Rapid increase of Plasmodium falciparum dhfr/dhps resistant haplotypes, after the adoption of sulphadoxine-pyrimethamine as first line treatment in 2002, in southern Mozambique

摘要: In late 2002, the health authorities of Mozambique implemented sulphadoxine-pyrimethamine (SP)/amodiaquine (AQ) as first-line treatment against uncomplicated falciparum malaria. 2004, this has been altered to SP/artesunate in line with WHO recommendations using Artemisinin Combination Therapies (ACTs), despite fact that all neighbouring countries have abandoned SP-drug combinations due high levels SP drug resistance. study area, one year prior change SP/AQ, alone was used treat malaria cases. The described here investigated immediate impact on frequency and CQ resistance-related haplotypes Plasmodium genes Pfdhfr, Pfdhps Pfcrt before a after introduction SP. Samples were collected during two cross sectional surveys early 2002 2003 involving 796 692 children or older adults randomly selected living Maciana, an area located Manhica district, Southern Mozambique. Out these, 171 173 P. positive samples measure resistance- related based results obtained by nested PCR followed sequence-specific oligonucleotide probe (SSOP)-ELISA. SP-resistance associated double mutant (SGEAA) haplotype increased significantly from 14% 35% (P < 0.001), while triple Pfdhfr (CIRNI) remained only changed marginally 46% 53% = 0.405) area. Conversely, combined Pfdhfr/Pfdhps quintuple 8% 26% 0.005). chloroquine resistance Pfcrt-CVIET above 90% both years. These retrospective findings add general concern lifespan combination found most likely cause ideal conditions for development artesunate tolerance populations may even endanger sensitivity second-line drug, Coartem®.