi, India
| | - Nabamita Bandyopadhyay
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka Sector 8, New Delhi, India
| | - Prashant K Mallick
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka Sector 8, New Delhi, India
| | - Jonathan Huck
- Department of Geography Arthur Lewis Building, The University of Manchester, Manchester, England
| | - Neena Valecha
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka Sector 8, New Delhi, India
| | - Om P Singh
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka Sector 8, New Delhi, India
| | - K Pradhan
- Jigyansha, International Center of Excellence for Malaria Research, Sector 1, Rourkela, Odisha, India
| | - Ranvir Singh
- Indian Council of Medical Research - National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - S K Sharma
- Indian Council of Medical Research, National Institute of Malaria Research, Dwarka Sector 8, New Delhi, India
| | - Harish C Srivastava
- Indian Council of Medical Research - National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Jane M Carlton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA.
| | - Alex Eapen
- Indian Council of Medical Research - National Institute of Malaria Research, IDVC Field Unit, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
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14
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Verzier LH, Coyle R, Singh S, Sanderson T, Rayner JC. Plasmodium knowlesi as a model system for characterising Plasmodium vivax drug resistance candidate genes. PLoS Negl Trop Dis 2019; 13:e0007470. [PMID: 31158222 PMCID: PMC6564043 DOI: 10.1371/journal.pntd.0007470] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 06/13/2019] [Accepted: 05/15/2019] [Indexed: 12/29/2022] Open
Abstract
Plasmodium vivax causes the majority of malaria outside Africa, but is poorly understood at a cellular level partly due to technical difficulties in maintaining it in in vitro culture conditions. In the past decades, drug resistant P. vivax parasites have emerged, mainly in Southeast Asia, but while some molecular markers of resistance have been identified, none have so far been confirmed experimentally, which limits interpretation of the markers, and hence our ability to monitor and control the spread of resistance. Some of these potential markers have been identified through P. vivax genome-wide population genetic analyses, which highlighted genes under recent evolutionary selection in Southeast Asia, where chloroquine resistance is most prevalent. These genes could be involved in drug resistance, but no experimental proof currently exists to support this hypothesis. In this study, we used Plasmodium knowlesi, the most closely related species to P. vivax that can be cultured in human erythrocytes, as a model system to express P. vivax genes and test for their role in drug resistance. We adopted a strategy of episomal expression, and were able to express fourteen P. vivax genes, including two allelic variants of several hypothetical resistance genes. Their expression level and localisation were assessed, confirming cellular locations conjectured from orthologous species, and suggesting locations for several previously unlocalised proteins, including an apical location for PVX_101445. These findings establish P. knowlesi as a suitable model for P. vivax protein expression. We performed chloroquine and mefloquine drug assays, finding no significant differences in drug sensitivity: these results could be due to technical issues, or could indicate that these genes are not actually involved in drug resistance, despite being under positive selection pressure in Southeast Asia. These data confirm that in vitro P. knowlesi is a useful tool for studying P. vivax biology. Its close evolutionary relationship to P. vivax, high transfection efficiency, and the availability of markers for colocalisation, all make it a powerful model system. Our study is the first of its kind using P. knowlesi to study unknown P. vivax proteins and investigate drug resistance mechanisms.
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Affiliation(s)
- Lisa H. Verzier
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, United Kingdom
| | - Rachael Coyle
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, United Kingdom
| | - Shivani Singh
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, United Kingdom
| | - Theo Sanderson
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, United Kingdom
| | - Julian C. Rayner
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, United Kingdom
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15
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Polymorphisms in genes associated with drug resistance of Plasmodium vivax in India. Parasitol Int 2019; 70:92-97. [DOI: 10.1016/j.parint.2019.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/24/2019] [Accepted: 03/01/2019] [Indexed: 02/07/2023]
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16
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Assessment of drug resistance associated genetic diversity in Mauritanian isolates of Plasmodium vivax reveals limited polymorphism. Malar J 2018; 17:416. [PMID: 30409138 PMCID: PMC6225721 DOI: 10.1186/s12936-018-2548-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/24/2018] [Indexed: 01/09/2023] Open
Abstract
Background Plasmodium vivax is the predominant malaria species in northern Mauritania. Molecular data on P. vivax isolates circulating in West Africa are scarce. The present study analysed molecular markers associated with resistance to antifolates (Pvdhfr and Pvdhps), chloroquine (Pvmdr1), and artemisinin (Pvk12) in P. vivax isolates collected in two cities located in the Saharan zone of Mauritania. Methods Blood samples were obtained from P. vivax-infected patients recruited for chloroquine therapeutic efficacy study in 2013 and febrile patients spontaneously consulting health facilities in Nouakchott and Atar in 2015–2016. Fragments of Pvdhfr (codons 13, 33, 57, 58, 61, 117, and 174), Pvdhps (codons 382, 383, 512, 553, and 585), Pvmdr1 (codons 976 and 1076) and Pvk12 (codon 552) genes were amplified by PCR and sequenced. Results Most of the isolates in Nouakchott (126/154, 81.8%) and Atar (44/45, 97.8%) carried the wild-type Pvdhfr allelic variant (IPFSTSI). In Nouakchott, all mutants (28/154; 18.2%) had double Pvdhfr mutations in positions 58 and 61 (allelic variant IPFRMSI), whereas in Atar only 1 isolate was mutant (S117N, allelic variant IPFSTNI). The wild-type Pvdhps allelic variant (SAKAV) was found in all tested isolates (Nouakchott, n = 93; Atar, n = 37). Few isolates in Nouakchott (5/115, 4.3%) and Atar (3/79, 3.8%) had the mutant Pvmdr1 allele 976F or 1076L, but not both, including in pre-treatment isolates obtained from patients treated successfully with chloroquine. All isolates (59 in Nouakchott and 48 in Atar) carried the wild-type V552 allele in Pvk12. Conclusions Polymorphisms in Pvdhfr, Pvdhps, Pvmdr1, and Pvk12 were limited in P. vivax isolates collected recently in Nouakchott and Atar. Compared to the isolates collected in Nouakchott in 2007–2009, there was no evidence for selection of mutants. The presence of one, but not both, of the two potential markers of chloroquine resistance in Pvmdr1 in pre-treatment isolates did not influence the clinical outcome, putting into question the role of Pvmdr1 mutant alleles 976F and 1076L in treatment failure. Molecular surveillance is an important component of P. vivax malaria control programme in the Saharan zone of Mauritania to predict possible emergence of drug-resistant parasites.
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17
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Silva SR, Almeida ACG, da Silva GAV, Ramasawmy R, Lopes SCP, Siqueira AM, Costa GL, Sousa TN, Vieira JLF, Lacerda MVG, Monteiro WM, de Melo GC. Chloroquine resistance is associated to multi-copy pvcrt-o gene in Plasmodium vivax malaria in the Brazilian Amazon. Malar J 2018; 17:267. [PMID: 30012145 PMCID: PMC6048775 DOI: 10.1186/s12936-018-2411-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/09/2018] [Indexed: 01/08/2023] Open
Abstract
Background The resistance of Plasmodium vivax to chloroquine has become an obstacle to control strategies based on the use of anti-malarials. The current study investigated the association between P. vivax CQ-resistance in vivo with copy number variation and mutations in the promoter region in pvcrt-o and pvmdr1 genes. Methods The study included patients with P. vivax that received supervised treatment with chloroquine and primaquine. Recurrences were actively recorded during this period. Results Among the 60 patients with P. vivax, 25 were CQ-resistant and 35 CQ-susceptible. A frequency of 7.1% of multi-copy pvcrt-o was observed in CQ-susceptible samples and 7.7% in CQ-resistant at D0 (P > 0.05) and 33.3% in CQ-resistant at DR (P < 0.05). For pvmdr1, 10.7% of the CQ-susceptible samples presented multiple copies compared to 11.1% in CQ-resistant at D0 and 0.0% in CQ-resistant at DR (P > 0.05). A deletion of 19 bp was found in 11/23 (47.6%) of the patients with CQ-susceptible P. vivax and 3/10 (23.1%) of the samples with in CQRPv at D0. At day DR, 55.5% of the samples with CQRPv had the 19 bp deletion. For the pvmdr-1 gene, was no variation in the analysed gene compared to the P. vivax reference Sal-1. Conclusions This was the first study with 42-day clinical follow-up to evaluate the variation of the number of copies and polymorphisms in the promoter region of the pvcrt-o and pvmdr1 genes in relation to treatment outcomes. Significantly higher frequency of multi-copy pvcrt-o was found in CQRPv samples at DR compared to CQ-susceptible, indicating parasite selection of this genotype after CQ treatment and its association with CQ-resistance in vivo. Electronic supplementary material The online version of this article (10.1186/s12936-018-2411-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Siuhelem Rocha Silva
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | - Anne Cristine Gomes Almeida
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | | | - Rajendranath Ramasawmy
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | - Stefanie Costa Pinto Lopes
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Instituto Leônidas & Maria Deane (ILMD), Fiocruz, Manaus, Amazonas, 69057-070, Brazil
| | - André Machado Siqueira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Instituto Nacional de Infectologia, Evandro Chagas, Fiocruz, Rio de Janeiro, 21040-360, Brazil
| | - Gabriel Luíz Costa
- Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Minas Gerais, 30190-002, Brazil
| | - Taís Nóbrega Sousa
- Centro de Pesquisas René Rachou, Fiocruz, Belo Horizonte, Minas Gerais, 30190-002, Brazil
| | | | - Marcus Vinícius Guimarães Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Instituto Leônidas & Maria Deane (ILMD), Fiocruz, Manaus, Amazonas, 69057-070, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil
| | - Gisely Cardoso de Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil. .,Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, 69040-000, Brazil.
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Kittichai V, Nguitragool W, Ngassa Mbenda HG, Sattabongkot J, Cui L. Genetic diversity of the Plasmodium vivax multidrug resistance 1 gene in Thai parasite populations. INFECTION GENETICS AND EVOLUTION 2018; 64:168-177. [PMID: 29936038 DOI: 10.1016/j.meegid.2018.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 11/19/2022]
Abstract
Plasmodium vivax resistance to chloroquine (CQ) was first reported over 60 years ago. Here we analyzed sequence variations in the multidrug resistance 1 gene (Pvmdr1), a putative molecular marker for P. vivax CQ resistance, in field isolates collected from three sites in Thailand during 2013-2016. Several single nucleotide polymorphisms previously implicated in reduced CQ sensitivity were found. These genetic variations encode amino acids in the two nucleotide-binding domains as well as the transmembrane domains of the protein. The high level of genetic diversity of Pvmdr1 provides insights into the evolutionary history of this gene. Specifically, there was little evidence of positive selection at amino acid F1076L in global isolates to be promoted as a possible marker for CQ resistance. Population genetic analysis clearly divided the parasites into eastern and western populations, which is consistent with their geographical separation by the central malaria-free area of Thailand. With CQ-primaquine remaining as the frontline treatment for vivax malaria in all regions of Thailand, such a population subdivision could be shaped and affected by the current drugs for P. falciparum since mixed P. falciparum/P. vivax infections often occur in this region.
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Affiliation(s)
- Veerayuth Kittichai
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Wang Nguitragool
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Liwang Cui
- Department of Entomology, Center for Malaria Research, Pennsylvania State University, University Park, PA, USA.
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Joy S, Mukhi B, Ghosh SK, Achur RN, Gowda DC, Surolia N. Drug resistance genes: pvcrt-o and pvmdr-1 polymorphism in patients from malaria endemic South Western Coastal Region of India. Malar J 2018; 17:40. [PMID: 29351800 PMCID: PMC5775544 DOI: 10.1186/s12936-018-2188-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 01/15/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Malaria is highly prevalent in many parts of India and is mostly caused by the parasite species Plasmodium vivax followed by Plasmodium falciparum. Chloroquine (CQ) is the first-line treatment for blood stage P. vivax parasites, but cases of drug resistance to CQ have been reported from India. One of the surveillance strategies which is used to monitor CQ drug resistance, is the analysis of single nucleotide polymorphisms (SNPs) of the associated gene markers. Susceptibility to CQ can also be determined by copy number assessment of multidrug resistant gene (mdr-1). The current study has examined the prevalence of SNPs in P. vivax orthologs of P. falciparum chloroquine resistant and multi-drug resistant genes (pvcrt-o and pvmdr-1, respectively) and pvmdr-1 copy number variations in isolates from the highly endemic Mangaluru city near the South Western Coastal region of India. METHODS A total of 140 blood samples were collected from P. vivax infected patients attending Wenlock Hospital Mangaluru during July 2014 to January 2016. Out of these 140 samples, sequencing was carried out for 54 (38.5%) and 85 (60.7%) isolates for pvcrt-o and pvmdr-1, respectively. Single nucleotide polymorphisms (SNPs) in the pvcrt-o and pvmdr-1 genes were analysed by direct sequencing method, while copy number variations of 60 isolates (42. 8%) were determined by real time PCR. RESULTS Out of 54 clinical isolates analysed for pvcrt-o, three (5.6%) showed K10 insertion and the rest had wild type sequence. This is the first report to show K10 insertion in P. vivax isolates from India. Further, out of 85 clinical isolates of P. vivax analysed for mutations in pvmdr-1 gene, only one isolate had wild type sequence (~ 1%) while the remaining (99%) carried mutant alleles. Seven non-synonymous mutations with two novel mutations (I946V and Y1028C) were observed. Of all the observed mutations in pvmdr-1 gene, T958M was most highly prevalent (present in 90% of samples) followed by F1076L (76%), and Y976F (7%). Amplification of pvmdr-1 gene was observed in 31.6% of the isolates, out of 60 amplified. CONCLUSION The observed variations both in pvmdr-1 and pvcrt-o genes indicate a trend towards parasite acquiring CQ resistance in this endemic area.
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Affiliation(s)
- Shiny Joy
- Molecular Biology and Genetics Unit, Jawaharlal Nehru Centre For Advanced Scientific Research, Jakkur, Bangalore, India
| | - Benudhar Mukhi
- Department of Biological Control, National Institute of Malaria Research, Poojanahalli, Bangalore, India
| | - Susanta K Ghosh
- Department of Biological Control, National Institute of Malaria Research, Poojanahalli, Bangalore, India
| | - Rajeshwara N Achur
- Department of Biochemistry, Kuvempu University, Shivamogga District, Shankaraghatta, Karnataka, India
| | - D Channe Gowda
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Namita Surolia
- Molecular Biology and Genetics Unit, Jawaharlal Nehru Centre For Advanced Scientific Research, Jakkur, Bangalore, India.
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González-Cerón L, Montoya A, Corzo-Gómez JC, Cerritos R, Santillán F, Sandoval MA. Genetic diversity and natural selection of Plasmodium vivax multi-drug resistant gene (pvmdr1) in Mesoamerica. Malar J 2017; 16:261. [PMID: 28666481 PMCID: PMC5493867 DOI: 10.1186/s12936-017-1905-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/23/2017] [Indexed: 01/09/2023] Open
Abstract
Background The Plasmodium vivax multidrug resistant 1 gene (pvmdr1) codes for a transmembrane protein of the parasite’s digestive vacuole. It is likely that the pvmdr1 gene mutations occur at different sites by convergent evolution. In here, the genetic variation of pvmdr1 at three sites of the Mesoamerican region was studied. Since 1950s, malarious patients of those areas have been treated only with chloroquine and primaquine. Methods Blood samples from patients infected with P. vivax were obtained in southern Mexico (SMX), in the Northwest (NIC-NW) and in the northeast (NIC-NE) of Nicaragua. Genomic DNA was obtained and fragments of pvmdr1 were amplified and sequenced. The nucleotide and amino acid changes as well as the haplotype frequency in pvmdr1 were determined per strain and per geographic site. The sequences of pvmdr1 obtained from the studied regions were compared with homologous sequences from the GenBank database to explore the P. vivax genetic structure. Results In 141 parasites, eight nucleotide changes (two changes were synonymous and other six were nonsynonymous) were detected in 1536 bp. The PvMDR1 amino acid changes Y976F, F1076FL were predominant in endemic parasites from NIC-NE and outbreak parasites in NIC-NW but absent in SMX. Thirteen haplotypes were resolved, and found to be closely related, but their frequency at each geographic site was different (P = 0.0001). The pvmdr1codons 925–1083 gene fragment showed higher genetic and haplotype diversity in parasites from NIC-NE than the other areas outside Latin America. The haplotype networks suggested local diversification of pvmdr1 and no significant departure from neutrality. The FST values were low to moderate regionally, but high between NIC-NE or NIC-NW and other regions inside and outside Latin America. Conclusions The pvmdr1 gene might have diversified recently at regional level. In the absence of significant natural, genetic drift might have caused differential pvmdr1 haplotype frequencies at different geographic sites in Mesoamerica. A very recent expansion of divergent pvmdr1 haplotypes in NIC-NE/NIC-NW produced high differentiation between these and parasites from other sites including SMX. These data are useful to set a baseline for epidemiological surveillance.
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Affiliation(s)
- Lilia González-Cerón
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Chiapas, Mexico.
| | - Alberto Montoya
- Departamento de Parasitología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua
| | - Josselin C Corzo-Gómez
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Chiapas, Mexico
| | - Rene Cerritos
- Division de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Frida Santillán
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Chiapas, Mexico
| | - Marco A Sandoval
- Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, Tapachula, Chiapas, Mexico
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Kumar R, Saravu K. Severe vivax malaria: a prospective exploration at a tertiary healthcare centre in Southwestern India. Pathog Glob Health 2017; 111:148-160. [PMID: 28367735 DOI: 10.1080/20477724.2017.1309342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Plasmodium vivax is recognized to cause severe malaria and mortality. We aimed to determine the proportion of disease severity, the spectrum of complications, underlying non-infectious comorbidities and predictors of severity in monoinfection P. vivax malaria among adults at a tertiary healthcare centre in Southwestern India. A prospective cohort study was conducted among microscopically confirmed monoinfection P. vivax acute malaria patients aged, ≥18 years. Cases with pregnancy and concomitant febrile illnesses including mixed malaria were excluded. Cases were distinguished as either 'severe' or 'non-severe' P. vivax malaria as per the definitions laid by the World Health Organization. Of total 511 acute P. vivax cases studied, 23.9% (122/511) had severe malaria. The proportion of severity did not vary between microscopy alone and additional nPCR proved monoinfection P. vivax subgroups. There was no significant difference (p = 0.296) in the occurrence of non-infectious comorbidities among non-severe (9.0%, 35/389) and severe (12.3%, 15/122) vivax groups. Multiple complications despite early parasite clearance resulted in delayed casualty in two cases, indicating overall case fatality rate of 3/1000 cases. Age >40 years, rising respiratory rate, total bilirubin, serum creatinine and falling hemoglobin were the independent predictors of disease severity in this vivax malaria cohort. Total and direct bilirubin and serum urea had good discriminatory performance for severe vivax malaria. Total bilirubin should be considered as an important prognostic marker while managing P. vivax malaria. Patients with multiple complications must be treated cautiously as there may be delayed deterioration leading to mortality despite parasite clearance.
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Affiliation(s)
- Rishikesh Kumar
- a Department of Medicine, Kasturba Medical College , Manipal University , Manipal , India
| | - Kavitha Saravu
- a Department of Medicine, Kasturba Medical College , Manipal University , Manipal , India.,b Manipal McGill Center for Infectious Diseases (MAC-ID) , Manipal University , Manipal , India
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22
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Abstract
Introduction: Relapses are important contributors to illness and morbidity in Plasmodium vivax and P. ovale infections. Relapse prevention (radical cure) with primaquine is required for optimal management, control and ultimately elimination of Plasmodium vivax malaria. A review was conducted with publications in English, French, Portuguese and Spanish using the search terms ‘P. vivax’ and ‘relapse’. Areas covered: Hypnozoites causing relapses may be activated weeks or months after initial infection. Incidence and temporal patterns of relapse varies geographically. Relapses derive from parasites either genetically similar or different from the primary infection indicating that some derive from previous infections. Malaria illness itself may activate relapse. Primaquine is the only widely available treatment for radical cure. However, it is often not given because of uncertainty over the risks of primaquine induced haemolysis when G6PD deficiency testing is unavailable. Recommended dosing of primaquine for radical cure in East Asia and Oceania is 0.5 mg base/kg/day and elsewhere is 0.25 mg base/kg/day. Alternative treatments are under investigation. Expert commentary: Geographic heterogeneity in relapse patterns and chloroquine susceptibility of P. vivax, and G6PD deficiency epidemiology mean that radical treatment should be given much more than it is today. G6PD testing should be made widely available so primaquine can be given more safely.
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Affiliation(s)
- Cindy S Chu
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand.,b Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Bangkok , Thailand
| | - Nicholas J White
- b Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Bangkok , Thailand.,c Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine , University of Oxford , Oxford , UK
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Saravu K, Kumar R, Ashok H, Kundapura P, Kamath V, Kamath A, Mukhopadhyay C. Therapeutic Assessment of Chloroquine-Primaquine Combined Regimen in Adult Cohort of Plasmodium vivax Malaria from Primary Care Centres in Southwestern India. PLoS One 2016; 11:e0157666. [PMID: 27315280 PMCID: PMC4912090 DOI: 10.1371/journal.pone.0157666] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 06/02/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several reports of chloroquine treatment failure and resistance in Plasmodium vivax malaria from Southeast Asian countries have been published. Present study was undertaken to assess the efficacy of chloroquine-primaquine (CQ-PQ) combined regimen for the treatment of P. vivax malaria patients who were catered by the selected primary health centres (PHCs) of Udupi taluk, Udupi district, Karnataka, India. METHOD Five PHCs were selected within Udupi taluk based on probability proportional to size. In-vivo therapeutic efficacy assessment of CQ (1500 mg over three days) plus PQ (210 mg over 14 days) regimen was carried out in accordance with the World Health Organization's protocol of 28 days follow-up among microscopically diagnosed monoinfection P. vivax cohort. RESULTS In total, 161 participants were recruited in the study of which, 155 (96.3%) participants completed till day 28 follow-up, fully complied with the treatment regimen and showed adequate clinical and parasitological response. Loss to follow up was noted with 5 (3.1%) participants and non-compliance with treatment regimen occurred with one participant (0.6%). Glucose-6-phosphate dehydrogenase deficiency (G6PDd, <30% of normal mean activity) was noted among 5 (3.1%) participants and one of them did develop PQ induced dark-brown urination which subsided after PQ discontinuation. G6PDd patients were treated with PQ 45 mg/week for eight weeks while PQ was discontinued in one case with G6PD 1.4 U/g Hb due to complaint of reddish-brown coloured urine by 48 hours of PQ initiation. Nested polymerase chain reaction test revealed 45 (28%) cases as mixed (vivax and falciparum) malaria. CONCLUSIONS The CQ-PQ combined regimen remains outstandingly effective to treat uncomplicated P. vivax malaria in Udupi taluk and thus it should continue as first line regimen. For all P. vivax cases, G6PD screening before PQ administration must be mandatory and made available in all PHCs.
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Affiliation(s)
- Kavitha Saravu
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka, India
- * E-mail:
| | - Rishikesh Kumar
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka, India
| | | | | | - Veena Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, India
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, India
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Overhead tank is the potential breeding habitat of Anopheles stephensi in an urban transmission setting of Chennai, India. Malar J 2016; 15:274. [PMID: 27169513 PMCID: PMC4865005 DOI: 10.1186/s12936-016-1321-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background Wells and overhead tanks (OHT) are the major breeding sources of the local malaria vector, Anopheles stephensi in the Indian city of Chennai; they play a significant role in vector breeding, and transmission of urban malaria. Many other man-made breeding habitats, such as cemented cisterns/containers, barrels or drums, sumps or underground tanks, and plastic pots/containers are maintained to supplement water needs, temporarily resulting in enhanced mosquito/vector breeding. Correlating breeding habitats with immature vector abundance is important in effective planning to strengthen operational execution of vector control measures. Methods A year-long, weekly study was conducted in Chennai to inspect available clear/clean water mosquito breeding habitats. Different breeding features, such as instar-wise, immature density and co-inhabitation with other mosquito species, were analysed. The characteristics of breeding habitats, i.e., type of habitat, water temperature and presence of aquatic organisms, organic matter and green algal remnants on the water surface at the time of inspection, were also studied. Immature density of vector was correlated with presence of other mosquito species, malaria prevalence, habitat characteristics and monthly/seasonal fluctuations. All the data collected from field observations were analysed using standard statistical tools. Results When the immature density of breeding habitats was analysed, using one-way ANOVA, it was observed that the density did not change in a significant way either across seasons or months. OHTs contributed significantly to the immature population when compared to wells and other breeding habitats of the study site. The habitat positivity of wells and OHTs was significantly associated with the presence of aquatic organisms, organic matter and algal remnants. Significant correlations of malaria prevalence with monthly immature density, as well as number of breeding habitats with immature vector mosquitoes, were also observed. Conclusions The findings that OHTs showed fairly high and consistent immature density of An. stephensi irrespective of seasons indicates the potentiality of the breeding habitat in contributing to vector density. The correlation between vector breeding habitats, immature density and malaria prevalence indicates the proximity of these habitats to malaria cases, proving its role in vector abundance and local malaria transmission. The preference of An. stephensi to breed in OHTs calls for intensified, appropriate and sustained intervention measures to curtail vector breeding and propagation to shrink malaria to pre-elimination level and beyond.
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Gunawardena S, Karunaweera ND. Advances in genetics and genomics: use and limitations in achieving malaria elimination goals. Pathog Glob Health 2016; 109:123-41. [PMID: 25943157 DOI: 10.1179/2047773215y.0000000015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Success of the global research agenda towards eradication of malaria will depend on the development of new tools, including drugs, vaccines, insecticides and diagnostics. Genetic and genomic information now available for the malaria parasites, their mosquito vectors and human host, can be harnessed to both develop these tools and monitor their effectiveness. Here we review and provide specific examples of current technological advances and how these genetic and genomic tools have increased our knowledge of host, parasite and vector biology in relation to malaria elimination and in turn enhanced the potential to reach that goal. We then discuss limitations of these tools and future prospects for the successful achievement of global malaria elimination goals.
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Gomes LR, Almeida-de-Oliveira NK, de Lavigne AR, de Lima SRF, de Pina-Costa A, Brasil P, Daniel-Ribeiro CT, Ménard D, Ferreira-da-Cruz MDF. Plasmodium vivax mdr1 genotypes in isolates from successfully cured patients living in endemic and non-endemic Brazilian areas. Malar J 2016; 15:96. [PMID: 26887935 PMCID: PMC4758108 DOI: 10.1186/s12936-016-1141-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/03/2016] [Indexed: 01/10/2023] Open
Abstract
Background Plasmodium vivax is the most widely distributed species causing the highest number of malaria cases in the world. In Brazil, P. vivax is responsible for approximately 84 % of reported cases. In the absence of a vaccine, control strategies are based on the management of cases through rapid diagnosis and adequate treatment, in addition to vector control measures. The approaches used to investigate P. vivax resistance to chloroquine (CQ) were exclusively in vivo studies because of the difficulty in keeping parasites in continuous in vitro culture. In view of the limitations related to follow-up of patients and to assessing the plasma dosage of CQ and its metabolites, an alternative approach to monitor chemo-resistance (QR) is to use molecular markers. Single nucleotide polymorphisms (SNPs) in the multidrug resistance gene pvmdr1 are putative determinants of CQ resistance (CQR), but such SNPs in P. vivax isolates from patients with good response to treatment should be further explored. The aim of this study is to investigate the mutations in the gene, supposedly associated to QR, in P. vivax isolates from successfully cured patients, living in Brazilian endemic and non-endemic areas. Methods Blood samples were collected from 49 vivax malaria patients from endemic (Amazon Basin: 45) and non-endemic (Atlantic Forest: four) Brazilian regions and analysed for SNPs in the CQR-related P. vivax gene (pvmdr1), using PCR-based methods. Results Among the 49 isolates genetically characterized for the gene pvmdr1, 34 (70 %) presented at least one mutation. T958M mutant alleles were the most frequent (73 %) followed Y976F (15 %) and F1076L (12 %). Single mutation was detected in 24 (70.5 %) isolates and double mutations in ten (29.5 %). The most common single mutant genotype was the 958M/Y976/F1076 (79 %), followed by 976F/F1076 (21 %) whereas 958M/Y976/1076L (60 %) and 976F/1076L (40 %) double mutant genotypes were detected. Single mutant profile was observed only in isolates from Amazon Basin, although double mutants were found both in the Amazon and Atlantic Forest regions. Interestingly, the genotype 958M/Y976/1076L was present in all isolates from the Atlantic Forest in the Rio de Janeiro State. Conclusions Considering that primaquine (PQ) efficacy is highly dependent on concurrent administration of a blood schizontocidal agent and that PQ could not circumvent CQR, together with the fact that no pvmdr1 mutation should be expected in successfully cured patients, these findings seem to indicate that the pvmdr1 gene is not a reliable marker of CQR. Further investigations are needed to define a reliable molecular marker for monitoring P. vivax CQR in P. vivax populations.
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Affiliation(s)
- Larissa Rodrigues Gomes
- Laboratório de Pesquisa em Malária - Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil.
| | - Natália Ketrin Almeida-de-Oliveira
- Laboratório de Pesquisa em Malária - Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil.
| | - Aline Rosa de Lavigne
- Laboratório de Pesquisa em Malária - Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil.
| | - Suelen Rezende Félix de Lima
- Laboratório de Pesquisa em Malária - Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil.
| | - Anielle de Pina-Costa
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil. .,Laboratório de Doenças Febris Agudas - Instituto Nacional de Infectologia Evandro Chagas (INI-IPEC) (Fiocruz), Rio de Janeiro, Brazil.
| | - Patrícia Brasil
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil. .,Laboratório de Doenças Febris Agudas - Instituto Nacional de Infectologia Evandro Chagas (INI-IPEC) (Fiocruz), Rio de Janeiro, Brazil.
| | - Cláudio Tadeu Daniel-Ribeiro
- Laboratório de Pesquisa em Malária - Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil.
| | - Didier Ménard
- Malaria Molecular Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia.
| | - Maria de Fatima Ferreira-da-Cruz
- Laboratório de Pesquisa em Malária - Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. .,Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal) Fiocruz, Rio de Janeiro, Brazil.
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Wilson ML, Krogstad DJ, Arinaitwe E, Arevalo-Herrera M, Chery L, Ferreira MU, Ndiaye D, Mathanga DP, Eapen A. Urban Malaria: Understanding its Epidemiology, Ecology, and Transmission Across Seven Diverse ICEMR Network Sites. Am J Trop Med Hyg 2015; 93:110-123. [PMID: 26259941 PMCID: PMC4574269 DOI: 10.4269/ajtmh.14-0834] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 06/19/2015] [Indexed: 11/30/2022] Open
Abstract
A major public health question is whether urbanization will transform malaria from a rural to an urban disease. However, differences about definitions of urban settings, urban malaria, and whether malaria control should differ between rural and urban areas complicate both the analysis of available data and the development of intervention strategies. This report examines the approach of the International Centers of Excellence for Malaria Research (ICEMR) to urban malaria in Brazil, Colombia, India (Chennai and Goa), Malawi, Senegal, and Uganda. Its major theme is the need to determine whether cases diagnosed in urban areas were imported from surrounding rural areas or resulted from transmission within the urban area. If infections are being acquired within urban areas, malaria control measures must be targeted within those urban areas to be effective. Conversely, if malaria cases are being imported from rural areas, control measures must be directed at vectors, breeding sites, and infected humans in those rural areas. Similar interventions must be directed differently if infections were acquired within urban areas. The hypothesis underlying the ICEMR approach to urban malaria is that optimal control of urban malaria depends on accurate epidemiologic and entomologic information about transmission.
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Affiliation(s)
- Mark L. Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Infectious Diseases Research Collaboration, Mulago Hospital Campus, Kampala, Uganda; Caucaseo Research Center/School of Health, Universidad del Valle, Cali, Colombia; Department of Chemistry, University of Washington, Seattle, Washington; Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; University Cheikh Anta Diop, Dakar, Senegal; College of Medicine, University of Malawi, Blantyre, Malawi; National Institute of Malaria Research (Indian Council of Medical Research), National Institute of Epidemiology Campus, Tamil Nadu, India
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Rishikesh K, Kamath A, Hande MH, Vidyasagar S, Acharya RV, Acharya V, Belle J, Shastry AB, Saravu K. Therapeutic assessment of chloroquine-primaquine combined regimen in adult cohort of Plasmodium vivax malaria from a tertiary care hospital in southwestern India. Malar J 2015; 14:310. [PMID: 26259839 PMCID: PMC4532140 DOI: 10.1186/s12936-015-0824-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background Of late there have been accounts of therapeutic failure and chloroquine resistance in Plasmodium vivax malaria especially from Southeast Asian regions. The present study was conducted to assess the therapeutic efficacy of chloroquine–primaquine (CQ–PQ) combined regimen in a cohort of uncomplicated P. vivax mono-infection. Methods A tertiary care hospital-based prospective study was conducted among adult cohort with mono-infection P. vivax malaria as per the World Health Organization’s protocol of in vivo assessment of anti-malarial therapeutic efficacy. Participants were treated with CQ 25 mg/kg body weight divided over 3 days and PQ 0.25 mg/kg body weight daily for 2 weeks. Results Of a total of 125 participants recruited, 122 (97.6%) completed day 28 follow up, three (2.4%) participants were lost to follow-up. Eight patients (6.4%) were ascertained to have mixed P. vivax and Plasmodium falciparum infection by nested polymerase chain reaction test. The majority of subjects (56.8%, 71/125) became aparasitaemic on day 2 followed by 35.2% (44/125) on day 3, and 8% (10/125) on day 7, and remained so thereafter. Overall only one therapeutic failure (0.8%, 1/125) occurred on day 3 due to persistence of fever and parasitaemia. Conclusions CQ–PQ combined regimen remains outstandingly effective for uncomplicated P. vivax malaria and should be retained as treatment of choice in the study region. One case of treatment failure indicates possible resistance which warrants constant vigilance and periodic surveillance.
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Affiliation(s)
- Kumar Rishikesh
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India.
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, India.
| | - Manjunatha H Hande
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India.
| | - Sudha Vidyasagar
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India.
| | - Raviraja V Acharya
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India.
| | - Vasudeva Acharya
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India.
| | - Jayaprakash Belle
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India.
| | - Ananthakrishna B Shastry
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India.
| | - Kavitha Saravu
- Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India.
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