Abstract
BackgroundCentral America and the island of Hispaniola have set out to eliminate malaria by 2030. However, since 2014 a notable upturn in the number of cases has been reported in the Mosquitia region shared by Nicaragua and Honduras. In addition, the proportion of Plasmodium falciparum malaria cases has increased significantly relative to vivax malaria. Chloroquine continues to be the first-line drug to treat uncomplicated malaria in the region. The objective of this study was to evaluate the emergence of chloroquine resistant strains of P. falciparum using a genetic approach. Plasmodium vivax populations are not analysed in this study.Methods205 blood samples from patients infected with P. falciparum between 2018 and 2021 were analysed. The pfcrt gene fragment encompassing codons 72–76 was analysed. Likewise, three fragments of the pfmdr1 gene were analysed in 51 samples by nested PCR and sequencing.ResultsAll samples revealed the CVMNK wild phenotype for the pfcrt gene and the N86, Y184F, S1034C, N1042D, D1246 phenotype for the pfmdr1 gene.ConclusionsThe increase in falciparum malaria cases in Nicaragua and Honduras cannot be attributed to the emergence of chloroquine-resistant mutants. Other possibilities should be investigated further. This is the first study to report the genotype of pfmdr1 for five loci of interest in Central America.
Highlights
Central America and the island of Hispaniola have set out to eliminate malaria by 2030
The increase in falciparum malaria cases in Nicaragua and Honduras cannot be attributed to the emergence of chloroquine-resistant mutants
In this study, 205 blood samples on filter paper collected for routine malaria diagnosis in Honduras and Nicaragua were analysed
Summary
Central America and the island of Hispaniola have set out to eliminate malaria by 2030. Fontecha et al Malaria Journal (2021) 20:465 According to these data, the current achievements for malaria control in Central America are heterogeneous and, in some cases, a significant setback has been reported. Nicaragua reported more than 25,000 cases of malaria in 2020, surpassing the figures of 2000, which indicates two decades lost in progress towards the control and elimination of the disease (Fig. 1) (Personal communication by the National Center for Diagnosis and Reference, Health Ministry, Nicaragua). Another worrying data is the proportional increase in the number of cases of Plasmodium falciparum malaria in the Mosquitia. Malaria due to P. falciparum was less than 10% in 2008 in both countries, and in 2020 it exceeded 50% in Nicaragua and 29% in Honduras
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