Abstract
BackgroundArtemisinin resistance described as increased parasite clearance time (PCT) is rare in Africa. More sensitive methods such as qPCR might better characterize the clearance phenotype in sub-Saharan Africa. MethodsPCT is explored in Mali using light microscopy and qPCR after artesunate for uncomplicated malaria. In two villages, patients were followed for 28 days. Blood smears and spots were collected respectively for microscopy and qPCR. Parasitemia slope half-life was calculated after microscopy. Patient residual parasitemia were measured by qPCR. ResultsUncorrected adequate clinical and parasitological responses (ACPR) observed in Faladje and Bougoula-Hameau were 78% and 92%, respectively (p=0.01). This reached 100% for both after molecular correction.Proportions of 24H microscopy positive patients in Faladje and Bougoula-Hameau were 97.2% and 72%, respectively (p<0.0001).Slope half-life was 2.8h in Faladje vs 2H in Bougoula-Hameau (p<0.001) andProportions of 72H patients with residual parasitemia were 68.5% and 40% in Faladje and Bougoula-Hameau, respectively (p=0.003). The mean residual parasitemia was 2.9 in Faladje vs. 0.008 in Bougoula-Hameau (p=0.002).Although artesunate is efficacious in Mali, the longer parasite clearance time with submicroscopic parasitemia observed may represent early signs of developing P. falciparum resistance to artemisinins.
Highlights
Malaria is still a devastating disease in endemic regions despite major efforts for its control and elimination
There were 2 Late Clinical Failure (LCF) and 24 Late Parasitological Failure (LPF) cases (78.3% ACPR) registered for Faladje versus 8 LPF (92% ACPR) for Bougoula-Hameau (p = 0.01)
The nearly 3-hour slope half-life of parasitemia clearance of Faladje did not reach the current 5-hour threshold for artemisinin resistance described in SEA (Dondorp et al, 2009), this observation merits careful consideration
Summary
Malaria is still a devastating disease in endemic regions despite major efforts for its control and elimination. Despite several studies on artemisinins efficacy in Africa, delay in parasite clearance time were rarely found (Borrmann et al, 2011; Ashley et al, 2014). Artemisinin resistance described as increased parasite clearance time (PCT) is rare in Africa. More sensitive methods such as qPCR might better characterize the clearance phenotype in sub-Saharan Africa. Results: Uncorrected adequate clinical and parasitological responses (ACPR) observed in Faladje and Bougoula-Hameau were 78% and 92%, respectively (p = 0.01). Artesunate is efficacious in Mali, the longer parasite clearance time with submicroscopic parasitemia observed may represent early signs of developing P. falciparum resistance to artemisinins.
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