Skip to main content

Free Content Drug resistance in Plasmodium falciparum from the Chittagong Hill Tracts, Bangladesh

Download Article:

You have access to the full text article on a website external to ingentaconnect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library

Abstract:

Summary Objective 

To assess the efficacy of antimalarial treatment and molecular markers of Plasmodium falciparum resistance in the Chittagong Hill Tracts of Bangladesh. Methods 

A total of 203 patients infected with P. falciparum were treated with quinine 3 days plus sulphadoxine/pyrimethamine (SP) combination therapy, and followed up during a 4-week period. Blood samples collected before treatment were genotyped for parasite mutations related to chloroquine (pfcrt and pfmdr1 genes) or SP resistance (dhfr and dhps). Results 

Of 186 patients who completed follow-up, 32 patients (17.2%) failed to clear parasitaemia or became positive again within 28 days after treatment. Recurring parasitaemia was related to age (χ 2 = 4.8, P < 0.05) and parasite rates on admission (t = 3.1, P < 0.01). PCR analysis showed that some of these cases were novel infections. The adjusted recrudescence rate was 12.9% (95% CI 8.1–17.7) overall, and 16.6% (95% CI 3.5–29.7), 15.5% (95% CI 8.3–22.7) and 6.9% (95% CI 0.4–13.4) in three age groups (<5 years, 5–14, ≥15). The majority of infections carried mutations associated with chloroquine resistance: 94% at pfcrt and 70% at pfmdr. Sp-resistant genotypes were also frequent: 99% and 73% of parasites carried two or more mutations at dhfr and dhps, respectively. The frequency of alleles at dhfr, dhps and pfmdr was similar in cases that were successfully treated and those that recrudesced. Conclusions 

The clinical trial showed that quinine 3-days combined to SP is still relatively effective in the Chittagong Hill Tracts. However, if this regimen is continued to be widely used, further development of SP resistance and reduced quinine sensitivity are to be expected. The genotyping results suggest that neither chloroquine nor SP can be considered a reliable treatment for P. falciparum malaria any longer in this area of Bangladesh.

Keywords: drug efficacy; genotyping; malaria; quinine; sulphadoxine–pyrimethamine

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2004.01249.x

Affiliations: 1:  Médecins sans Frontières-Holland, Dhaka, Bangladesh 2:  Shoklo Malaria Research Unit, Mae Sot, Thailand 3:  Southwest Foundation for Biomedical Research, San Antonio, TX, USA

Publication date: June 1, 2004

bsc/tmih/2004/00000009/00000006/art00011
dcterms_title,dcterms_description,pub_keyword
6
5
20
40
5

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
ingentaconnect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more