ABSTRACT
In most African countries ; sulfadoxine-pyrimethamine ( Sp) had been the second-line drug to treat chloraquine in resistant Plasmodium falciparum infections in the 1990s and early 2000s . Although its use a monotherapy has been restricted in recent years ; SP has become important for intermittent preventive treatement (IPT) in pregnant women in Africa ; and some countries have been resorting to the combination artesunate -SP for the treatement of uncomplicated malaria .Therefore ; the evaluation of its efficacy remains relevant.In this study ; 58 symptomatic children were treated with SP according to the standard World Health Organization protocol and followed for 14 days .The sequences of P.Falciparum dihydrofolate reductase (dhfr)and dihydropteroate synthase (dhps) genes were determined to correlate these genetic markers and clinical outcome .In addition; blood samples form patients who did not satisfy the inclusion criteria were analysed for the presence of the key dhfr mutation .Results do not suggest any correlation between the observed mutations and SP treatement failure but show a high prevalence of mutations associated with resistance to antifolate drugs and sulfa drugs .However ; it will be important to pursue clinical studie on SP efficacy and epidemiological surveys using these molecular markers ; in particular because in Cameroon the major markers proposed to be highly associated with SP failure elsewhere in the world ; i.e.dhfr mutant codon Glu-540; have not yet been repoted
Subject(s)
Child , Malaria/prevention & control , Molecular EpidemiologyABSTRACT
Background: Malaria is the primary cause of hospitalization in Ctte d'Ivoire. Early treatment is one of the strategies to control this illness. However; the spread of resistance of Plasmodium falciparum to antimalarial drugs can seriously compromise this strategy. Objectives: The aim of this study was to assess the in vitro susceptibility of P. falciparum to monodesethylamodiaquine and aminoalcohols in Abidjan (Ctte d'Ivoire). Methods: We assessed the in vitro susceptibility of isolates collected from patients with uncomplicated malaria by using the WHO optical microtest technique. Results: The proportions of resistance to monodesethylamodiaquine; m?floquine and halofantrine were 12.5; 15.6and 25.9; respectively. For quinine; none of isolates showed evidence of in vitro resistance. However; two isolates (6.1) had IC 50 values above 300 nM. The IC 50 of each drug was positively and significantly correlated to that of the other three drugs; and the correlation was higher between halofantrine and mefloquine. Conclusions: Our results showed that the in vitro chloroquine resistance reported in previous studies has been extended to other antimalarial drugs investigated in this study except for quinine. Therefore; it is necessary to implement a long-term monitoring system of antimalarial drug resistance. 15.6and 25.9; respectively. For quinine; none of isolates showed evidence of in vitro resistance. However; two isolates (6.1) had IC 50 values above 300 nM. The IC 50 of each drug was positively and significantly correlated to that of the other three drugs; and the correlation was higher between halofantrine and mefloquine. Conclusions: Our results showed that the in vitro chloroquine resistance reported in previous studies has been extended to other antimalarial drugs investigated in this study except for quinine. Therefore; it is necessary to implement a long-term monitoring system of antimalarial drug resistance