Drug resistance in Plasmodium falciparum from the Chittagong Hill Tracts, Bangladesh.

Hdl Handle:
http://hdl.handle.net/10144/17262
Title:
Drug resistance in Plasmodium falciparum from the Chittagong Hill Tracts, Bangladesh.
Authors:
van den Broek, I; van der Wardt, S; Talukder, L; Chakma, S; Brockman, A; Nair, S; Anderson, T C
Journal:
Tropical Medicine & International Health
Abstract:
OBJECTIVE: To assess the efficacy of antimalarial treatment and molecular markers of Plasmodium falciparum resistance in the Chittagong Hill Tracts of Bangladesh. METHODS: A total of 203 patients infected with P. falciparum were treated with quinine 3 days plus sulphadoxine/pyrimethamine (SP) combination therapy, and followed up during a 4-week period. Blood samples collected before treatment were genotyped for parasite mutations related to chloroquine (pfcrt and pfmdr1 genes) or SP resistance (dhfr and dhps). RESULTS: Of 186 patients who completed follow-up, 32 patients (17.2%) failed to clear parasitaemia or became positive again within 28 days after treatment. Recurring parasitaemia was related to age (chi(2) = 4.8, P < 0.05) and parasite rates on admission (t = 3.1, P < 0.01). PCR analysis showed that some of these cases were novel infections. The adjusted recrudescence rate was 12.9% (95% CI 8.1-17.7) overall, and 16.6% (95% CI 3.5-29.7), 15.5% (95% CI 8.3-22.7) and 6.9% (95% CI 0.4-13.4) in three age groups (<5 years, 5-14, > or =15). The majority of infections carried mutations associated with chloroquine resistance: 94% at pfcrt and 70% at pfmdr. Sp-resistant genotypes were also frequent: 99% and 73% of parasites carried two or more mutations at dhfr and dhps, respectively. The frequency of alleles at dhfr, dhps and pfmdr was similar in cases that were successfully treated and those that recrudesced. CONCLUSIONS: The clinical trial showed that quinine 3-days combined to SP is still relatively effective in the Chittagong Hill Tracts. However, if this regimen is continued to be widely used, further development of SP resistance and reduced quinine sensitivity are to be expected. The genotyping results suggest that neither chloroquine nor SP can be considered a reliable treatment for P. falciparum malaria any longer in this area of Bangladesh.
Affiliation:
Médecins sans Frontières-Holland, Gulshan, Dhaka, Bangladesh. ingrid.van.den.braek@london.msf.org
Publisher:
Wiley-Blackwell
Issue Date:
Jun-2004
URI:
http://hdl.handle.net/10144/17262
DOI:
10.1111/j.1365-3156.2004.01249.x
PubMed ID:
15189458
Additional Links:
http://www.blackwell-synergy.com/loi/tmi
Language:
en
ISSN:
1360-2276
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorvan den Broek, I-
dc.contributor.authorvan der Wardt, S-
dc.contributor.authorTalukder, L-
dc.contributor.authorChakma, S-
dc.contributor.authorBrockman, A-
dc.contributor.authorNair, S-
dc.contributor.authorAnderson, T C-
dc.date.accessioned2008-01-31T15:42:48Z-
dc.date.available2008-01-31T15:42:48Z-
dc.date.issued2004-06-
dc.identifier.citationDrug resistance in Plasmodium falciparum from the Chittagong Hill Tracts, Bangladesh. 2004, 9 (6):680-7 Trop. Med. Int. Healthen
dc.identifier.issn1360-2276-
dc.identifier.pmid15189458-
dc.identifier.doi10.1111/j.1365-3156.2004.01249.x-
dc.identifier.urihttp://hdl.handle.net/10144/17262-
dc.description.abstractOBJECTIVE: To assess the efficacy of antimalarial treatment and molecular markers of Plasmodium falciparum resistance in the Chittagong Hill Tracts of Bangladesh. METHODS: A total of 203 patients infected with P. falciparum were treated with quinine 3 days plus sulphadoxine/pyrimethamine (SP) combination therapy, and followed up during a 4-week period. Blood samples collected before treatment were genotyped for parasite mutations related to chloroquine (pfcrt and pfmdr1 genes) or SP resistance (dhfr and dhps). RESULTS: Of 186 patients who completed follow-up, 32 patients (17.2%) failed to clear parasitaemia or became positive again within 28 days after treatment. Recurring parasitaemia was related to age (chi(2) = 4.8, P < 0.05) and parasite rates on admission (t = 3.1, P < 0.01). PCR analysis showed that some of these cases were novel infections. The adjusted recrudescence rate was 12.9% (95% CI 8.1-17.7) overall, and 16.6% (95% CI 3.5-29.7), 15.5% (95% CI 8.3-22.7) and 6.9% (95% CI 0.4-13.4) in three age groups (<5 years, 5-14, > or =15). The majority of infections carried mutations associated with chloroquine resistance: 94% at pfcrt and 70% at pfmdr. Sp-resistant genotypes were also frequent: 99% and 73% of parasites carried two or more mutations at dhfr and dhps, respectively. The frequency of alleles at dhfr, dhps and pfmdr was similar in cases that were successfully treated and those that recrudesced. CONCLUSIONS: The clinical trial showed that quinine 3-days combined to SP is still relatively effective in the Chittagong Hill Tracts. However, if this regimen is continued to be widely used, further development of SP resistance and reduced quinine sensitivity are to be expected. The genotyping results suggest that neither chloroquine nor SP can be considered a reliable treatment for P. falciparum malaria any longer in this area of Bangladesh.en
dc.language.isoenen
dc.publisherWiley-Blackwell-
dc.relation.urlhttp://www.blackwell-synergy.com/loi/tmi-
dc.rightsArchived on this site with the kind permission of Wiley-Blackwellen
dc.subject.meshATP-Binding Cassette Transportersen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAnimalsen
dc.subject.meshAntimalarialsen
dc.subject.meshBangladeshen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshChloroquineen
dc.subject.meshDrug Combinationsen
dc.subject.meshDrug Resistanceen
dc.subject.meshFemaleen
dc.subject.meshGenetic Markersen
dc.subject.meshGenotypeen
dc.subject.meshHumansen
dc.subject.meshMalaria, Falciparumen
dc.subject.meshMaleen
dc.subject.meshMembrane Proteinsen
dc.subject.meshMembrane Transport Proteinsen
dc.subject.meshMutationen
dc.subject.meshParasitemiaen
dc.subject.meshPlasmodium falciparumen
dc.subject.meshPolymerase Chain Reactionen
dc.subject.meshProtozoan Proteinsen
dc.subject.meshPyrimethamineen
dc.subject.meshQuinineen
dc.subject.meshSulfadoxineen
dc.subject.meshTreatment Outcomeen
dc.titleDrug resistance in Plasmodium falciparum from the Chittagong Hill Tracts, Bangladesh.en
dc.contributor.departmentMédecins sans Frontières-Holland, Gulshan, Dhaka, Bangladesh. ingrid.van.den.braek@london.msf.orgen
dc.identifier.journalTropical Medicine & International Healthen

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