Molecular diagnosis of resistance to antimalarial drugs during epidemics and in war zones.
Plasmodium falciparum mutations pfcrt K76T and the dhfr/dhps "quintuple mutant" are molecular markers of resistance to chloroquine and sulfadoxine-pyrimethamine, respectively. During an epidemic of P. falciparum malaria in an area of political unrest in northern Mali, where standard efficacy studies have been impossible, we measured the prevalence of these markers in a cross-sectional survey. In 80% of cases of infection, pfcrt K76T was detected, but none of the cases carried the dhfr/dhps quintuple mutant. On the basis of these results, chloroquine was replaced by sulfadoxine-pyrimethamine in control efforts. This example illustrates how molecular markers for drug resistance can provide timely data that inform malaria-control policy during epidemics and other emergency situations.
Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy, and Dentistry, University of Bamako, Bamako, Mali.
Abdoulaye A
AA
Djimdé
Amagana
A
Dolo
Amed
A
Ouattara
Sira
S
Diakité
Christopher V
CV
Plowe
Ogobara K
OK
Doumbo
D000818:Animals; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use*; D002738:Chloroquine / Q000494:pharmacology / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D016054:DNA, Protozoan / Q000032:analysis; D004196:Disease Outbreaks; D004338:Drug Combinations; D004352:Drug Resistance, Microbial / Q000235:genetics; D017125:Genes, Protozoan / Q000235:genetics; D005819:Genetic Markers; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D008302:Mali / Q000453:epidemiology; D017720:Molecular Epidemiology; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000235:genetics; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011739:Pyrimethamine / Q000494:pharmacology; D013413:Sulfadoxine / Q000494:pharmacology; D014857:Warfare
D000962:Antimalarials; D016054:DNA, Protozoan; D004338:Drug Combinations; D005819:Genetic Markers; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine