Antimalarial drug resistance molecular makers of Plasmodium falciparum isolates from Sudan during 2015-2017

BACKGROUND

Current malaria control and elimination strategies rely mainly on efficacious antimalarial drugs. However, drug resistance is a major threat facing malaria control programs. Determination of drug resistance molecular markers is useful in the monitoring and surveillance of malaria drug efficacy. This study aimed to determine the mutations and haplotypes frequencies of different genes linked with antimalarial drug resistance in certain areas in Sudan.

METHODS

A total of 226 dried blood spots (DBS) of microscopically diagnosed P. falciparum isolates were collected from Khartoum and three other areas in Sudan during 2015-2017. Plasmodium falciparum confirmation and multiplicity of infection was assessed using the Sanger's 101 SNPs-barcode and speciation was confirmed using regions of the parasite mitochondria. Molecular genotyping of drug resistance genes (Pfcrt, Pfmdr1, Pfdhfr, Pfdhps, exonuclease, Pfk13, parasite genetic background (PGB) (Pfarps10, ferredoxin, Pfcrt, Pfmdr2)) was also performed. All genotypes were generated by selective regions amplicon sequencing of the parasite genome using the Illumina MiSeq platform at the Wellcome Sanger Institute, UK then genotypes were translated into drug resistance haplotypes and species determination.

FINDINGS

In total 225 samples were confirmed to be P. falciparum. A higher proportion of multiplicity of infection was observed in Gezira (P<0.001) based on the Sanger 101 SNPs -barcode. The overall frequency of mutant haplotype Pfcrt 72-76 CVIET was 71.8%. For Pfmdr1, N86Y was detected in 53.6%, Y184F was observed in 88.1% and D1246Y was detected in 1.5% of the samples. The most frequently observed haplotype was YFD 47.4%. For Pfdhfr (codons 51, 59,108,164), the ICNI haplotype was the most frequent (80.7%) while for Pfdhps (codons 436, 437, 540, 581, 613) the (SGEAA) was most frequent haplotype (41%). The Quadruple mutation (dhfr N51I, S108N + dhps A437G, K540E) was the highest frequent combined mutation (33.9%). In Pfkelch13 gene, 18 non-synonymous mutations were detected, 7 of them were detected in other African countries. The most frequent Pfk13 mutation was E433D detected in four samples. All of the Pfk13 mutant alleles have not been reported to belong to mutations associated with delayed parasite clearance in Southeast Asia. PGB mutations were detected only in Pfcrt N326S\I (46.3%) and Pfcrt I356T (8.2%). The exonuclease mutation was not detected. There was no significant variation in mutant haplotypes between study areas.

CONCLUSIONS

There was high frequency of mutations in Pfcrt, Pfdhfr and Pfdhps in this study. These mutations are associated with chloroquine and sulfadoxine-pyrimethamine (SP) resistance. Many SNPs in Pfk13 not linked with delayed parasite clearance were observed. The exonuclease E415G mutation which is linked with piperaquine resistance was not reported.

Prevalence and infection pattern of Trypanosoma evansi in camels in mid-eastern Sudan

The antigen detection enzyme immunoassay (AgELISA) in conjunction with parasitological examination of blood were used to study the enzootic situation of cameline trypanosomiasis in mid-Eastern Sudan. A one year survey showed that the infection is endemic among pastoral camels with a prevalence of 5.4% based on parasitological examination and 31.3% based on AgELISA. The infection rate was higher during the dry period (November to May) than the wet season. Young camels had a much lower infection rate as detected by parasitological techniques, but not with AgELISA. A lower prevalence of infection was detected by buffy coat technique (BCT) in herds of camels raised by nomads compared with those kept by agropastoralists and in camels located in the southern districts of mid-Eastern Sudan.

An outbreak of cameline filariasis in the Sudan

Sheathed microfilariae (mean length 278 +/- 10 microns SEM; mean width 7.2 +/- 0.8 microns) were detected in the blood of 7/14 housed camels (Camelus dromedarius). Microfilaraemic camels of either sex were inappetent, lethargic, reluctant to move and exhibited weakness in the hind limbs; some remained in sternal recumbency. Cardiac disorders, orchitis and skin nodules were conspicuously absent. The microfilariae showed a biphasic pattern in the blood that peaked at 20:00 and plateaued between 04:00 and 06:00. Adult filarial worms were recovered from the mesenteric and femoral arteries. Marked clinical improvement within 1-2 weeks was seen in three camels treated at 10:00 with a single subcutaneous injection of 0.2 mg/kg of ivermectin. These camels became amicrofilaraemic 2-5 days after treatment and remained so for the length of the observation period (133 days). Treatment of two camels at the time of high microfilaraemia (06:30) resulted in adverse reaction and death.

Prevalence of Toxoplasma gondii antibodies in pastoral camels (Camelus dromedarius) in the Butana plains, mid-Eastern Sudan

A total of 482 serum samples from pastoral camels in the Butana plains, mid-Eastern Sudan, were tested for Toxoplasma antibodies by the latex agglutination test (LAT). Sixty-seven percent of the camels were seroreactive. The prevalence rate of seroreactivity increased significantly with age (P less than 0.01) and was highest among camels aged over 7 years (74.2%). The prevalence rate of seropositivity decreased proportionally with the level of serum dilution. At dilutions of 1:32 and above, the prevalence rate was 25.9%. There were no sex-linked differences in seroreactivity. This study suggests widespread infection with Toxoplasma gondii among pastoral camels, a finding that warrants a closer look into the possible ways infection is acquired by camels in their arid environment, its economic impact, as well as its public health significance, especially among the nomads who consume cameline milk and liver raw.

The efficacy of berenil (diminazene aceturate) against Trypanosoma evansi infection in mice

The efficacy of berenil (diminazene aceturate) was studied in experimental Trypanosoma evansi infection in albino mice. The criteria used for the assessment of the anti-trypanosomal effect of berenil included the examination of the blood and tissues for T. evansi and the clinical, pathological and enzyme histochemical changes seen in the lungs, heart, liver, kidney and spleen at intervals after treatment. Single doses of 10 and 20 mg/kg of berenil given intraperitoneally or intramuscularly to infected mice produced a complete elimination of the protozoon and caused a slow tissue recovery mirrored in the persistence of lesions in different organs. Single doses of 3.5 mg/kg of berenil were less effective and none of the three dose levels of the drug used induced toxic effects in albino mice.