1
|
Milong Melong CS, Peloewetse E, Russo G, Tamgue O, Tchoumbougnang F, Paganotti GM. An overview of artemisinin-resistant malaria and associated Pfk13 gene mutations in Central Africa. Parasitol Res 2024; 123:277. [PMID: 39023630 DOI: 10.1007/s00436-024-08301-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024]
Abstract
Malaria caused by Plasmodium falciparum is one of the deadliest and most common tropical infectious diseases. However, the emergence of artemisinin drug resistance associated with the parasite's Pfk13 gene, threatens the public health of individual countries as well as current efforts to reduce malaria burdens globally. It is of concern that artemisinin-resistant parasites may be selected or have already emerged in Africa. This narrative review aims to evaluate the published evidence concerning validated, candidate, and novel Pfk13 polymorphisms in ten Central African countries. Results show that four validated non-synonymous polymorphisms (M476I, R539T, P553L, and P574L), directly associated with a delayed therapy response, have been reported in the region. Also, two Pfk13 polymorphisms associated to artemisinin resistance but not validated (C469F and P527H) have been reported. Furthermore, several non-validated mutations have been observed in Central Africa, and one allele A578S, is commonly found in different countries, although additional molecular and biochemical studies are needed to investigate whether those mutations alter artemisinin effects. This information is discussed in the context of biochemical and genetic aspects of Pfk13, and related to the regional malaria epidemiology of Central African countries.
Collapse
Affiliation(s)
- Charlotte Sabine Milong Melong
- Department of Biochemistry, Faculty of Sciences, University of Douala, P.O. Box 24157, Douala, Cameroon
- Botswana-University of Pennsylvania Partnership, P.O. Box 45498, Gaborone, Riverwalk, Botswana
| | - Elias Peloewetse
- Department of Biological Sciences, Faculty of Sciences, University of Botswana, Private Bag, 0022, Gaborone, UB, Botswana
| | - Gianluca Russo
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, Sapienza University of Rome, P.Le Aldo Moro 5, 00185, Rome, Italy
| | - Ousman Tamgue
- Department of Biochemistry, Faculty of Sciences, University of Douala, P.O. Box 24157, Douala, Cameroon
| | - Francois Tchoumbougnang
- Department of Processing and Quality Control of Aquatic Products, Institute of Fisheries and Aquatic Sciences, University of Douala, P.O. Box 7236, Douala, Cameroon
| | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, P.O. Box 45498, Gaborone, Riverwalk, Botswana.
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| |
Collapse
|
2
|
Sima-Biyang YV, Ontoua SS, Longo-Pendy NM, Mbou-Boutambe C, Makouloutou-Nzassi P, Moussadji CK, Lekana-Douki JB, Boundenga L. Epidemiology of malaria in Gabon: A systematic review and meta-analysis from 1980 to 2023. J Infect Public Health 2024; 17:102459. [PMID: 38870682 DOI: 10.1016/j.jiph.2024.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024] Open
Abstract
The objective of this were conducted to elucidate spatiotemporal variations in malaria epidemiology in Gabon since 1980. For that, five databases, were used to collect and identify all studies published between 1980 and 2023 on malaria prevalence, antimalarial drug resistance, markers of antimalarial drug resistance and insecticide resistance marker. The findings suggest that Gabon continues to face malaria as an urgent public health problem, with persistently high prevalence rates. Markers of resistance to CQ persist despite its withdrawal, and markers of resistance to SP have emerged with a high frequency, reaching 100 %, while ACTs remain effective. Also, recent studies have identified markers of resistance to the insecticides Kdr-w and Kdr-e at frequencies ranging from 25 % to 100 %. Ace1R mutation was reported with a frequency of 0.4 %. In conclusion, the efficacy of ACTs remains above the threshold recommended by the WHO. Organo-phosphates and carbamates could provide an alternative for vector control.
Collapse
Affiliation(s)
- Yann Vital Sima-Biyang
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Central African Regional Doctoral School in Tropical Infectiology (EDR), BP 876 Franceville, Gabon
| | - Steede Seinnat Ontoua
- Central African Regional Doctoral School in Tropical Infectiology (EDR), BP 876 Franceville, Gabon; Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon
| | - Neil Michel Longo-Pendy
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon
| | - Clark Mbou-Boutambe
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Central African Regional Doctoral School in Tropical Infectiology (EDR), BP 876 Franceville, Gabon
| | - Patrice Makouloutou-Nzassi
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Department of Animal Biology and Ecology, Tropical Ecology Research Institute (IRET/CENAREST), Libreville BP 13354, Gabon
| | - Cyr Kinga Moussadji
- Primatology Center, Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon
| | - Jean-Bernard Lekana-Douki
- Unit of Evolution, Epidemiology and Parasite Resistance (UNEEREP), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Department of Parasitology-Mycology-Tropical Medicine, University of Health Sciences, Faculty of Medicine, BP 4009 Libreville, Gabon
| | - Larson Boundenga
- Unit of Research in Ecology of Health (URES), Franceville Interdisciplinary Center for Medical Research (CIRMF), BP 769 Franceville, Gabon; Department of Anthropology, Durham University, South Road, Durham DH1 3LE, UK.
| |
Collapse
|
3
|
Wamae K, Ndwiga L, Kharabora O, Kimenyi K, Osoti V, de Laurent Z, Wambua J, Musyoki J, Ngetsa C, Kalume P, Mwambingu G, Hamaluba M, van der Pluijm R, Dondorp AM, Bailey J, Juliano J, Bejon P, Ochola-Oyier L. Targeted amplicon deep sequencing of ama1 and mdr1 to track within-host P. falciparum diversity throughout treatment in a clinical drug trial. Wellcome Open Res 2024; 7:95. [PMID: 37456906 PMCID: PMC10349275 DOI: 10.12688/wellcomeopenres.17736.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 07/20/2023] Open
Abstract
Introduction Antimalarial therapeutic efficacy studies are routinely conducted in malaria-endemic countries to assess the effectiveness of antimalarial treatment strategies. Targeted amplicon sequencing (AmpSeq) uniquely identifies and quantifies genetically distinct parasites within an infection. In this study, AmpSeq of Plasmodium falciparum apical membrane antigen 1 ( ama1), and multidrug resistance gene 1 ( mdr1), were used to characterise the complexity of infection (COI) and drug-resistance genotypes, respectively. Methods P. falciparum-positive samples were obtained from a triple artemisinin combination therapy clinical trial conducted in 30 children under 13 years of age between 2018 and 2019 in Kilifi, Kenya. Nine of the 30 participants presented with recurrent parasitemia from day 26 (624h) onwards. The ama1 and mdr1 genes were amplified and sequenced, while msp1, msp2 and glurp data were obtained from the original clinical study. Results The COI was comparable between ama1 and msp1, msp2 and glurp; overall, ama1 detected more microhaplotypes. Based on ama1, a stable number of microhaplotypes were detected throughout treatment until day 3. Additionally, a recrudescent infection was identified with an ama1 microhaplotype initially observed at 30h and later in an unscheduled follow-up visit. Using the relative frequencies of ama1 microhaplotypes and parasitemia, we identified a fast (<1h) and slow (>5h) clearing microhaplotype. As expected, only two mdr1 microhaplotypes (NF and NY) were identified based on the combination of amino acid polymorphisms at codons 86 and 184. Conclusions This study highlights AmpSeq as a tool for highly-resolution tracking of parasite microhaplotypes throughout treatment and can detect variation in microhaplotype clearance estimates. AmpSeq can also identify slow-clearing microhaplotypes, a potential early sign of selection during treatment. Consequently, AmpSeq has the capability of improving the discriminatory power to distinguish recrudescences from reinfections accurately.
Collapse
Affiliation(s)
- Kevin Wamae
- Bioscience, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Leonard Ndwiga
- Bioscience, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Oksana Kharabora
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27599, USA
| | - Kelvin Kimenyi
- Bioscience, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Victor Osoti
- Bioscience, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Juliana Wambua
- Bioscience, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Jennifer Musyoki
- Bioscience, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Caroline Ngetsa
- Bioscience, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Peter Kalume
- Bioscience, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Mainga Hamaluba
- Bioscience, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rob van der Pluijm
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Arjen M. Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jeffrey Bailey
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Jonathan Juliano
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27599, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip Bejon
- Bioscience, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | |
Collapse
|
4
|
Pembet Singana B, Casimiro PN, Matondo Diassivi B, Kobawila SC, Youndouka JM, Basco LK, Ringwald P, Briolant S, Ndounga M. Prevalence of malaria among febrile patients and assessment of efficacy of artemether-lumefantrine and artesunate-amodiaquine for uncomplicated malaria in Dolisie, Republic of the Congo. Malar J 2022; 21:137. [PMID: 35501861 PMCID: PMC9063077 DOI: 10.1186/s12936-022-04143-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/28/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In the Republic of the Congo, malaria represents a major public health problem affecting all age groups. A regular surveillance of the current efficacy of first-line anti-malarial drugs is required in the face of possible emergence and spread of artemisinin-resistant Plasmodium falciparum strains in Africa. The purpose of this study was to determine the prevalence of malaria among febrile patients of all ages and assess the efficacy of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) in Congolese children. METHODS Febrile patients of all ages were initially screened for malaria by both rapid diagnostic test (RDT) and microscopy. Patients less than 12 years of age, with parasitaemia ≥ 1000 asexual parasites of P. falciparum/µL of blood, without any signs of severity, were enrolled in a therapeutic efficacy study and treated after obtaining their parents' (or legal guardian's) informed consent in two health centres in Dolisie. The patients were followed for 28 days in accordance with the 2009 World Health Organization standard protocol. If parasitaemia reappeared on or after day 7, the genetic profiles (genes expressing merozoite surface protein-1 [msp1], merozoite surface protein-2 [msp2], and glutamine-rich protein [glurp]) of pre-treatment and post-treatment isolates were compared by nested polymerase chain reaction (PCR) followed by capillary electrophoresis to make a distinction between recrudescence and re-infection. The clinical and parasitological outcome was analysed by the per-protocol method and Kaplan-Meier survival curves. RESULTS A total of 994 febrile patients of all ages were screened by RDT and microscopy. Of 994 patients, 323 (32.5%) presented a positive RDT, and 266 (26.8%) were microscopy-positive. Based on microscopy as the reference diagnostic method, the sensitivity and the specificity of the RDT were 98.9 and 91.8%, respectively. The Cohen's kappa coefficient was 0.86. A total of 121 children aged less than 12 years (61 in AL treatment group and 60 in ASAQ treatment group) were included in therapeutic efficacy study. Before PCR correction, the proportions of adequate clinical and parasitological response were 96.6% for AL and 86.0% for ASAQ in the per-protocol population (P < 0.05). The PCR-corrected efficacy rates were 98.2% and 94.2% for AL and ASAQ, respectively (P > 0.05). Both treatments were well tolerated. CONCLUSIONS AL and ASAQ remain highly effective for the first-line treatment of uncomplicated P. falciparum malaria in Dolisie. Despite high efficacy of first- and second-line treatment, there is a continuing need to scale up effective malaria preventive interventions and vector control strategies in the country. TRIAL REGISTRATION NUMBER ACTRN12616001422415.
Collapse
Affiliation(s)
- Brice Pembet Singana
- grid.442828.00000 0001 0943 7362Faculté des Sciences et Techniques, Université Marien Ngouabi, BP 69 Brazzaville, Republic of the Congo
| | - Prisca Nadine Casimiro
- Institut National de Recherche en Sciences de la Santé, Brazzaville, Republic of the Congo
| | | | - Simon Charles Kobawila
- grid.442828.00000 0001 0943 7362Faculté des Sciences et Techniques, Université Marien Ngouabi, BP 69 Brazzaville, Republic of the Congo
| | - Jean-Mermoz Youndouka
- Programme National de Lutte Contre le Paludisme, Direction Générale de l’Epidémiologie de la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Leonardo K. Basco
- Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France ,grid.483853.10000 0004 0519 5986IHU-Méditerranée Infection, Marseille, France
| | - Pascal Ringwald
- grid.3575.40000000121633745Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Sébastien Briolant
- Aix Marseille Univ., IRD, AP-HM, SSA, VITROME, Marseille, France ,grid.483853.10000 0004 0519 5986IHU-Méditerranée Infection, Marseille, France ,grid.418221.cUnité de Parasitologie Entomologie, Département de Microbiologie et Maladies Infectieuses, Institut de Recherche Biomédicale des Armées, Marseille, France
| | - Mathieu Ndounga
- Programme National de Lutte Contre le Paludisme, Direction Générale de l’Epidémiologie de la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| |
Collapse
|
5
|
Koko VS, Warsame M, Vonhm B, Jeuronlon MK, Menard D, Ma L, Taweh F, Tehmeh L, Nyansaiye P, Pratt OJ, Parwon S, Kamara P, Asinya M, Kollie A, Ringwald P. Artesunate-amodiaquine and artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in Liberia: in vivo efficacy and frequency of molecular markers. Malar J 2022; 21:134. [PMID: 35477399 PMCID: PMC9044686 DOI: 10.1186/s12936-022-04140-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background Artesunate–amodiaquine (ASAQ) and Artemether–lumefantrine (AL) are the recommended treatment for uncomplicated Plasmodium falciparum malaria in Liberia. Intermittent preventive treatment with sulfadoxine/pyrimethamine is also recommended for pregnant women. The therapeutic efficacy of Artesunate–amodiaquine and Artemether–lumefantrine, and the frequency of molecular markers associated with anti-malarial drug resistance were investigated. Methods The therapeutic efficacy of ASAQ and AL was evaluated using the standard World Health Organization protocol (WHO. Methods for Surveillance of Antimalarial Drug Efficacy. Geneva: World Health Organization; 2009. https://www.who.int/malaria/publications/atoz/9789241597531/en/). Eligible children were recruited and monitored clinically and parasitologically for 28 days. Polymorphisms in the Pfkelch 13, chloroquine resistance transporter (Pfcrt), multidrug resistance 1 (Pfmdr-1), dihydrofolate reductase (Pfdhfr), and dihydropteroate synthase (Pfdhps) genes and copy number variations in the plasmepsin-2 (Pfpm2) gene were assessed in pretreatment samples. Results Of the 359 children enrolled, 180 were treated with ASAQ (89 in Saclepea and 91 in Bensonville) and 179 with AL (90 in Sinje and 89 in Kakata). Of the recruited children, 332 (92.5%) reached study endpoints. PCR-corrected per-protocol analysis showed ACPR of 90.2% (95% CI: 78.6–96.7%) in Bensonville and 92.7% (95% CI: 83.4.8–96.5%) in Saclepea for ASAQ, while ACPR of 100% was observed in Kakata and Sinje for AL. In both treatment groups, only two patients had parasites on day 3. No artemisinin resistance associated Pfkelch13 mutations or multiple copies of Pfpm2 were found. Most samples tested had the Pfcrt 76 T mutation (80/91, 87.9%), while the Pfmdr-1 86Y (40/91, 44%) and 184F (47/91, 51.6%) mutations were less frequent. The Pfdhfr triple mutant (51I/59R/108 N) was the predominant allele (49.2%). For the Pfdhps gene, it was the 540E mutant (16.0%), and the 436A mutant (14.3%). The quintuple allele (51I/59R/108 N-437G/540E) was detected in only one isolate (1/357). Conclusion This study reports a decline in the efficacy of ASAQ treatment, while AL remained highly effective, supporting the recent decision by NMCP to replace ASAQ with AL as first-line treatment for uncomplicated falciparum malaria. No association between the presence of the mutations in Pfcrt and Pfmdr-1 and the risk of parasite recrudescence in patients treated with ASAQ was observed. Parasites with signatures known to be associated with artemisinin and piperaquine resistance were not detected. The very low frequency of the quintuple Pfdhfr/Pfdhps mutant haplotype supports the continued use of SP for IPTp. Monitoring of efficacy and resistance markers of routinely used anti-malarials is necessary to inform malaria treatment policy. Trial registration ACTRN12617001064392. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04140-7.
Collapse
Affiliation(s)
- Victor S Koko
- National Malaria Control Programme, Ministry of Health, Monrovia, Liberia.
| | - Marian Warsame
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Benjamin Vonhm
- National Public Health Institute of Liberia-NPHIL, Monrovia, Liberia
| | | | - Didier Menard
- Malaria Genetics and Resistance Unit, INSERM U1201, Institut Pasteur, Paris, France.,Laboratoire de Parasitologie et Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Parasitologie et Pathologie Tropicale, UR7292 Dynamique des Interactions Hôte Pathogène, Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
| | - Laurence Ma
- Biomics Platform, C2RT, Institut Pasteur, Paris, France
| | - Fahn Taweh
- National Public Health Institute of Liberia-NPHIL, Monrovia, Liberia
| | - Lekilay Tehmeh
- Quality Control Unit, Ministry of Health, Monrovia, Liberia
| | - Paye Nyansaiye
- National Malaria Control Programme, Ministry of Health, Monrovia, Liberia
| | - Oliver J Pratt
- National Malaria Control Programme, Ministry of Health, Monrovia, Liberia
| | - Sei Parwon
- Saclepea Comprehensive Health Center, Saclepea, Ministry of Health, Saclepea, Liberia
| | - Patrick Kamara
- Sinje Health Centre, Garwula, Ministery of Health, Garwula, Liberia
| | - Magnus Asinya
- Charles Henry Rennie Hospital, Kakata, Ministry of Health, Kakata, Liberia
| | - Aaron Kollie
- Bensonville Hospital, Bensonville, Ministry of Health, Bensonville, Liberia
| | - Pascal Ringwald
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| |
Collapse
|
6
|
Marwa K, Kapesa A, Baraka V, Konje E, Kidenya B, Mukonzo J, Kamugisha E, Swedberg G. Therapeutic efficacy of artemether-lumefantrine, artesunate-amodiaquine and dihydroartemisinin-piperaquine in the treatment of uncomplicated Plasmodium falciparum malaria in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2022; 17:e0264339. [PMID: 35271592 PMCID: PMC8912261 DOI: 10.1371/journal.pone.0264339] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Sub-Saharan Africa has the highest burden of malaria in the world. Artemisinin-based combination therapies (ACTs) have been the cornerstone in the efforts to reduce the global burden of malaria. In the effort to facilitate early detection of resistance for artemisinin derivatives and partner drugs, WHO recommends monitoring of ACT’s efficacy in the malaria endemic countries. The present systematic meta-analysis study summarises the evidence of therapeutic efficacy of the commonly used artemisinin-based combinations for the treatment of uncomplicated P. falciparum malaria in Sub-Saharan Africa after more than a decade since the introduction of the drugs. Methods Fifty two studies carried out from 2010 to 2020 on the efficacy of artemether-lumefantrine or dihydro-artemisinin piperaquine or artesunate amodiaquine in patients with uncomplicated P. falciparum malaria in Sub-Saharan Africa were searched for using the Google Scholar, Cochrane Central Register of controlled trials (CENTRAL), PubMed, Medline, LILACS, and EMBASE online data bases. Data was extracted by two independent reviewers. Random analysis effect was performed in STATA 13. Heterogeneity was established using I2 statistics. Results Based on per protocol analysis, unadjusted cure rates in malaria infected patients treated with artemether-lumefantrine (ALU), artesunate-amodiaquine (ASAQ) and dihydroartemisinin-piperaquine (DHP) were 89%, 94% and 91% respectively. However, the cure rates after PCR correction were 98% for ALU, 99% for ASAQ and 99% for DHP. Conclusion The present meta-analysis reports the overall high malaria treatment success for artemether-lumefantrine, artesunate-amodiaquine and dihydroartemisinin-piperaquine above the WHO threshold value in Sub-Saharan Africa.
Collapse
Affiliation(s)
- Karol Marwa
- Department of Pharmacology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- * E-mail: ,
| | - Anthony Kapesa
- Department of Community Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Vito Baraka
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Evelyne Konje
- Department of Epidemiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson Kidenya
- Department of Biochemistry, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Jackson Mukonzo
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda
| | - Erasmus Kamugisha
- Department of Biochemistry, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Gote Swedberg
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
7
|
Wamae K, Ndwiga L, Kharabora O, Kimenyi K, Osoti V, de Laurent Z, Wambua J, Musyoki J, Ngetsa C, Kalume P, Mwambingu G, Hamaluba M, van der Pluijm R, Dondorp A, Bailey J, Juliano J, Bejon P, Ochola-Oyier L. Targeted Amplicon deep sequencing of ama1 and mdr1 to track within-host P. falciparum diversity throughout treatment in a clinical drug trial. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17736.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antimalarial therapeutic efficacy studies are routinely conducted in malaria-endemic countries to assess the effectiveness of antimalarial treatment strategies. Targeted amplicon deep sequencing (TADS) uniquely identifies and quantifies genetically distinct parasites within an infection. In this study, TADS Plasmodium falciparum apical membrane antigen 1 (ama1), and multidrug resistance gene 1 (mdr1), were used to characterize the complexity of infection (COI) and drug-resistance genotypes, respectively. P. falciparum positive samples were obtained from a triple artemisinin combination therapy clinical trial conducted in 30 children under 13 years of age between 2018 and 2019 in Kilifi, Kenya. Of the 30 participants, 9 presented with recurrent parasitemia from day 26 (624h) onwards. The ama1 and mdr1 genes were amplified and sequenced, while msp1, msp2 and glurp data were obtained from the original clinical study. The COI was comparable between ama1 and msp1, msp2 and glurp, however, overall ama1 detected more haplotypes. Based on ama1, a stable number of haplotypes were detected throughout treatment up until day 3. Additionally, a recrudescent infection was identified with an ama1 haplotype initially observed at 30h and later in an unscheduled follow-up visit. Using the relative frequencies of ama1 haplotypes and parasitaemia, we identified a fast (<1h) and slow (>5h) clearing haplotype. As expected, only two mdr1 haplotypes (NF and NY) were identified based on the combination of amino acid polymorphisms at codons 86 and 184. This study highlights TADS as a sensitive tool for tracking parasite haplotypes throughout treatment and can detect variation in haplotype clearance estimates. TADS can also identify slow clearing haplotypes, a potential early sign of selection during treatment. Consequently, TADS has the capability of improving the discriminatory power to accurately distinguish recrudescences from reinfections.
Collapse
|
8
|
Drug associations as alternative and complementary therapy for neglected tropical diseases. Acta Trop 2022; 225:106210. [PMID: 34687644 DOI: 10.1016/j.actatropica.2021.106210] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/02/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022]
Abstract
The present paper aims to establish different treatments for neglected tropical disease by a survey on drug conjugations and possible fixed-dose combinations (FDC) used to obtain alternative, safer and more effective treatments. The source databases used were Science Direct and PubMed/Medline, in the intervals between 2015 and 2021 with the drugs key-words or diseases, like "schistosomiasis", "praziquantel", "malaria", "artesunate", "Chagas' disease", "benznidazole", "filariasis", diethylcarbamazine", "ivermectin", " albendazole". 118 works were the object of intense analysis, other articles and documents were used to increase the quality of the studies, such as consensuses for harmonizing therapeutics and historical articles. As a result, an effective NTD control can be achieved when different public health approaches are combined with interventions guided by the epidemiology of each location and the availability of appropriate measures to detect, prevent and control disease. It was also possible to verify that the FDCs promote a simplification of the therapeutic regimen, which promotes better patient compliance and enables a reduction in the development of parasitic resistance, requiring further studies aimed at resistant strains, since the combined APIs usually act by different mechanisms or at different target sites. In addition to eliminating the process of developing a new drug based on the identification and validation of active compounds, which is a complex, long process and requires a strong long-term investment, other advantages that FDCs have are related to productive gain and gain from the industrial plant, which can favor and encourage the R&D of new FDCs not only for NTDs but also for other diseases that require the use of more than one drug.
Collapse
|
9
|
Koehne E, Adegnika AA, Held J, Kreidenweiss A. Pharmacotherapy for artemisinin-resistant malaria. Expert Opin Pharmacother 2021; 22:2483-2493. [PMID: 34311639 DOI: 10.1080/14656566.2021.1959913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Malaria, the most devastating parasitic disease, is currently treated with artemisinin-based combination therapies (ACTs). Unfortunately, some ACTs are unable to rapidly clear Plasmodium falciparum parasites from the blood stream and are failing to cure malaria patients; a problem, so far, largely confined to Southeast Asia. There is a fear of resistant Plasmodium falciparum emerging in other parts of the world including Sub-Saharan Africa. Strategies for alternative treatments, ideally non-artemisinin based, are needed. AREAS COVERED This narrative review gives an overview of approved antimalarials and of some compounds in advanced drug development that could be used when an ACT is failing. The selection was based on a literature search in PubMed and WHO notes for malaria treatment. EXPERT OPINION The ACT drug class can still cure malaria in malaria endemic regions. However, the appropriate ACT drug should be chosen considering the background resistance of the partner drug of the local parasite population. Artesunate-pyronaridine, the 'newest' recommended ACT, and atovaquone-proguanil are, so far, effective, and safe treatments for uncomplicated falciparum malaria. Therefore, all available ACTs should be safeguarded from parasite resistance and the development of new antimalarial drug classes needs to be accelerated.
Collapse
Affiliation(s)
- Erik Koehne
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Ayola Akim Adegnika
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Jana Held
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| |
Collapse
|
10
|
Riloha Rivas M, Warsame M, Mbá Andeme R, Nsue Esidang S, Ncogo PR, Phiri WP, Oki Eburi C, Edú Maye CE, Menard D, Legrand E, Berzosa P, Garcia L, Lao Seoane AK, Ntabangana SC, Ringwald P. Therapeutic efficacy of artesunate-amodiaquine and artemether-lumefantrine and polymorphism in Plasmodium falciparum kelch13-propeller gene in Equatorial Guinea. Malar J 2021; 20:275. [PMID: 34158055 PMCID: PMC8220721 DOI: 10.1186/s12936-021-03807-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background Artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) are the currently recommended first- and second-line therapies for uncomplicated Plasmodium falciparum infections in Equatorial Guinea. This study was designed to evaluate the efficacy of these artemisinin-based combinations and detect mutations in P. falciparum kelch13-propeller domain gene (Pfkelch13). Methods A single-arm prospective study evaluating the efficacy of ASAQ and AL at three sites: Malabo, Bata and Ebebiyin was conducted between August 2017 and July 2018. Febrile children aged six months to 10 years with confirmed uncomplicated P. falciparum infection and other inclusion criteria were sequentially enrolled first in ASAQ and then in AL at each site, and followed up for 28 days. Clinical and parasitological parameters were assessed. The primary endpoint was PCR-adjusted adequate clinical and parasitological response (ACPR). Samples on day-0 were analysed for mutations in Pfkelch13 gene. Results A total 264 and 226 patients were enrolled in the ASAQ and AL treatment groups, respectively. Based on per-protocol analysis, PCR-adjusted cure rates of 98.6% to 100% and 92.4% to 100% were observed in patients treated with ASAQ and AL, respectively. All study children in both treatment groups were free of parasitaemia by day-3. Of the 476 samples with interpretable results, only three samples carried non-synonymous Pfkelch13 mutations (E433D and A578S), and none of them is the known markers associated with artemisinin resistance. Conclusion The study confirmed high efficacy of ASAQ and AL for the treatment of uncomplicated falciparum infections as well as the absence of delayed parasite clearance and Pfkelch13 mutations associated with artemisinin resistance. Continued monitoring of the efficacy of these artemisinin-based combinations, at least every two years, along with molecular markers associated with artemisinin and partner drug resistance is imperative to inform national malaria treatment policy and detect resistant parasites early. Trial registration ACTRN12617000456358, Registered 28 March 2017; http://www.anzctr.org.au/trial/MyTrial.aspx
Collapse
Affiliation(s)
- Matilde Riloha Rivas
- National Malaria Control Programme, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Marian Warsame
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Ramona Mbá Andeme
- National Malaria Control Programme, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Salomón Nsue Esidang
- National Malaria Control Programme, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | | | | | - Consuelo Oki Eburi
- National Malaria Control Programme, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Corona Eyang Edú Maye
- National Malaria Control Programme, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Didier Menard
- Malaria Genetics and Resistance Unit, INSERM U1201, Institut Pasteur, Paris, France
| | - Eric Legrand
- Malaria Genetics and Resistance Unit, INSERM U1201, Institut Pasteur, Paris, France
| | - Pedro Berzosa
- Malaria and NTDs Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| | - Luz Garcia
- Malaria and NTDs Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| | | | | | - Pascal Ringwald
- World Health Organization, Headquarters, Geneva, Switzerland
| |
Collapse
|
11
|
Ndwiga L, Kimenyi KM, Wamae K, Osoti V, Akinyi M, Omedo I, Ishengoma DS, Duah-Quashie N, Andagalu B, Ghansah A, Amambua-Ngwa A, Tukwasibwe S, Tessema SK, Karema C, Djimde AA, Dondorp AM, Raman J, Snow RW, Bejon P, Ochola-Oyier LI. A review of the frequencies of Plasmodium falciparum Kelch 13 artemisinin resistance mutations in Africa. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2021; 16:155-161. [PMID: 34146993 PMCID: PMC8219943 DOI: 10.1016/j.ijpddr.2021.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022]
Abstract
Artemisinin resistance (AR) emerged in South East Asia 13 years ago and the identification of the resistance conferring molecular marker, Plasmodium falciparum Kelch 13 (Pfk13), 7 years ago has provided an invaluable tool for monitoring AR in malaria endemic countries. Molecular Pfk13 surveillance revealed the resistance foci in the Greater Mekong Subregion, an independent emergence in Guyana, South America, and a low frequency of mutations in Africa. The recent identification of the R561H Pfk13 AR associated mutation in Tanzania, Uganda and in Rwanda, where it has been associated with delayed parasite clearance, should be a concern for the continent. In this review, we provide a summary of Pfk13 resistance associated propeller domain mutation frequencies across Africa from 2012 to 2020, to examine how many other countries have identified these mutations. Only four African countries reported a recent identification of the M476I, P553L, R561H, P574L, C580Y and A675V Pfk13 mutations at low frequencies and with no reports of clinical treatment failure, except for Rwanda. These mutations present a threat to malaria control across the continent, since the greatest burden of malaria remains in Africa. A rise in the frequency of these mutations and their spread would reverse the gains made in the reduction of malaria over the last 20 years, given the lack of new antimalarial treatments in the event artemisinin-based combination therapies fail. The review highlights the frequency of Pfk13 propeller domain mutations across Africa, providing an up-to-date perspective of Pfk13 mutations, and appeals for an urgent and concerted effort to monitoring antimalarial resistance markers in Africa and the efficacy of antimalarials by re-establishing sentinel surveillance systems.
Collapse
Affiliation(s)
- Leonard Ndwiga
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya
| | - Kelvin M Kimenyi
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya; Centre for Biotechnology and Bioinformatics, University of Nairobi, Nairobi, Kenya
| | - Kevin Wamae
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya
| | - Victor Osoti
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya
| | - Mercy Akinyi
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya; Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Irene Omedo
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya; Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Deus S Ishengoma
- National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Nancy Duah-Quashie
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ben Andagalu
- United States Army Medical Research Directorate-Africa, Kenya Medical Research Institute/Walter Reed Project, Kisumu, Kenya
| | - Anita Ghansah
- Department of Parasitology, Noguchi Memorial Institute for Medical Research (NMIMR), Accra, Ghana
| | | | | | | | - Corine Karema
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Quality and Equity Healthcare, Kigali, Rwanda
| | - Abdoulaye A Djimde
- Malaria Research and Training Centre, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jaishree Raman
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Disease, Sandringham, Gauteng, South Africa; Wits Research Institute for Malaria, Univerisity of Witwatersrand, Johannesburg, South Africa
| | - Robert W Snow
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Philip Bejon
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, 80108, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | |
Collapse
|
12
|
Nambei W, Biago U, Balizou O, Pounguinza S, Moyen M, Ndoua C, Gody J. [Monitoring the Efficacy of Artemether-Lumefantrine in the Treatment of Uncomplicated Plasmodium Falciparum Malaria by Kelch 13 Gene Mutations in Bangui, Central African Republic]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2021; 1:mtsibulletin.n1.2021.82. [PMID: 35586639 PMCID: PMC9022751 DOI: 10.48327/mtsibulletin.n1.2021.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/11/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Drug resistance remains a major challenge for the management of malaria. This study investigated the efficacy of antimalarial combination artemether-lumefantrine (AL) in the treatment of uncomplicated malaria in Bangui, Central African Republic. MATERIALS AND METHODS An evaluative cross-sectional study was conducted between the 15th February and the 7th March 2017 in the Complexe Pédiatrique in Bangui among children aged 6 months to 15 years. Clinical outcome was classified according to WHO criteria as adequate clinical and parasitological response (ACPR), late parasitologic failure (LPF), late clinical failure (LCF), and early treatment failure (ETF). The occurrence of mutations in the K 13 gene was studied by PCR-RFLP. RESULTS A total of 55 patients were included. After PCR correction, ACPR at D28 was 97.8% and LCF was 2.2%. Treatment failures were due to new infections. No mutations in the K-13 gene associated with artemisinin resistance were identified. All participants had wild type alleles. The decrease of anemia and fever was substantial. DISCUSSION AND CONCLUSION This study showed that AL remained efficacious and well-tolerated. However, all participants in Central African Republic had wild type alleles unlike contrary in Rwanda where a R561H mutation has been identified. A regular monitoring of efficacy and study of molecular markers of drug resistance to artemisinin is essential.
Collapse
Affiliation(s)
- W.S. Nambei
- Département des sciences biomédicales, Faculté des sciences de la santé, Université de Bangui, République centrafricaine
| | - U. Biago
- Complexe pédiatrique de Bangui, République centrafricaine
| | - O. Balizou
- Complexe pédiatrique de Bangui, République centrafricaine
| | - S. Pounguinza
- Laboratoire national de biologie clinique et de santé publique
| | - M. Moyen
- Service national de lutte contre le paludisme
| | - C. Ndoua
- Service national de lutte contre le paludisme
| | - J.C. Gody
- Complexe pédiatrique de Bangui, République centrafricaine
| |
Collapse
|
13
|
Dejon-Agobé JC, Adegnika AA, Grobusch MP. Haematological changes in Schistosoma haematobium infections in school children in Gabon. Infection 2021; 49:645-651. [PMID: 33486713 PMCID: PMC8316219 DOI: 10.1007/s15010-020-01575-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/30/2020] [Indexed: 01/03/2023]
Abstract
Background Schistosomiasis is a parasitic disease affecting the blood cell. As a chronic disease, schistosomiasis particularly impacts on the human host’s haematological profile. We assessed here the impact of urogenital schistosomiasis on the full blood counts (FBC) as proxy diagnostic tool for schistosomiasis. Methods A cross-sectional study was conducted among school children living in Lambaréné, Gabon. Schistosomiasis status was determined using urine filtration technique. EDTA blood samples were analysed using a Pentra ABX 60® analyzer. Results Compared to their infection-free counterparts, school children infected with Schistosoma haematobium displayed an altered FBC profile, with changes in all three blood cell lines. Adjusted for praziquantel intake, soil-transmitted helminthic infections and Plasmodium falciparum infection status, schistosomiasis was independently associated with a decreasing trend of mean haemoglobin (β = − 0.20 g/dL, p-value = 0.08) and hematocrit (β = − 0.61%, p-value = 0.06) levels, a lower mean MCV (β = − 1.50µm3, p-value = 0.02) and MCH (β = − 0.54 pg, p-value = 0.04), and higher platelet (β = 28.2 103/mm3, p-value = 0.002) and leukocyte (β = 1.13 103/mm3, p-value = 0.0003) counts, respectively. Conclusions Schistosomiasis is associated with a characteristic FBC profile of schoolchildren living in Lambaréné, indicating the necessity to consider schistosomiasis as a single cause of disease, or a co-morbidity, when interpreting FBC in endemic areas.
Collapse
Affiliation(s)
- Jean Claude Dejon-Agobé
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, BP 242, Lambaréné, Gabon.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Ayôla A Adegnika
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, BP 242, Lambaréné, Gabon.,Department of Parasitology, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands.,Institut Für Tropenmedizin, Eberhard Karls University Tübingen, 72074, Tübingen, Germany.,German Center for Infection Research, Partner Site Tübingen, 72074, Tübingen, Germany.,Fondation Pour la Recherche Scientifique, 72 BP 045, Cotonou, Benin
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, BP 242, Lambaréné, Gabon. .,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands. .,Institut Für Tropenmedizin, Eberhard Karls University Tübingen, 72074, Tübingen, Germany. .,Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone. .,Institute of Infectious Diseases and Molecular Medicine (IIDMM), Cape Town, Republic of South Africa.
| |
Collapse
|
14
|
Bilici M. Synthesis of a Novel Molecularly Imprinted Polymer for the Sensitive and Selective Determination of Artemisinin in Urine Samples Based on Solid-Phase Extraction (SPE) and Determination with High-Performance Liquid Chromatography (HPLC). ANAL LETT 2020. [DOI: 10.1080/00032719.2020.1795187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Mustafa Bilici
- Faculty of Medicine, Department of Basic Medical Sciences, Van Yuzuncu Yil University, Van, Turkey
- Faculty of Science, Department of Chemistry, Van Yuzuncu Yil University, Van, Turkey
| |
Collapse
|
15
|
Beavogui AH, Camara A, Delamou A, Diallo MS, Doumbouya A, Kourouma K, Bouedouno P, Guilavogui T, Dos Santos Souza S, Kelley J, Talundzic E, Fofana A, Plucinski MM. Efficacy and safety of artesunate-amodiaquine and artemether-lumefantrine and prevalence of molecular markers associated with resistance, Guinea: an open-label two-arm randomised controlled trial. Malar J 2020; 19:223. [PMID: 32580771 PMCID: PMC7315541 DOI: 10.1186/s12936-020-03290-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anti-malarial resistance is a threat to recent gains in malaria control. This study aimed to assess the efficacy and safety of artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) in the management of uncomplicated malaria and to measure the prevalence of molecular markers of resistance of Plasmodium falciparum in sentinel sites in Maferinyah and Labé Health Districts in Guinea in 2016. METHODS This was a two-arm randomised controlled trial of the efficacy of AL and ASAQ among children aged 6-59 months with uncomplicated Plasmodium falciparum malaria in two sites. Children were followed for 28 days to assess clinical and parasitological response. The primary outcome was the Kaplan-Meier estimate of Day 28 (D28) efficacy after correction by microsatellite-genotyping. Pre-treatment (D0) and day of failure samples were assayed for molecular markers of resistance in the pfk13 and pfmdr1 genes. RESULTS A total of 421 participants were included with 211 participants in the Maferinyah site and 210 in Labé. No early treatment failure was observed in any study arms. However, 22 (5.3%) participants developed a late treatment failure (8 in the ASAQ arm and 14 in the AL arm), which were further classified as 2 recrudescences and 20 reinfections. The Kaplan-Meier estimate of the corrected efficacy at D28 was 100% for both AL and ASAQ in Maferinyah site and 99% (95% Confidence Interval: 97.2-100%) for ASAQ and 99% (97.1-100%) for AL in Labé. The majority of successfully analysed D0 (98%, 380/389) and all day of failure (100%, 22/22) samples were wild type for pfk13. All 9 observed pfk13 mutations were polymorphisms not associated with artemisinin resistance. The NFD haplotype was the predominant haplotype in both D0 (197/362, 54%) and day of failure samples (11/18, 61%) successfully analysed for pfmdr1. CONCLUSION This study observed high efficacy and safety of both ASAQ and AL in Guinea, providing evidence for their continued use to treat uncomplicated malaria. Continued monitoring of ACT efficacy and safety and molecular makers of resistance in Guinea is important to detect emergence of parasite resistance and to inform evidence-based malaria treatment policies.
Collapse
Affiliation(s)
- Abdoul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea. .,Department of Medical Sciences, Gamal Abdel Nasser University, Conakry, Guinea. .,Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Gamal Abdel Nasser University, Conakry, Guinea.
| | - Alioune Camara
- Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Gamal Abdel Nasser University, Conakry, Guinea.,Department of Public Health, Gamal Abdel Nasser University, Conakry, Guinea.,National Malaria Control Programme, Conakry, Guinea
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Centre d'Excellence Africain pour la Prévention et le Contrôle des Maladies Transmissibles (CEA-PCMT), Gamal Abdel Nasser University, Conakry, Guinea.,Department of Public Health, Gamal Abdel Nasser University, Conakry, Guinea
| | - Mamadou Saliou Diallo
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Abdoulaye Doumbouya
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Karifa Kourouma
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Patrice Bouedouno
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | | | - Julia Kelley
- Atlanta Research and Education Foundation and Malaria Branch, Centers for Disease Control and Prevention, Atlanta, USA
| | - Eldin Talundzic
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Mateusz M Plucinski
- Malaria Branch and U.S. President's Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, USA
| |
Collapse
|