Detection of persistent Plasmodium spp. infections in Ugandan children after artemether-lumefantrine treatment.
During a longitudinal study investigating the dynamics of malaria in Ugandan lakeshore communities, a consistently high malaria prevalence was observed in young children despite regular treatment. To explore the short-term performance of artemether-lumefantrine (AL), a pilot investigation into parasite carriage after treatment(s) was conducted in Bukoba village. A total of 163 children (aged 2-7 years) with a positive blood film and rapid antigen test were treated with AL; only 8.7% of these had elevated axillary temperatures. On day 7 and then on day 17, 40 children (26.3%) and 33 (22.3%) were positive by microscopy, respectively. Real-time PCR analysis demonstrated that multi-species Plasmodium infections were common at baseline, with 41.1% of children positive for Plasmodium falciparum/Plasmodium malariae, 9.2% for P. falciparum/ Plasmodium ovale spp. and 8.0% for all three species. Moreover, on day 17, 39.9% of children infected with falciparum malaria at baseline were again positive for the same species, and 9.2% of those infected with P. malariae at baseline were positive for P. malariae. Here, chronic multi-species malaria infections persisted in children after AL treatment(s). Better point-of-care diagnostics for non-falciparum infections are needed, as well as further investigation of AL performance in asymptomatic individuals.
Department of Production and Population Health,Royal Veterinary College,Hatfield, Hertfordshire,UK.
Martha
M
Betson
Faculty of Infectious and Tropical Diseases,London School of Hygiene and Tropical Medicine,London,UK.
José C
JC
Sousa-Figueiredo
Vector Control Division,Ministry of Health,Kampala,Uganda.
Aaron
A
Atuhaire
Vector Control Division,Ministry of Health,Kampala,Uganda.
Moses
M
Arinaitwe
Vector Control Division,Ministry of Health,Kampala,Uganda.
Moses
M
Adriko
Vector Control Division,Ministry of Health,Kampala,Uganda.
Gerald
G
Mwesigwa
Vector Control Division, Mayuge District,Uganda.
Juma
J
Nabonge
Vector Control Division,Ministry of Health,Kampala,Uganda.
Narcis B
NB
Kabatereine
Faculty of Infectious and Tropical Diseases,London School of Hygiene and Tropical Medicine,London,UK.
Colin J
CJ
Sutherland
Department of Parasitology,Liverpool School of Tropical Medicine,Liverpool,UK.
J Russell
JR
Stothard
D000962:Antimalarials / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D003955:Diagnostic Tests, Routine; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D000078102:Lumefantrine; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D010961:Plasmodium / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D010963:Plasmodium falciparum / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D041122:Plasmodium ovale / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D019095:Point-of-Care Systems; D015995:Prevalence; D014454:Uganda / Q000453:epidemiology
D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D000077549:Artemether; D000078102:Lumefantrine