High prevalence of Plasmodium falciparum pfcrt K76T mutation in pregnant women taking chloroquine prophylaxis in Senegal.
OBJECTIVE
The risk of malaria infection is increased during pregnancy, and many countries recommend chloroquine prophylaxis in pregnant women, despite Plasmodium falciparum chloroquine resistance. Chloroquine resistance is associated with the pfcrt gene K76T mutation. The aim of this study was to compare the prevalence rate of pfcrt T76 mutation in P. falciparum isolates from infected pregnant and non-pregnant individuals from Senegal.


METHODS
The study was conducted in the rural maternity hospital of Thiadiaye, Senegal, where malaria is seasonal. Sixty-nine P. falciparum isolates from infected women were collected at delivery. These women were part of a cohort study; they were followed from their first antenatal visit and advised to take chloroquine prophylaxis. For each woman, the earliest P. falciparum-infected blood sample was also used. A control group of 49 non-pregnant individuals with asymptomatic P. falciparum infection was enrolled.


RESULTS
During pregnancy, prevalence of T76 mutant parasites was higher than in the 49 non-pregnant controls (P<0.001). Among pregnant women, this rate was highest at delivery (P=0.06), and tended to be higher in women who had taken chloroquine prophylaxis, as assessed in urine samples (P=0.08).


CONCLUSIONS
Chloroquine prophylaxis is responsible for increased drug consumption and increased drug pressure that may lead to the selection of drug-resistant parasites. This is the first report showing that P. falciparum-infected pregnant women harbour pfcrt T76 mutant parasites more often than non-pregnant individuals, and that the prevalence of this mutation is higher at term than earlier during pregnancy.
Bertin
Gwladys
G
Institut de Recherche pour le Développement, UR010, Mother and Child Health in the Tropics, Faculté de Pharmacie, 75006 Paris, France.
Ndam
Nicaise Tuikue
NT
Jafari-Guemouri
Sayeh
S
Fievet
Nadine
N
Renart
Emily
E
Sow
Sokhna
S
Le Hesran
Jean-Yves
JY
Deloron
Philippe
P
D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use*; D018890:Chemoprevention; D002738:Chloroquine / Q000494:pharmacology / Q000627:therapeutic use*; D016054:DNA, Protozoan; D004351:Drug Resistance; D005260:Female; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D016778:Malaria, Falciparum / Q000469:parasitology / Q000517:prevention & control*; D008565:Membrane Proteins / Q000235:genetics*; D026901:Membrane Transport Proteins; D009154:Mutation; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000235:genetics / Q000378:metabolism; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000469:parasitology / Q000517:prevention & control*; D015995:Prevalence; D015800:Protozoan Proteins; D012675:Senegal
D000962:Antimalarials; D016054:DNA, Protozoan; D008565:Membrane Proteins; D026901:Membrane Transport Proteins; C416369:PfCRT protein, Plasmodium falciparum; D015800:Protozoan Proteins; D002738:Chloroquine