1
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Kane F, Toure M, Sogoba N, Traore B, Keita M, Konate D, Diawara SI, Sanogo D, Keita S, Sanogo I, Doumbia CO, Keïta B, Traoré AS, Sissoko I, Coulibaly H, Thiam SM, Barry A, Shaffer JG, Diakite M, Doumbia S. Modeling clinical malaria episodes in different ecological settings in Mali, 2018-2022. IJID REGIONS 2024; 10:24-30. [PMID: 38076024 PMCID: PMC10698665 DOI: 10.1016/j.ijregi.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 02/12/2024]
Abstract
Objectives Following the scaling-up of malaria control strategies in Mali, understanding the changes in age-specific prevalence of infection and risk factors associated with remains necessary to determine new priorities to progress toward disease elimination. This study aimed to estimate the risk of clinical malaria using longitudinal data across three different transmission settings in Mali. Methods Cohort-based longitudinal studies were performed from April 2018 to December 2022. Incidence of malaria was measured through community health center-based passive case detection. Generalized estimation equation model was used to assess risk factors for clinical malaria. Results A total of 21,453 clinical presentations were reported from 4500 participants, mainly from July to November. Data shows a significant association between malaria episodes, sex, age group, season, and year. Women had lower risk, the risk of clinical episode increased with age up to 14 years then declined, and in both sites, the dry-season risk of clinical episode was significantly lower compared to the rainy season. Conclusion Determining factors associated with the occurrence of clinical malaria across different ecological settings across the country could help in the development of new strategies aiming to accelerate malaria elimination in an area where malaria transmission remains intense.
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Affiliation(s)
- Fousseyni Kane
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamoudou Toure
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Nafomon Sogoba
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bourama Traore
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Moussa Keita
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Drissa Konate
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sory Ibrahim Diawara
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Daouda Sanogo
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Soumba Keita
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ibrahim Sanogo
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Cheick Oumar Doumbia
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bourama Keïta
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Amadou Sekou Traoré
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ibrahim Sissoko
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hamady Coulibaly
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sidibé M'Baye Thiam
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Alyssa Barry
- Institute for Mental and Physical Health and Clinical Translation (IMPACT) and School of Medicine, Deakin University, Geelong, Australia
| | - Jeffey G. Shaffer
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Mahamadou Diakite
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Seydou Doumbia
- West African International Center for Excellence in Malaria Research, Techniques and Technologies of Bamako, Bamako, Mali
- University Clinical Research Center (UCRC), University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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2
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Kouriba B, Arama C, Ouologuem DT, Cissoko Y, Diakite M, Beavogui AH, Wele M, Tekete M, Fofana B, Dama S, Maiga H, Kone A, Niangaly A, Diarra I, Daou M, Guindo A, Traore K, Coulibaly D, Kone AK, Dicko A, Clark TG, Doumbo OK, Djimde A. IFNγ, TNFα polymorphisms and IFNγ serum levels are associated with the clearance of drug-resistant P. falciparum in Malian children. Cytokine 2023; 164:156137. [PMID: 36773528 DOI: 10.1016/j.cyto.2023.156137] [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: 10/05/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/11/2023]
Abstract
Host immunity has been suggested to clear drug-resistant parasites in malaria-endemic settings. However, the immunogenetic mechanisms involved in parasite clearance are poorly understood. Characterizing the host's immunity and genes involved in controlling the parasitic infection can inform the development of blood-stage malaria vaccines. This study investigates host regulatory cytokines and immunogenomic factors associated with the clearance of Plasmodium falciparum carrying a chloroquine resistance genotype. Biological samples from participants of previous drug efficacy trials conducted in two Malian localities were retrieved. The P. falciparum chloroquine resistance transporter (Pfcrt) gene was genotyped using parasite DNA. Children carrying parasites with the mutant allele (Pfcrt-76T) were classified based on their ability to clear their parasites. The levels of the different cytokines were measured in serum. The polymorphisms of specific human genes involved in malaria susceptibility were genotyped using human DNA. The prevalence of the Pfcrt-76T was significantly higher in Kolle than in Bandiagara (81.6 % vs 38.6 %, p < 10-6). The prevalence of children who cleared their mutant parasites was significantly higher in Bandiagara than in Kolle (82.2 % vs 67.4 %, p < 0.05). The genotyping of host genes revealed that IFN-γ -874 T and TNF-α -308A alleles were positively associated with parasite clearance. Cytokine profiling revealed that IFN-γ level was positively associated with parasite clearance (p = 0.04). This study highlights the role of host's immunity and immunogenetic factors to clear resistant parasites, suggesting further characterization of these polymorphisms may help to develop novel approaches to antiparasitic treatment strategies.
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Affiliation(s)
- Bourema Kouriba
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali; Centre d'Infectiologie Charles Mérieux-Mali, Mali.
| | - Charles Arama
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Dinkorma T Ouologuem
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Yacouba Cissoko
- Department of Infectious and Tropical Diseases, Point G Teaching Hospital, Bamako, Mali
| | - Mahamadou Diakite
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Abdoul Habib Beavogui
- Maferinyah National Training and Research Center in Rural Health, Forecariah, Guinea
| | - Mamadou Wele
- Institute of Applied Sciences, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Mamadou Tekete
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Bakary Fofana
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Souleymane Dama
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Hamma Maiga
- Institut National de Santé Publique, Bamako, Mali
| | - Aminatou Kone
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Amadou Niangaly
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Issa Diarra
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Modibo Daou
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Ando Guindo
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Karim Traore
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Drissa Coulibaly
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Abdoulaye K Kone
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Alassane Dicko
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Taane G Clark
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Ogobara K Doumbo
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Abdoulaye Djimde
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali.
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3
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Diarra Y, Koné O, Sangaré L, Doumbia L, Haidara DBB, Diallo M, Maiga A, Sango HA, Sidibé H, Mihigo J, Nace D, Ljolje D, Talundzic E, Udhayakumar V, Eckert E, Woodfill CJ, Moriarty LF, Lim P, Krogstad DJ, Halsey ES, Lucchi NW, Koita OA. Therapeutic efficacy of artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Mali, 2015-2016. Malar J 2021; 20:235. [PMID: 34034754 PMCID: PMC8146210 DOI: 10.1186/s12936-021-03760-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 05/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The current first-line treatments for uncomplicated malaria recommended by the National Malaria Control Programme in Mali are artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ). From 2015 to 2016, an in vivo study was carried out to assess the clinical and parasitological responses to AL and ASAQ in Sélingué, Mali. METHODS Children between 6 and 59 months of age with uncomplicated Plasmodium falciparum infection and 2000-200,000 asexual parasites/μL of blood were enrolled, randomly assigned to either AL or ASAQ, and followed up for 42 days. Uncorrected and PCR-corrected efficacy results at days 28 and 42. were calculated. Known markers of resistance in the Pfk13, Pfmdr1, and Pfcrt genes were assessed using Sanger sequencing. RESULTS A total of 449 patients were enrolled: 225 in the AL group and 224 in the ASAQ group. Uncorrected efficacy at day 28 was 83.4% (95% CI 78.5-88.4%) in the AL arm and 93.1% (95% CI 89.7-96.5%) in the ASAQ arm. The per protocol PCR-corrected efficacy at day 28 was 91.0% (86.0-95.9%) in the AL arm and 97.1% (93.6-100%) in the ASAQ arm. ASAQ was significantly (p < 0.05) better than AL for each of the aforementioned efficacy outcomes. No mutations associated with artemisinin resistance were identified in the Pfk13 gene. Overall, for Pfmdr1, the N86 allele and the NFD haplotype were the most common. The NFD haplotype was significantly more prevalent in the post-treatment than in the pre-treatment isolates in the AL arm (p < 0.01) but not in the ASAQ arm. For Pfcrt, the CVIET haplotype was the most common. CONCLUSIONS The findings indicate that both AL and ASAQ remain effective for the treatment of uncomplicated malaria in Sélingué, Mali.
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Affiliation(s)
- Youssouf Diarra
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Oumar Koné
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Lansana Sangaré
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Lassina Doumbia
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Mouctar Diallo
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ababacar Maiga
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hamadoun A Sango
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Halidou Sidibé
- National Malaria Control Programme, Ministry of Health and Public Hygiene, Bamako, Mali
| | - Jules Mihigo
- U.S. President's Malaria Initiative, USAID Office, Bamako, Mali
| | - Douglas Nace
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dragan Ljolje
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eldin Talundzic
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Leah F Moriarty
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. President's Malaria Initiative, Atlanta, GA, USA
| | - Pharath Lim
- Medical Care Development International, Silver Spring, MD, USA
| | - Donald J Krogstad
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Eric S Halsey
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. President's Malaria Initiative, Atlanta, GA, USA
| | - Naomi W Lucchi
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ousmane A Koita
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
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4
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Monitoring of the Sensitivity In Vivo of Plasmodium falciparum to Artemether-Lumefantrine in Mali. Trop Med Infect Dis 2021; 6:tropicalmed6010013. [PMID: 33498803 PMCID: PMC7838931 DOI: 10.3390/tropicalmed6010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022] Open
Abstract
In Mali, since 2007, artemether-lumefantrine has been the first choice against uncomplicated malaria. Despite its effectiveness, a rapid selection of markers of resistance to partner drugs has been documented. This work evaluated the treatment according to the World Health Organization's standard 28-day treatment method. The primary endpoint was the clinical and parasitological response corrected by a polymerase chain reaction. It was more than 99.9 percent, the proportion of patients with anemia significantly decrease compared to baseline (p < 0.001), and no serious events were recorded. Plasmodium falciparum remains sensitive to artemether-lumefantrine in Mali.
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5
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Impact of Three-Year Intermittent Preventive Treatment Using Artemisinin-Based Combination Therapies on Malaria Morbidity in Malian Schoolchildren. Trop Med Infect Dis 2020; 5:tropicalmed5030148. [PMID: 32957604 PMCID: PMC7560034 DOI: 10.3390/tropicalmed5030148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022] Open
Abstract
Previous studies have shown that a single season of intermittent preventive treatment in schoolchildren (IPTsc) targeting the transmission season has reduced the rates of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Efficacy over the course of multiple years of IPTsc has been scantly investigated. Methods: An open, randomized-controlled trial among schoolchildren aged 6–13 years was conducted from September 2007 to January 2010 in Kolle, Mali. Students were included in three arms: sulphadoxine-pyrimethamine+artesunate (SP+AS), amodiaquine+artesunate (AQ+AS), and control (C). All students received two full doses, given 2 months apart, and were compared with respect to the incidence of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Results: A total of 296 students were randomized. All-cause clinic visits were in the SP+AS versus control (29 (20.1%) vs. 68 (47.2%); 20 (21.7%) vs. 41 (44.6%); and 14 (21.2%) vs. 30 (44.6%); p < 0.02) in 2007, 2008, and 2009, respectively. The prevalence of asymptomatic parasitemia was lower in the SP+AS compared to control (38 (7.5%) vs. 143 (28.7%); and 47 (12.7%) vs. 75 (21.2%); p < 0.002) in 2007 and 2008, respectively. Hemoglobin concentration was significantly higher in children receiving SP+AS (11.96, 12.06, and 12.62 g/dL) than in control children (11.60, 11.64, and 12.15 g/dL; p < 0.001) in 2007, 2008, and 2009, respectively. No impact on clinical malaria was observed. Conclusion: IPTsc with SP+AS reduced the rates of all-cause clinic visits and anemia during a three-year implementation.
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6
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Bretscher MT, Dahal P, Griffin J, Stepniewska K, Bassat Q, Baudin E, D'Alessandro U, Djimde AA, Dorsey G, Espié E, Fofana B, González R, Juma E, Karema C, Lasry E, Lell B, Lima N, Menéndez C, Mombo-Ngoma G, Moreira C, Nikiema F, Ouédraogo JB, Staedke SG, Tinto H, Valea I, Yeka A, Ghani AC, Guerin PJ, Okell LC. The duration of chemoprophylaxis against malaria after treatment with artesunate-amodiaquine and artemether-lumefantrine and the effects of pfmdr1 86Y and pfcrt 76T: a meta-analysis of individual patient data. BMC Med 2020; 18:47. [PMID: 32098634 PMCID: PMC7043031 DOI: 10.1186/s12916-020-1494-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/09/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The majority of Plasmodium falciparum malaria cases in Africa are treated with the artemisinin combination therapies artemether-lumefantrine (AL) and artesunate-amodiaquine (AS-AQ), with amodiaquine being also widely used as part of seasonal malaria chemoprevention programs combined with sulfadoxine-pyrimethamine. While artemisinin derivatives have a short half-life, lumefantrine and amodiaquine may give rise to differing durations of post-treatment prophylaxis, an important additional benefit to patients in higher transmission areas. METHODS We analyzed individual patient data from 8 clinical trials of AL versus AS-AQ in 12 sites in Africa (n = 4214 individuals). The time to PCR-confirmed reinfection after treatment was used to estimate the duration of post-treatment protection, accounting for variation in transmission intensity between settings using hidden semi-Markov models. Accelerated failure-time models were used to identify potential effects of covariates on the time to reinfection. The estimated duration of chemoprophylaxis was then used in a mathematical model of malaria transmission to determine the potential public health impact of each drug when used for first-line treatment. RESULTS We estimated a mean duration of post-treatment protection of 13.0 days (95% CI 10.7-15.7) for AL and 15.2 days (95% CI 12.8-18.4) for AS-AQ overall. However, the duration varied significantly between trial sites, from 8.7-18.6 days for AL and 10.2-18.7 days for AS-AQ. Significant predictors of time to reinfection in multivariable models were transmission intensity, age, drug, and parasite genotype. Where wild type pfmdr1 and pfcrt parasite genotypes predominated (<=20% 86Y and 76T mutants, respectively), AS-AQ provided ~ 2-fold longer protection than AL. Conversely, at a higher prevalence of 86Y and 76T mutant parasites (> 80%), AL provided up to 1.5-fold longer protection than AS-AQ. Our simulations found that these differences in the duration of protection could alter population-level clinical incidence of malaria by up to 14% in under-5-year-old children when the drugs were used as first-line treatments in areas with high, seasonal transmission. CONCLUSION Choosing a first-line treatment which provides optimal post-treatment prophylaxis given the local prevalence of resistance-associated markers could make a significant contribution to reducing malaria morbidity.
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Affiliation(s)
- Michael T Bretscher
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Prabin Dahal
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jamie Griffin
- School of Mathematical Sciences, Queen Mary University of London, London, UK
| | - Kasia Stepniewska
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Umberto D'Alessandro
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Abdoulaye A Djimde
- Malaria Research and Training Center, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Emmanuelle Espié
- Epicentre, Paris, France.,Clinical and Epidemiology Department, GSK Vaccines, R&D Center, Wavre, Belgium
| | - Bakary Fofana
- Malaria Research and Training Center, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Raquel González
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Elizabeth Juma
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Corine Karema
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Bertrand Lell
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.,Centre de Recherches Medicales de Lambarene, Lambarene, Gabon
| | - Nines Lima
- Department of Paediatrics, University of Calabar, Calabar, Nigeria
| | - Clara Menéndez
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Medicales de Lambarene, Lambarene, Gabon.,Institute for Tropical Medicine, University of Tubingen, Tubingen, Germany.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Clarissa Moreira
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Frederic Nikiema
- Institut de Recherche en Science de la Sante, Bobo-Dioulasso, Burkina Faso
| | - Jean B Ouédraogo
- Institut de Recherche en Science de la Sante, Bobo-Dioulasso, Burkina Faso
| | - Sarah G Staedke
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Halidou Tinto
- Institut de Recherche en Science de la Sante, Nanoro, Burkina Faso
| | - Innocent Valea
- Institut de Recherche en Science de la Sante, Nanoro, Burkina Faso
| | - Adoke Yeka
- Uganda Malaria Surveillance Project, Kampala, Uganda
| | - Azra C Ghani
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucy C Okell
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
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7
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Diakité SAS, Traoré K, Sanogo I, Clark TG, Campino S, Sangaré M, Dabitao D, Dara A, Konaté DS, Doucouré F, Cissé A, Keita B, Doumbouya M, Guindo MA, Toure MB, Sogoba N, Doumbia S, Awandare GA, Diakité M. A comprehensive analysis of drug resistance molecular markers and Plasmodium falciparum genetic diversity in two malaria endemic sites in Mali. Malar J 2019; 18:361. [PMID: 31718631 PMCID: PMC6849310 DOI: 10.1186/s12936-019-2986-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/24/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Drug resistance is one of the greatest challenges of malaria control programme in Mali. Recent advances in next-generation sequencing (NGS) technologies provide new and effective ways of tracking drug-resistant malaria parasites in Africa. The diversity and the prevalence of Plasmodium falciparum drug-resistance molecular markers were assessed in Dangassa and Nioro-du-Sahel in Mali, two sites with distinct malaria transmission patterns. Dangassa has an intense seasonal malaria transmission, whereas Nioro-du-Sahel has an unstable and short seasonal malaria transmission. METHODS Up to 270 dried blood spot samples (214 in Dangassa and 56 in Nioro-du-Sahel) were collected from P. falciparum positive patients in 2016. Samples were analysed on the Agena MassARRAY® iPLEX platform. Specific codons were targeted in Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps, Pfarps10, Pfferredoxin, Pfexonuclease and Pfmdr2 genes. The Sanger's 101-SNPs-barcode method was used to assess the genetic diversity of P. falciparum and to determine the parasite species. RESULTS The Pfcrt_76T chloroquine-resistance genotype was found at a rate of 64.4% in Dangassa and 45.2% in Nioro-du-Sahel (p = 0.025). The Pfdhfr_51I-59R-108N pyrimethamine-resistance genotype was 14.1% and 19.6%, respectively in Dangassa and Nioro-du-Sahel. Mutations in the Pfdhps_S436-A437-K540-A581-613A sulfadoxine-resistance gene was significantly more prevalent in Dangassa as compared to Nioro-du-Sahel (p = 0.035). Up to 17.8% of the isolates from Dangassa vs 7% from Nioro-du-Sahel harboured at least two codon substitutions in this haplotype. The amodiaquine-resistance Pfmdr1_N86Y mutation was identified in only three samples (two in Dangassa and one in Nioro-du-Sahel). The lumefantrine-reduced susceptibility Pfmdr1_Y184F mutation was found in 39.9% and 48.2% of samples in Dangassa and Nioro-du-Sahel, respectively. One piperaquine-resistance Exo_E415G mutation was found in Dangassa, while no artemisinin resistance genetic-background were identified. A high P. falciparum diversity was observed, but no clear genetic aggregation was found at either study sites. Higher multiplicity of infection was observed in Dangassa with both COIL (p = 0.04) and Real McCOIL (p = 0.02) methods relative to Nioro-du-Sahel. CONCLUSIONS This study reveals high prevalence of chloroquine and pyrimethamine-resistance markers as well as high codon substitution rate in the sulfadoxine-resistance gene. High genetic diversity of P. falciparum was observed. These observations suggest that the use of artemisinins is relevant in both Dangassa and Nioro-du-Sahel.
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Affiliation(s)
- Seidina A S Diakité
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali.
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana.
| | - Karim Traoré
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Ibrahim Sanogo
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Modibo Sangaré
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Djeneba Dabitao
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Antoine Dara
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Drissa S Konaté
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Fousseyni Doucouré
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Amadou Cissé
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Bourama Keita
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Mory Doumbouya
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Merepen A Guindo
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Mahamoudou B Toure
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Nafomon Sogoba
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Seydou Doumbia
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Gordon A Awandare
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | - Mahamadou Diakité
- Malaria Research and Training Center, University of Sciences, Technics and Technologies of Bamako (USTTB), Bamako, Mali
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8
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Ould Ahmedou Salem MS, Mint Lekweiry K, Bouchiba H, Pascual A, Pradines B, Ould Mohamed Salem Boukhary A, Briolant S, Basco LK, Bogreau H. Characterization of Plasmodium falciparum genes associated with drug resistance in Hodh Elgharbi, a malaria hotspot near Malian-Mauritanian border. Malar J 2017; 16:140. [PMID: 28381273 PMCID: PMC5382448 DOI: 10.1186/s12936-017-1791-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/26/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A malaria hotspot in the southeastern region of Mauritania, near the Malian border, may hamper malaria control strategies. The objectives were to estimate the prevalence of genetic polymorphisms associated with drug resistance in Plasmodium falciparum isolates and establish baseline data. METHODS The study was conducted in two malaria-endemic areas in Hodh Elgharbi, situated in the Malian-Mauritanian border area. Blood samples were collected from symptomatic patients. Single nucleotide polymorphisms in Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps were genotyped using PCR-restriction fragment length polymorphism, DNA sequencing and primer extension. The Pfmdr1 gene copy number was determined by real-time PCR. RESULTS Of 280 P. falciparum-infected patients, 193 (68.9%) carried the Pfcrt 76T mutant allele. The Pfmdr1 86Y and 184F mutations were found in 61 (23.1%) of 264 isolates and 167 (67.6%) of 247 samples that were successfully genotyped, respectively. Pfmdr1 mutant alleles 1034C, 1042D and 1246Y were rarely observed. Of 102 P. falciparum isolates analysed, ten (9.8%) had more than one copy of Pfmdr1 gene. The prevalence of isolates harbouring at least triple mutant Pfdhfr 51I, 59R, 108 N/T was 42% (112/268), of which 42 (37.5%) had an additional Pfdhps 437G mutation. The Pfdhps 540E mutation was observed in four isolates (1.5%), including three associated with Pfdhfr triple mutant. Only two quintuple mutants (Pfdhfr-51I-59R-108N Pfdhps-437G-540E) were observed. CONCLUSIONS The observed mutations in Pfdhfr, Pfdhps, Pfmdr1, and Pfcrt may jeopardize the future of seasonal malaria chemoprevention based on amodiaquine-sulfadoxine-pyrimethamine, intermittent preventive treatment for pregnant women using sulfadoxine-pyrimethamine, and treatment with artesunate-amodiaquine. Complementary studies should be carried out to document the distribution, origin and circulation of P. falciparum populations in this region and more widely in the country to assess the risk of the spread of resistance.
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Affiliation(s)
- Mohamed Salem Ould Ahmedou Salem
- Unité de Recherche «Génomes et Milieux», Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau campus universitaire, BP 5026, Nouakchott, Mauritania.
| | - Khadijetou Mint Lekweiry
- Unité de Recherche «Génomes et Milieux», Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau campus universitaire, BP 5026, Nouakchott, Mauritania
| | - Houssem Bouchiba
- Unité Parasitologie et entomologie, Département des maladies infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France.,Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix-Marseille Université, UM 63, CNRS 7278, IRD 198, Inserm 1095, AP-HM, Institut Hospitalo-Universitaire (IHU) - Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France
| | - Aurelie Pascual
- Unité Parasitologie et entomologie, Département des maladies infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France.,Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix-Marseille Université, UM 63, CNRS 7278, IRD 198, Inserm 1095, AP-HM, Institut Hospitalo-Universitaire (IHU) - Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France
| | - Bruno Pradines
- Unité Parasitologie et entomologie, Département des maladies infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France.,Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix-Marseille Université, UM 63, CNRS 7278, IRD 198, Inserm 1095, AP-HM, Institut Hospitalo-Universitaire (IHU) - Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.,Centre national de référence pour le paludisme, Marseille, France
| | - Ali Ould Mohamed Salem Boukhary
- Unité de Recherche «Génomes et Milieux», Faculté des Sciences et Techniques, Université de Nouakchott Al-Aasriya, Nouveau campus universitaire, BP 5026, Nouakchott, Mauritania
| | - Sébastien Briolant
- Unité Parasitologie et entomologie, Département des maladies infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France.,Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix-Marseille Université, UM 63, CNRS 7278, IRD 198, Inserm 1095, AP-HM, Institut Hospitalo-Universitaire (IHU) - Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France
| | - Leonardo K Basco
- Unité Parasitologie et entomologie, Département des maladies infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France.,Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix-Marseille Université, UM 63, CNRS 7278, IRD 198, Inserm 1095, AP-HM, Institut Hospitalo-Universitaire (IHU) - Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France
| | - Hervé Bogreau
- Unité Parasitologie et entomologie, Département des maladies infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France.,Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix-Marseille Université, UM 63, CNRS 7278, IRD 198, Inserm 1095, AP-HM, Institut Hospitalo-Universitaire (IHU) - Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France
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9
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Risk of drug resistance in Plasmodium falciparum malaria therapy-a systematic review and meta-analysis. Parasitol Res 2016; 116:781-788. [PMID: 28028628 DOI: 10.1007/s00436-016-5353-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/13/2016] [Indexed: 12/30/2022]
Abstract
Plasmodium falciparum is responsible for the vast majority of the morbidity and mortality associated with malaria infection globally. Although a number of studies have reported the emergence of drug resistance in different therapies for P. falciparum infection, the degree of the drug resistance in different antimalarials is still unclear. This research investigated the risk of drug resistance in the therapies with different medications based on meta-analyses. Relevant original randomized control trials (RCTs) were searched in all available electronic databases. Pooled relative risks (RRs) with 95% confidence intervals (95% CIs) were used to evaluate the risk of drug resistance resulting from different treatments. Seventy-eight studies were included in the meta-analysis to compare drug resistance in the treatment of P. falciparum infections and yielded the following results: chloroquine (CQ) > sulfadoxine-pyrimethamine (SP) (RR = 3.67, p < 0.001 ), mefloquine (MQ) < SP (RR = 0.26, p < 0.001), artesunate + sulfadoxine-pyrimethamine (AS + SP) > artemether + lumefantrine (AL) (RR = 2.94, p < 0.001), dihydroartemisinin + piperaquine (DHA + PQ) < AL (RR = 0.7, p < 0.05), and non-artemisinin-based combination therapies (NACTs) > artemisinin-based combination therapies (ACTs) (RR = 1.93, p < 0.001); no significant difference was found in amodiaquine (AQ) vs. SP, AS + AQ vs. AS + SP, AS + AQ vs. AL, or AS + MQ vs. AL. These results presented a global view for the current status of antimalarial drug resistance and provided a guidance for choice of antimalarials for efficient treatment and prolonging the life span of the current effective antimalarial drugs.
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10
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Abstract
INTRODUCTION Placental malaria (PM) is a major public health problem that constitutes a significant health concern for the mother, and especially for the developing fetus and offspring. Current means of prevention have limitations, including a restricted window of intervention that excludes the first trimester of pregnancy, and the fact that very few drugs can be used for this purpose. The identification of the VAR2CSA antigen, specific to PM parasites, offers an excellent opportunity to develop a vaccine against this disease. Proof of concept of a first-generation vaccine is nearing completion, and two clinical trials are underway. AREAS COVERED This review focuses on PM, which is mainly caused by Plasmodium falciparum. The review highlights recent advances and the key milestones that led to the identification of the optimal vaccine target within the large VAR2CSA protein. The paper also points out how future improvements can strengthen this process to achieve an effective vaccine in the field. EXPERT OPINION The approach taken to develop a P. falciparum erythrocyte membrane protein 1-based vaccine to protect pregnant women is very promising in view of the current difficulties of achieving a sterilizing vaccine against malaria parasite. This approach could help us to control the deleterious effect of malaria infections that characterize severe clinical forms.
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11
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Maiga H, Djimde AA, Beavogui AH, Toure O, Tekete M, Sangare CPO, Dara A, Traore ZI, Traore OB, Dama S, N'Dong C, Niangaly H, Diallo N, Dembele D, Sagara I, Doumbo OK. Efficacy of sulphadoxine-pyrimethamine + artesunate, sulphadoxine-pyrimethamine + amodiaquine, and sulphadoxine-pyrimethamine alone in uncomplicated falciparum malaria in Mali. Malar J 2015; 14:64. [PMID: 25889633 PMCID: PMC4326408 DOI: 10.1186/s12936-015-0557-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plasmodium falciparum resistance to artemisinin has been reported in South-East Asia. Long half-life drugs are increasingly being used for malaria prevention. The potential spread of parasite resistance to these regimens is real and makes regular efficacy surveillance a priority. METHODS From August to December 2004 and July to December 2005, a randomized open label trial of sulphadoxine-pyrimethamine (SP) + artesunate (AS) versus SP + amodiaquine (AQ), and SP alone, was conducted in two villages of Mali. PCR was used to distinguish new infections from recrudescent P. falciparum infections. Patients were followed for 28 days to assess treatment efficacy. RESULTS Overall 912 children aged between six to 59 months, with uncomplicated P. falciparum malaria were recruited. Baseline characteristics were similar in the three treatment arms. Crude ACPRs were 94.9%; 98.6% and 93.5% for SP + AS; SP + AQ and SP alone arms respectively (SP + AS versus SP + AQ, p = 0.01; SP + AS versus SP, p = 0.5; SP + AQ versus SP, p = 0.001). After PCR adjustment, cACPRs were 99%; 100% and 97.2% for SP + AS; SP + AQ and SP alone arms, respectively (SP + AS versus SP + AQ, p = 0.25; SP + AS versus SP, p = 0.12; SP + AQ versus SP, p = 0.007). CONCLUSION Sulphadoxine-pyrimethamine + amodiaquine therapy was as efficacious as sulphadoxine-pyrimethamine + artesunate, but more efficacious than sulphadoxine-pyrimethamine alone in the treatment of uncomplicated P. falciparum malaria in Mali.
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Affiliation(s)
- Hamma Maiga
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Abdoulaye A Djimde
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Abdoul H Beavogui
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Ousmane Toure
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Mamadou Tekete
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Cheick Papa O Sangare
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Antoine Dara
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Zoumana I Traore
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Oumar B Traore
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Souleymane Dama
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Christelle N'Dong
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Hamidou Niangaly
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Nouhoum Diallo
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Demba Dembele
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Issaka Sagara
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
| | - Ogobara K Doumbo
- Molecular Epidemiology and Drug Resistance Unit, University of Sciences Techniques and Technology of Bamako, PO Box: 1805, Bamako, Mali.
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12
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Abstract
BACKGROUND Anaemia is a global public health problem. Children under five years of age living in developing countries (mostly Africa and South-East Asia) are highly affected. Although the causes for anaemia are multifactorial, malaria has been linked to anaemia in children living in malaria-endemic areas. Administering intermittent preventive antimalarial treatment (IPT) to children might reduce anaemia, since it could protect children from new Plasmodium parasite infection (the parasites that cause malaria) and allow their haemoglobin levels to recover. OBJECTIVES To assess the effect of IPT for children with anaemia living in malaria-endemic areas. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, Cochrane Central of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; and LILACS. We also searched the World Health Organization (WHO) International Clinical Trial Registry Platform and metaRegister of Controlled Trials (mRCT) for ongoing trials up to 4 December 2014. SELECTION CRITERIA Randomized controlled trials (RCTs) evaluating the effect of IPT on children with anaemia. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. We analysed data by conducting meta-analyses, stratifying data according to whether participants received iron supplements or not. We used GRADE to assess the quality of evidence. MAIN RESULTS Six trials with 3847 participants met our inclusion criteria. Trials were conducted in areas of low malaria endemicity (three trials), and moderate to high endemicity (three trials). Four trials were in areas of seasonal malaria transmission. Iron was given to all children in two trials, and evaluated in a factorial design in a further two trials.IPT for children with anaemia probably has little or no effect on the proportion anaemic at 12 weeks follow-up (four trials, 2237 participants, (moderate quality evidence).IPT in anaemic children probably increases the mean change in haemoglobin levels from baseline to follow-up at 12 weeks on average by 0.32 g/dL (MD 0.32, 95% CI 0.19 to 0.45; four trials, 1672 participants, moderate quality evidence); and may improve haemoglobin levels at 12 weeks (MD 0.35, 95% CI 0.06 to 0.64; four trials, 1672 participants, low quality evidence). For both of these outcomes, subgroup analysis did not demonstrate a difference between children receiving iron and those that did not.IPT for children with anaemia probably has little or no effect on mortality or hospital admissions at six months (three trials, 3160 participants moderate quality evidence). Subgroup analysis did not show a difference between those children receiving iron supplements and those that did not. AUTHORS' CONCLUSIONS Trials did show a small effect on average haemoglobin levels but this did not appear to translate into an effect on mortality and hospital admissions. Three of the six trials were conducted in low endemicity areas where transmission is low and thus any protective effect is likely to be modest.
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Affiliation(s)
| | - Abdunoor M Kabanywanyi
- Ifakara Health InstituteP O Box 78373Kiko Avenue, Old Bagamoyo RoadDar‐es‐salaamTanzania
| | - Anke C Rohwer
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa7505
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13
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Sagara I, Piarroux R, Djimde A, Giorgi R, Kayentao K, Doumbo OK, Gaudart J. Delayed anemia assessment in patients treated with oral artemisinin derivatives for uncomplicated malaria: a pooled analysis of clinical trials data from Mali. Malar J 2014; 13:358. [PMID: 25217396 PMCID: PMC4177171 DOI: 10.1186/1475-2875-13-358] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/02/2014] [Indexed: 11/16/2022] Open
Abstract
Background In sub-Saharan Africa, artemisinin-based combination therapy (ACT) and injectable artesunate are the first-line treatments for uncomplicated and severe Plasmodium falciparum malaria, respectively. However, recent studies suggest that delayed anaemia is associated with these treatments in non-immune travellers. This paper aimed to assess the risk factors associated with delayed anaemia after falciparum malaria treatment with artemisinin-containing drugs in malaria-endemic populations. Methods Pooled, individual malaria patient data were extracted from 13 clinical trials performed from 2002 to 2011 in various settings of Mali. Treatment regimens were artemether-lumefantrine, artesunate plus amodiaquine, artesunate plus sulphadoxine-pyrimethamine, artesunate plus sulphamethoxypyrazine-pyrimethamine, artesunate plus mefloquine, artesunate-pyronaridine, artesunate monotherapy, chloroquine, sulphadoxine-pyrimethamine, amodiaquine and sulphadoxine-pyrimethamine plus amodiaquine. Univariate and multivariate analyses were performed using the generalized linear and latent mixed model procedures to assess risk factors associated with haemoglobin concentration evolution and anaemia during the treatment follow-up. Results A total of 5,990 participants were recruited and followed from day 0 to day 28. The participants’ median age was five years, ranging from three months to 70 years. There was a decrease in haemoglobin level on day 7 in all treatment arms, but the magnitude varied across treatments. There was a significant risk of haemoglobin level decrease on day 7 in the artemisinin-based therapy compared to the non-artemisinin treatments. The risk of haemoglobin concentration drop was associated with age group < five years old (0.61 g/dL 95% CI (0.71 to 0.51), p < 0.001), baseline high parasite density (0.43 g/dL 95% CI (0.51 to 0.35), p < 0.001) and treatment failure (0.40 g/dL 95% CI (0.59 to 0.20), p = 0.018), while high haemoglobin level at baseline was a protective factor (0.53 to 0.59) p < 0.001). No association was found between artemisinin-based therapy and severe delayed anaemia. Conclusions Oral artemisinin derivative treatments for uncomplicated P. falciparum malaria are associated with a transient and clinically moderate haemoglobin decrease by day 7 but not associated with a delayed severe anaemia. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-358) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Issaka Sagara
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Odonto-Stomatogy, University of Sciences, Techniques and Technologies of Bamako, BP 1805 Point G Bamako, Mali.
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14
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Gharbi M, Flegg JA, Pradines B, Berenger A, Ndiaye M, Djimdé AA, Roper C, Hubert V, Kendjo E, Venkatesan M, Brasseur P, Gaye O, Offianan AT, Penali L, Le Bras J, Guérin PJ, Study MOTFNRCFIM. Surveillance of travellers: an additional tool for tracking antimalarial drug resistance in endemic countries. PLoS One 2013; 8:e77775. [PMID: 24204960 PMCID: PMC3813754 DOI: 10.1371/journal.pone.0077775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/04/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There are growing concerns about the emergence of resistance to artemisinin-based combination therapies (ACTs). Since the widespread adoption of ACTs, there has been a decrease in the systematic surveillance of antimalarial drug resistance in many malaria-endemic countries. The aim of this work was to test whether data on travellers returning from Africa with malaria could serve as an additional surveillance system of local information sources for the emergence of drug resistance in endemic-countries. METHODOLOGY Data were collected from travellers with symptomatic Plasmodium falciparum malaria returning from Senegal (n = 1,993), Mali (n = 2,372), Cote d'Ivoire (n = 4,778) or Cameroon (n = 3,272) and recorded in the French Malaria Reference Centre during the period 1996-2011. Temporal trends of the proportion of parasite isolates that carried the mutant genotype, pfcrt 76T, a marker of resistance to chloroquine (CQ) and pfdhfr 108N, a marker of resistance to pyrimethamine, were compared for travellers and within-country surveys that were identified through a literature review in PubMed. The in vitro response to CQ was also compared between these two groups for parasites from Senegal. RESULTS The trends in the proportion of parasites that carried pfcrt 76T, and pfdhfr 108N, were compared for parasites from travellers and patients within-country using the slopes of the curves over time; no significant differences in the trends were found for any of the 4 countries. These results were supported by in vitro analysis of parasites from the field in Senegal and travellers returning to France, where the trends were also not significantly different. CONCLUSION The results have not shown different trends in resistance between parasites derived from travellers or from parasites within-country. This work highlights the value of an international database of drug responses in travellers as an additional tool to assess the emergence of drug resistance in endemic areas where information is limited.
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Affiliation(s)
- Myriam Gharbi
- Unité Mixte de Recherche 216, Institut de Recherche et de Développement, Paris, France
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Paris, France
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Ecole des Hautes Etudes en Santé Publique, Sorbonne Paris Cité, Rennes, France
| | - Jennifer A. Flegg
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Centre for Tropical Medicine & Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Bruno Pradines
- Département d’Infectiologie de Terrain, Institut de Recherche Biomédicale des Armées, Marseille, France
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Aix Marseille Université, Marseille, France
- Centre National de Référence du Paludisme, Marseille, France
| | - Ako Berenger
- Malariology Department, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Magatte Ndiaye
- Service de parasitologie, Faculté de Médecine et Pharmacie Université Cheikh Anta Diop, Dakar, Sénégal
| | - Abdoulaye A. Djimdé
- Malaria Research and Training Center & Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Cally Roper
- Pathogen Molecular Biology Department of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Véronique Hubert
- Centre National de Référence du Paludisme & Service de Parasitologie Mycologie, CHU Bichat-Claude Bernard APHP, Paris, France
| | - Eric Kendjo
- Centre National de Référence du Paludisme and Service de Parasitologie Mycologie, CHU Pitié-Salpétrière APHP, Paris, France
| | - Meera Venkatesan
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Philippe Brasseur
- UMR 198, Institut de Recherche pour le Développement, Dakar, Sénégal
| | - Oumar Gaye
- Service de parasitologie, Faculté de Médecine et Pharmacie Université Cheikh Anta Diop, Dakar, Sénégal
| | - André T. Offianan
- Malariology Department, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Louis Penali
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
| | - Jacques Le Bras
- Unité Mixte de Recherche 216, Institut de Recherche et de Développement, Paris, France
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Paris, France
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Centre National de Référence du Paludisme & Service de Parasitologie Mycologie, CHU Bichat-Claude Bernard APHP, Paris, France
| | - Philippe J. Guérin
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Ecole des Hautes Etudes en Santé Publique, Sorbonne Paris Cité, Rennes, France
- Centre for Tropical Medicine & Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- UMR S 707: Epidemiology Information Systems Modeling, INSERM and Université Pierre et Marie-Curie-Paris6, Paris, France
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Abdul-Ghani R, Farag HF, Allam AF. Sulfadoxine-pyrimethamine resistance in Plasmodium falciparum: a zoomed image at the molecular level within a geographic context. Acta Trop 2013; 125:163-90. [PMID: 23131424 DOI: 10.1016/j.actatropica.2012.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
Abstract
Antimalarial chemotherapy is one of the main pillars in the prevention and control of malaria. Following widespread resistance of Plasmodium falciparum to chloroquine, sulfadoxine-pyrimethamine came to the scene as an alternative to the cheap and well-tolerated chloroquine. However, widespread resistance to sulfadoxine-pyrimethamine has been documented. In vivo efficacy tests are the gold standard for assessing drug resistance and treatment failure. However, they have many disadvantages, such as influence of host immunity and drug pharmacokinetics. In vitro tests of antimalarial drug efficacy also have many technical difficulties. Molecular markers of resistance have emerged as epidemiologic tools to investigate antimalarial drug resistance even before becoming clinically evident. Mutations in P. falciparum dihydrofolate reductase and dihydrofolate synthase have been extensively studied as molecular markers for resistance to pyrimethamine and sulfadoxine, respectively. This review highlights the resistance of P. falciparum at the molecular level presenting both supporting and opposing studies on the utility of molecular markers.
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Kone A, Mu J, Maiga H, Beavogui AH, Yattara O, Sagara I, Tekete MM, Traore OB, Dara A, Dama S, Diallo N, Kodio A, Traoré A, Björkman A, Gil JP, Doumbo OK, Wellems TE, Djimde AA. Quinine treatment selects the pfnhe-1 ms4760-1 polymorphism in Malian patients with Falciparum malaria. J Infect Dis 2012; 207:520-7. [PMID: 23162138 DOI: 10.1093/infdis/jis691] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The mechanism of Plasmodium falciparum resistance to quinine is not known. In vitro quantitative trait loci mapping suggests involvement of a predicted P. falciparum sodium-hydrogen exchanger (pfnhe-1) on chromosome 13. METHODS We conducted prospective quinine efficacy studies in 2 villages, Kollé and Faladié, Mali. Cases of clinical malaria requiring intravenous therapy were treated with standard doses of quinine and followed for 28 days. Treatment outcomes were classified using modified World Health Organization protocols. Molecular markers of parasite polymorphisms were used to distinguish recrudescent parasites from new infections. The prevalence of pfnhe-1 ms4760-1 among parasites before versus after quinine treatment was determined by direct sequencing. RESULTS Overall, 163 patients were enrolled and successfully followed. Without molecular correction, the mean adequate clinical and parasitological response (ACPR) was 50.3% (n = 163). After polymerase chain reaction correction to account for new infections, the corrected ACPR was 100%. The prevalence of ms4760-1 increased significantly, from 26.2% (n = 107) before quinine treatment to 46.3% (n = 54) after therapy (P = .01). In a control sulfadoxine-pyrimethamine study, the prevalence of ms4760-1 was similar before and after treatment. CONCLUSIONS This study supports a role for pfnhe-1 in decreased susceptibility of P. falciparum to quinine in the field.
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Affiliation(s)
- Aminatou Kone
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy, and Odonto-Stomatology, University of Science, Techniques and Technology, Bamako, Mali
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Ouologuem DT, Djimdé AA, Diallo N, Doumbo OK, Roos DS. Toxoplasma gondii seroprevalence in Mali. J Parasitol 2012; 99:371-4. [PMID: 22924926 DOI: 10.1645/ge-3239.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The protozoan parasite Toxoplasma gondii is globally distributed, with considerable local variation in prevalence based on behavioral and environmental factors. To assess prevalence and estimate risk in Mali, we conducted a survey of 760 serum samples previously collected for malaria studies. A modified agglutination test detected antibodies in ∼27% of the adult population, with no significant differences between men and women, or between urban and rural study sites. In the village of Kolle, seroprevalence rose from 0% in infants (<1 yr, but after weaning of maternal immunoglobulin G) to 0.8% (1-5 yr), 2.7% (6-10), 11.3% (11-15), and 26.8% (>15); differences between the <10-, 11-15-, and >15-yr age groups were highly significant (P ≤ 0.01). We also observed an increase in anti- T. gondii antibody titers with age. Modeling the observed age distribution suggests a seroconversion rate of ∼1%/yr, indicating that congenital toxoplasmosis may be an under-appreciated public health concern in Mali.
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Affiliation(s)
- Dinkorma T Ouologuem
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science, Techniques and Technologies of Bamako, Mali
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Tekete MM, Toure S, Fredericks A, Beavogui AH, Sangare CPO, Evans A, Smith P, Maiga H, Traore ZI, Doumbo OK, Barnes KI, Djimde AA. Effects of amodiaquine and artesunate on sulphadoxine-pyrimethamine pharmacokinetic parameters in children under five in Mali. Malar J 2011; 10:275. [PMID: 21936885 PMCID: PMC3197573 DOI: 10.1186/1475-2875-10-275] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 09/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sulphadoxine-pyrimethamine, in combination with artesunate or amodiaquine, is recommended for the treatment of uncomplicated malaria and is being evaluated for intermittent preventive treatment. Yet, limited data is available on pharmacokinetic interactions between these drugs. METHODS In a randomized controlled trial, children aged 6-59 months with uncomplicated falciparum malaria, received either one dose of sulphadoxine-pyrimethamine alone (SP), one dose of SP plus three daily doses of amodiaquine (SP+AQ) or one dose of SP plus 3 daily doses of artesunate (SP+AS). Exactly 100 μl of capillary blood was collected onto filter paper before drug administration at day 0 and at days 1, 3, 7, 14, 21 and 28 after drug administration for analysis of sulphadoxine and pyrimethamine pharmacokinetic parameters. RESULTS Fourty, 38 and 31 patients in the SP, SP+AQ and SP+AS arms, respectively were included in this study. The concentrations on day 7 (that are associated with therapeutic efficacy) were similar between the SP, SP+AQ and SP+AS treatment arms for sulphadoxine (median [IQR] 35.25 [27.38-41.70], 34.95 [28.60-40.85] and 33.40 [24.63-44.05] μg/mL) and for pyrimethamine (56.75 [46.40-92.95], 58.75 [43.60-98.60] and 59.60 [42.45-86.63] ng/mL). There were statistically significant differences between the pyrimethamine volumes of distribution (4.65 [3.93-6.40], 4.00 [3.03-5.43] and 5.60 [4.40-7.20] L/kg; p = 0.001) and thus elimination half-life (3.26 [2.74 -3.82], 2.78 [2.24-3.65] and 4.02 [3.05-4.85] days; p < 0.001). This study confirmed the lower SP concentrations previously reported for young children when compared with adult malaria patients. CONCLUSION Despite slight differences in pyrimethamine volumes of distribution and elimination half-life, these data show similar exposure to SP over the critical initial seven days of treatment and support the current use of SP in combination with either AQ or AS for uncomplicated falciparum malaria treatment in young Malian children.
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Affiliation(s)
- Mamadou M Tekete
- Molecular Epidemiology and Drug Resistance Unit, Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, P,O, Box: 1805, Bamako, Mali
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Abstract
Intermittent preventive treatment of infants (IPTi) with sulphadoxine pyrimethamine (SP) is recommended as an additional malaria control intervention in high transmission areas of sub-Saharan Africa, provided its protective efficacy is not compromised by SP resistance. A significant obstacle in implementing SP-IPTi, is in establishing the degree of resistance in an area. Since SP monotherapy is discontinued, no contemporary measures of in vivo efficacy can be made, so the World Health Organisation has recommended a cut-off based upon molecular markers, stating that SP-IPTi should not be implemented when the prevalence of the dhps 540E mutation among infections exceeds 50%. We created a geo-referenced database of SP resistance markers in Africa from published literature. By selecting surveys of malaria infected blood samples conducted since 2004 we have mapped the contemporary prevalence of dhps 540E. Additional maps are freely available in interactive form at http://www.drugresistancemaps.org/ipti/. Eight countries in East Africa are classified as unsuitable for SP-IPTi when data are considered at a national level. Fourteen countries in Central and West Africa were classified as suitable while seven countries had no available contemporary data to guide policy. There are clear deficiencies in molecular surveillance data coverage. We discuss requirements for ongoing surveillance of SP resistance markers in support of the use of SP-IPTi.
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Dicko A, Toure SO, Traore M, Sagara I, Toure OB, Sissoko MS, Diallo AT, Rogier C, Salomon R, de Sousa A, Doumbo OK. Increase in EPI vaccines coverage after implementation of intermittent preventive treatment of malaria in infant with Sulfadoxine -pyrimethamine in the district of Kolokani, Mali: results from a cluster randomized control trial. BMC Public Health 2011; 11:573. [PMID: 21767403 PMCID: PMC3155918 DOI: 10.1186/1471-2458-11-573] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 07/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though the efficacy of Intermittent Preventive Treatment in infants (IPTi) with Sulfadoxine-Pyrimethamine (SP) against clinical disease and the absence of its interaction with routine vaccines of the Expanded Immunization Programme (EPI) have been established, there are still some concerns regarding the addition of IPTi, which may increase the work burden and disrupt the routine EPI services especially in Africa where the target immunization coverage remains to be met. However IPTi may also increase the adherence of the community to EPI services and improve EPI coverage, once the benefice of strategy is perceived. METHODS To assess the impact of IPTi implementation on the coverage of EPI vaccines, 22 health areas of the district of Kolokani were randomized at a 1:1 ratio to either receive IPTi-SP or to serve as a control. The EPI vaccines coverage was assessed using cross-sectional surveys at baseline in November 2006 and after one year of IPTi pilot-implementation in December 2007. RESULTS At baseline, the proportion of children of 9-23 months who were completely vaccinated (defined as children who received BGG, 3 doses of DTP/Polio, measles and yellow fever vaccines) was 36.7% (95% CI 25.3% -48.0%). After one year of implementation of IPTi-SP using routine health services, the proportion of children completely vaccinated rose to 53.8% in the non intervention zone and 69.5% in the IPTi intervention zone (P <0.001).The proportion of children in the target age groups who received IPTi with each of the 3 vaccinations DTP2, DTP3 and Measles, were 89.2% (95% CI 85.9%-92.0%), 91.0% (95% CI 87.6% -93.7%) and 77.4% (95% CI 70.7%-83.2%) respectively. The corresponding figures in non intervention zone were 2.3% (95% CI 0.9% -4.7%), 2.6% (95% CI 1.0% -5.6%) and 1.7% (95% CI 0.4% - 4.9%). CONCLUSION This study shows that high coverage of the IPTi can be obtained when the strategy is implemented using routine health services and implementation results in a significant increase in coverage of EPI vaccines in the district of Kolokani, Mali.
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Affiliation(s)
- Alassane Dicko
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, P.O. Box 1805 Bamako, Mali
- Department of Public Health, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, P.O. Box 1805 Bamako, Mali
| | - Sidy O Toure
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, P.O. Box 1805 Bamako, Mali
| | - Mariam Traore
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, P.O. Box 1805 Bamako, Mali
| | - Issaka Sagara
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, P.O. Box 1805 Bamako, Mali
| | - Ousmane B Toure
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, P.O. Box 1805 Bamako, Mali
| | - Mahamadou S Sissoko
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, P.O. Box 1805 Bamako, Mali
| | | | - Christophe Rogier
- Institut de Recherche Biomédicale des Armées IRBA - ex-IMTSSA & UMR6236-URMITE, Allée du Médecin colonel Jamot, Parc du Pharo, BP60109, 13262 Marseille cedex 07, France
| | - Roger Salomon
- Institut de Santé Publique, d'Épidémiologie et de Développement, Université Victor Segalen Bordeaux 2, Case 11 146 Rue Léo Saignat, 33076 Bordeaux Cedex - France
| | - Alexandra de Sousa
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, 20 Avenue Appia, 121 Geneva 27, Switzerland
| | - Ogobara K Doumbo
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, P.O. Box 1805 Bamako, Mali
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Wélé M, Djimdé AA, Guindo A, Beavogui AH, Traoré IZ, Sadou A, Blaise D, Diallo DA, Wellems TE, Doumbo OK. High frequency of PfCRT 76T in two Malian villages and its prevalence in severe relative to non-severe malaria. Acta Trop 2011; 119:11-3. [PMID: 21300016 PMCID: PMC4792268 DOI: 10.1016/j.actatropica.2011.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 01/04/2011] [Accepted: 01/11/2011] [Indexed: 11/16/2022]
Abstract
We investigated PfCRT 76T mutation in severe and non-severe malaria in Southern Mali. One hundred and ninety three severe malaria cases were each matched against two non-severe malaria cases. Patients with G6PD deficiency and any known hemoglobin abnormality were excluded. PfCRT 76T was present in 60.8% (n=386) non-severe malaria cases and in 77.2% (n=193) severe malaria cases (p<0.0001). In children 5 years or younger, these proportions were 62.9% (n=294) vs. 73.5% (n=147), respectively (p<0.01). PfCRT 76T was therefore associated with malaria severity in this setting of Mali.
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Affiliation(s)
- Mamadou Wélé
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali
| | - Abdoulaye A. Djimdé
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali
| | - Aldiouma Guindo
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali
| | - Abdoul H. Beavogui
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali
| | - Isaac Z. Traoré
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali
| | - Aboubacar Sadou
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali
| | - Dackouo Blaise
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali
| | - Dapa A. Diallo
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali
| | - Thomas E. Wellems
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ogobara K. Doumbo
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Mali
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Howard N, Durrani N, Sanda S, Beshir K, Hallett R, Rowland M. Clinical trial of extended-dose chloroquine for treatment of resistant falciparum malaria among Afghan refugees in Pakistan. Malar J 2011; 10:171. [PMID: 21699697 PMCID: PMC3132200 DOI: 10.1186/1475-2875-10-171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 06/23/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Falciparum malaria is a significant problem for Afghan refugees in Pakistan. Refugee treatment guidelines recommended standard three-day chloroquine treatment (25 mg/kg) for first episodes and extended five-day treatment (40 mg/kg) for recrudescent infections, based on the assumption that a five-day course would more likely achieve a cure. An in-vivo randomized controlled trial was conducted among refugees with uncomplicated falciparum malaria to determine whether five-day treatment (CQ40) was more effective than standard treatment (CQ25). METHODS 142 falciparum patients were recruited into CQ25 or CQ40 treatment arms and followed up to 60 days with regular blood smears. The primary outcome was parasitological cure without recrudescence. Treatment failures were retreated with CQ40. PCR genotyping of 270 samples, from the same and nearby sites, was used to support interpretation of outcomes. RESULTS 84% of CQ25 versus 51% of CQ40 patients experienced parasite recrudescence during follow-up (adjusted odds ratio 0.17, 95%CI 0.08-0.38). Cure rates were significantly improved with CQ40, particularly among adults. Fever clearance time, parasite clearance time, and proportions gametocytaemic post-treatment were similar between treatment groups. Second-line CQ40 treatment resulted in higher failure rates than first-line CQ40 treatment. CQ-resistance marker pfcrt 76T was found in all isolates analysed, while pfmdr1 86Y and 184Y were found in 18% and 37% of isolates respectively. CONCLUSIONS CQ is not suitable for first-line falciparum treatment in Afghan refugee communities. The extended-dose CQ regimen can overcome 39% of resistant infections that would recrudesce under the standard regimen, but the high failure rate after directly observed treatment demonstrates its use is inappropriate.
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Affiliation(s)
- Natasha Howard
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Naeem Durrani
- HealthNet-TPO, Peshawar Pakistan and Kabul Afghanistan
| | - Sanda Sanda
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Khalid Beshir
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Rachel Hallett
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Mark Rowland
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- HealthNet-TPO, Peshawar Pakistan and Kabul Afghanistan
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Frosch AEP, Venkatesan M, Laufer MK. Patterns of chloroquine use and resistance in sub-Saharan Africa: a systematic review of household survey and molecular data. Malar J 2011; 10:116. [PMID: 21554692 PMCID: PMC3112453 DOI: 10.1186/1475-2875-10-116] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 05/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a result of widespread chloroquine and sulphadoxine-pyrimethamine (SP) resistance, 90% of sub-Saharan African countries had adopted policies of artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria by 2007. In Malawi, cessation of chloroquine use was followed by the re-emergence of chloroquine-susceptible malaria. It was expected that introduction of ACT would lead to a return in chloroquine susceptibility throughout Africa, but this has not yet widely occurred. This observation suggests that there is continuing use of ineffective anti-malarials in Africa and that persistent chloroquine-resistant malaria is due to ongoing drug pressure despite national policy changes. METHODS To estimate drug use on a national level, 2006-2007 Demographic Health Survey and Multiple Indicator Cluster Survey data from 21 African countries were analysed. Resistance data were compiled by systematic review of the published literature on the prevalence of the Plasmodium falciparum chloroquine resistance transporter polymorphism at codon 76, which causes chloroquine resistance. RESULTS Chloroquine was the most common anti-malarial used according to surveys from 14 of 21 countries analysed, predominantly in West Africa. SP was most commonly reported in two of 21 countries. Among eight countries with longitudinal molecular resistance data, the four countries where the highest proportion of children treated for fever received chloroquine (Uganda, Burkina Faso, Guinea Bissau, and Mali) also showed no significant declines in the prevalence of chloroquine-resistant infections. The three countries with low or decreasing chloroquine use among children who reported fever treatment (Malawi, Kenya, and Tanzania) had statistically significant declines in the prevalence of chloroquine resistance. CONCLUSIONS This study demonstrates that in 2006-2007, chloroquine and SP continued to be used at high rates in many African countries. In countries reporting sustained chloroquine use, chloroquine-resistant malaria persists. In contrast, a low level of estimated chloroquine use is associated with a declining prevalence of chloroquine resistance.
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Affiliation(s)
- Anne E P Frosch
- Center for Vaccine Development, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD, USA
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Beavogui AH, Djimde AA, Gregson A, Toure AM, Dao A, Coulibaly B, Ouologuem D, Fofana B, Sacko A, Tekete M, Kone A, Niare O, Wele M, Plowe CV, Picot S, Doumbo OK. Low infectivity of Plasmodium falciparum gametocytes to Anopheles gambiae following treatment with sulfadoxine-pyrimethamine in Mali. Int J Parasitol 2010; 40:1213-20. [PMID: 20460125 PMCID: PMC3571761 DOI: 10.1016/j.ijpara.2010.04.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 04/19/2010] [Accepted: 04/20/2010] [Indexed: 11/22/2022]
Abstract
Sulfadoxine-pyrimethamine (SP) treatment increases the rate of gametocyte carriage and selects SP resistance-conferring mutations in Plasmodium falciparum dihydrofolate reductase (DHFR) and dihydropteroate synthase (DHPS), raising concerns of increased malaria transmission and spread of drug resistance. In a setting in Mali where SP was highly efficacious, we measured the prevalence of DHFR and DHPS mutations in P. falciparum infections with microscopy-detected gametocytes following SP treatment, and used direct feeding to assess infectivity to Anopheles gambiae sensu lato. Children and young adults presenting with uncomplicated malaria were treated with SP or chloroquine and followed for 28 days. Gametocyte carriage peaked at 67% 1 week after treatment with a single dose of SP. Those post-SP gametocytes carried significantly more DHFR and DHPS mutations than pre-treatment asexual parasites from the same population. Only 0.5% of 1728 mosquitoes fed on SP-treated gametocyte carriers developed oocysts, while 11% of 198 mosquitoes fed on chloroquine-treated gametocyte carriers were positive for oocysts. This study shows that in an area of high SP efficacy, although SP treatment sharply increased gametocyte carriage, the infectiousness of these gametocytes to the vector may be very low. Accurate and robust methods for measuring infectivity are needed to guide malaria control interventions that affect transmission.
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Affiliation(s)
- Abdoul H. Beavogui
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
- Malaria Research Unit, EA 4170, University Lyon 1, Faculty of Medicine, 8 Avenue Rockefeller, 69373 Lyon, France
| | - Abdoulaye A. Djimde
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Aric Gregson
- Howard Hughes Medical Institute, Center for Vaccine Development, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, USA
| | - Abdoulaye M. Toure
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Adama Dao
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Boubacar Coulibaly
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Dinkorma Ouologuem
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Bakary Fofana
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Adama Sacko
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Mamadou Tekete
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Aminatou Kone
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Oumou Niare
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Mamadou Wele
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
| | - Christopher V. Plowe
- Howard Hughes Medical Institute, Center for Vaccine Development, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, USA
| | - Stephane Picot
- Malaria Research Unit, EA 4170, University Lyon 1, Faculty of Medicine, 8 Avenue Rockefeller, 69373 Lyon, France
| | - Ogobara K. Doumbo
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
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Kone A, van de Vegte-Bolmer M, Siebelink-Stoter R, van Gemert GJ, Dara A, Niangaly H, Luty A, Doumbo OK, Sauerwein R, Djimde AA. Sulfadoxine-pyrimethamine impairs Plasmodium falciparum gametocyte infectivity and Anopheles mosquito survival. Int J Parasitol 2010; 40:1221-8. [PMID: 20515695 DOI: 10.1016/j.ijpara.2010.05.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 05/19/2010] [Accepted: 05/20/2010] [Indexed: 11/26/2022]
Abstract
Sulfadoxine-pyrimethamine (SP) is currently the drug of choice for intermittent preventive treatment of Plasmodium falciparum both in pregnancy and infancy. A prolonged parasite clearance time conferred by dhfr and dhps mutations is believed to be responsible for increased gametocyte prevalence in SP treated individuals. However, using a direct feeding assay in Mali, we showed that gametocytes present in peripheral venous blood post-SP treatment had reduced infectivity for Anopheles gambiae sensu stricto (ss) mosquitoes. We investigated the potential mechanisms involved in the dhfr and dhps quintuple mutant NF-135 and the single dhps 437 mutant NF-54. Concentrations of sulfadoxine (S) and pyrimethamine (P) equivalent to the serum levels of the respective drugs on day 3 (S=61 microg/ml, P=154.7 ng/ml) day 7 (S=33.8 microg/ml, P=66.6 ng/ml) and day 14 (S=14.2 microg/ml, P=15.7 ng/ml) post-SP treatment were used to study the effect on gametocytogenesis, gametocyte maturation and infectivity to Anopheles stephensi mosquitoes fed through an artificial membrane. The drugs readily induced gametocytogenesis in the mutant NF-135 strain but effectively killed the wild-type NF-54. However, both drugs impaired gametocyte maturation yielding odd-shaped non-exflagellating mature gametocytes. The concomitant ingestion of both S and P together with gametocytemic blood-meal significantly reduced the prevalence of oocyst positivity as well as oocyst density when compared to controls (P<0.001). In addition, day 3 concentrations of SP decreased mosquito survival by up to 65% (P<0.001). This study demonstrates that SP is deleterious in vitro for gametocyte infectivity as well as mosquito survival.
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Affiliation(s)
- Aminatou Kone
- Malaria Research and Training Center (MRTC), Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, P.O. Box 1805, Point G, Bamako, Mali
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Danquah I, Coulibaly B, Meissner P, Petruschke I, Müller O, Mockenhaupt FP. Selection of pfmdr1 and pfcrt alleles in amodiaquine treatment failure in north-western Burkina Faso. Acta Trop 2010; 114:63-6. [PMID: 20060374 DOI: 10.1016/j.actatropica.2009.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 12/07/2009] [Accepted: 12/29/2009] [Indexed: 11/28/2022]
Abstract
In 111 children under five years of age and with uncomplicated malaria in Nouna, north-western Burkina Faso, amodiaquine treatment failed in 75% (after PCR-based exclusion of new infections, 32%). In these, we assessed the role of Plasmodium falciparum pfmdr1 and pfcrt polymorphisms in amodiaquine resistance. Except for pfmdr1 1246Y (prevalence, 5%), no P. falciparum allele predicted treatment outcome. Pfcrt 76T as well as pfmdr1 86Y, 86Y-184F-1246D, and 86Y-184Y-1246Y were positively selected in treatment failures, and pfmdr1 86N-184F-1246D negatively. The weak association of pfmdr1/pfcrt alleles with amodiaquine treatment outcome suggests further factors to be involved in the unsatisfactory low efficacy of the drug and limits the usefulness of these markers in this area.
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Affiliation(s)
- Ina Danquah
- Institute of Tropical Medicine and International Health, Charité - University Medical School Berlin, Spandauer Damm 130, 14050 Berlin, Germany
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Dicko A, Sagara I, Djimdé AA, Touré SO, Traore M, Dama S, Diallo AI, Barry A, Dicko M, Coulibaly OM, Rogier C, de Sousa A, Doumbo OK. Molecular markers of resistance to sulphadoxine-pyrimethamine one year after implementation of intermittent preventive treatment of malaria in infants in Mali. Malar J 2010; 9:9. [PMID: 20064223 PMCID: PMC2820043 DOI: 10.1186/1475-2875-9-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 01/10/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment in infants (IPTi) with sulphadoxine-pyrimethamine (SP) given during routine vaccinations is efficacious in preventing malaria disease and shows no interaction with the vaccines. However, there is a fear that IPTi may result in a rapid increase of parasite resistance to SP. METHODS To evaluate the impact of IPTi on SP-resistance point mutations, the 22 health sub-districts in the district of Kolokani, Mali, were randomized in a 1:1 ratio and starting in December 2006, IPTi with SP was implemented in 11 health sub-districts (intervention zone), while the other 11 health sub-districts served as the control (non-intervention zone). Blood smears and blood dots on filter paper were obtained from children aged 0-5 years, randomly selected in each of heath sub-districts during two cross-sectional surveys. The first survey was conducted in May 2007 before the start of the transmission season to collect baseline prevalence of the molecular markers of resistance to SP and the second in December 2007 after the end of the transmission season and one year after implementation of IPTi. A total of 427 and 923 randomly selected blood samples from the first and second surveys respectively were analysed by PCR for dhfr and dhps mutations. RESULTS Each of the three dhfr mutations at codons 51, 59 and 108 was present in 35% and 57% of the samples during the two surveys with no significant differences between the two zones. Dhps mutations at codons 437 and 540 were present respectively in about 20% and 1% of the children during the two surveys in both zones at similar proportion. The prevalence of quadruple mutants (triple dhfr-mutants + dhps-437G) associated with in-vivo resistance to SP in Mali after one year implementation of IPTi was also similar between the two zones (11.6% versus 11.2%, p = 0.90) and to those obtained at baseline survey (10.3% versus 8.1%). CONCLUSION This study shows no increase in the frequency of molecular markers of SP resistance in areas where IPTi with SP was implemented for one year.
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Affiliation(s)
- Alassane Dicko
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine Pharmacy and Dentistry, University of Bamako, PO Box 1805 Bamako, Mali.
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Djimde AA, Barger B, Kone A, Beavogui AH, Tekete M, Fofana B, Dara A, Maiga H, Dembele D, Toure S, Dama S, Ouologuem D, Sangare CPO, Dolo A, Sogoba N, Nimaga K, Kone Y, Doumbo OK. A molecular map of chloroquine resistance in Mali. ACTA ACUST UNITED AC 2009; 58:113-8. [PMID: 20041947 DOI: 10.1111/j.1574-695x.2009.00641.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Plasmodium falciparum chloroquine resistance (CQR) transporter point mutation (PfCRT 76T) is known to be the key determinant of CQR. Molecular detection of PfCRT 76T in field samples may be used for the surveillance of CQR in malaria-endemic countries. The genotype-resistance index (GRI), which is obtained as the ratio of the prevalence of PfCRT 76T to the incidence of CQR in a clinical trial, was proposed as a simple and practical molecular-based addition to the tools currently available for monitoring CQR in the field. In order to validate the GRI model across populations, time, and resistance patterns, we compiled data from the literature and generated new data from 12 sites across Mali. We found a mean PfCRT 76T mutation prevalence of 84.5% (range 60.9-95.1%) across all sites. CQR rates predicted from the GRI model were extrapolated onto a map of Mali to show the patterns of resistance throughout the participating regions. We present a comprehensive map of CQR in Mali, which strongly supports recent changes in drug policy away from chloroquine.
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Affiliation(s)
- Abdoulaye A Djimde
- Department of Epidemiology of Parasitic Diseases, Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, Mali, West Africa.
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