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    Jan 26, 2021
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    Drug resistance in Plasmodium falciparum from the Chittagong Hill Tracts, Bangladesh.

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    Authors
    van den Broek, I
    van der Wardt, S
    Talukder, L
    Chakma, S
    Brockman, A
    Nair, S
    Anderson, T C
    Affiliation
    Médecins sans Frontières-Holland, Gulshan, Dhaka, Bangladesh. ingrid.van.den.braek@london.msf.org
    Issue Date
    2004-06
    
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    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.
    Publisher
    Wiley-Blackwell
    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
    ae974a485f413a2113503eed53cd6c53
    10.1111/j.1365-3156.2004.01249.x
    Scopus Count
    Collections
    Malaria

    entitlement

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