Molecular diagnosis of resistance to antimalarial drugs during epidemics and in war zones

J Infect Dis. 2004 Aug 15;190(4):853-5. doi: 10.1086/422758. Epub 2004 Jul 15.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Animals
  • Antimalarials / pharmacology
  • Antimalarials / therapeutic use*
  • Chloroquine / pharmacology
  • Chloroquine / therapeutic use*
  • Cross-Sectional Studies
  • DNA, Protozoan / analysis
  • Disease Outbreaks*
  • Drug Combinations
  • Drug Resistance, Microbial / genetics
  • Genes, Protozoan / genetics
  • Genetic Markers
  • Humans
  • Malaria, Falciparum / blood
  • Malaria, Falciparum / epidemiology*
  • Malaria, Falciparum / prevention & control
  • Mali / epidemiology
  • Molecular Epidemiology
  • Plasmodium falciparum / drug effects*
  • Plasmodium falciparum / genetics
  • Polymerase Chain Reaction
  • Prevalence
  • Pyrimethamine / pharmacology
  • Sulfadoxine / pharmacology
  • Warfare*

Substances

  • Antimalarials
  • DNA, Protozoan
  • Drug Combinations
  • Genetic Markers
  • fanasil, pyrimethamine drug combination
  • Sulfadoxine
  • Chloroquine
  • Pyrimethamine