Distribution of Plasmodium vivax pvdhfr and pvdhps alleles and their association with sulfadoxine-pyrimethamine treatment outcomes in Indonesia.

Puji B S Asih,Ismail E Rozi,Ahmad S Taufik,Neil F Lobo,Din Syafruddin,Wajio Sumarto,Sekar Tuti,Mulyanto Mulyanto,Rodiah Nababan,Robert W Sauerwein,Rita M Dewi,Sylvia S Marantina

doi:10.1186/s12936-015-0903-0

Abstract

BackgroundSympatric existence of Plasmodium falciparum and Plasmodium vivax, and the practice of malaria treatment without microscopic confirmation suggest that the accidental treatment of vivax malaria with sulfadoxine–pyrimethamine (SP) is common.MethodsIn this study, the frequency distribution of alleles associated with SP resistance were analysed among the P. vivax infections from malariometric surveys and its association with SP treatment failure in clinical studies in Indonesia. The dhfr and dhps alleles were detected using PCR–RFLP method.ResultsAnalysis of 159 P. vivax isolates from malariometric surveys and 69 samples from in vivo SP efficacy study revealed various the existence of various alleles of the pvdhfr and pfdhps genes including 57L/I, 58R, 61M, and 117N/T. Allele 13L of the dhfr gene and 553G of the dhps gene were not detected in any isolates examined in both studies. In the dhfr gene, tandem repeat type-A was the major tandem repeat observed in any isolates analysed. In the dhps gene, only the 383G allele was observed. Isolates carrying double, triple and quadruple mutants of dhfr gene were found in Lampung, Purworejo, Sumba, and Papua. Although this study revealed a wide distribution of dhfr and dhps alleles among the P. vivax isolates across a broad geographic regions in Indonesia, impact on SP efficacy was not observed in Sumba.ConclusionWith proper malaria diagnosis, SP may still be used as a rational anti-malarial drug either as a single prescription or in combination with artemisinin.

Highlights

Sympatric existence of Plasmodium falciparum and Plasmodium vivax, and the practice of malaria treatment without microscopic confirmation suggest that the accidental treatment of vivax malaria with sulfadoxine– pyrimethamine (SP) is common
Asih et al Malar J (2015) 14:365 been recommended to treat vivax malaria in Indonesia, the sympatric existence of P. falciparum and Plasmodium vivax and the practice of malaria treatment without microscopic confirmation suggest that accidental treatment of vivax malaria with SP has often taken place
SP has never been recommended for the treatment of patients with P. vivax malaria, the selection pressure exerted by the drug is expected to have continued progressively in P. falciparum and P. vivax [5]

Summary

Introduction

Sympatric existence of Plasmodium falciparum and Plasmodium vivax, and the practice of malaria treatment without microscopic confirmation suggest that the accidental treatment of vivax malaria with sulfadoxine– pyrimethamine (SP) is common. Asih et al Malar J (2015) 14:365 been recommended to treat vivax malaria in Indonesia, the sympatric existence of P. falciparum and Plasmodium vivax and the practice of malaria treatment without microscopic confirmation suggest that accidental treatment of vivax malaria with SP has often taken place. SP has never been recommended for the treatment of patients with P. vivax malaria, the selection pressure exerted by the drug is expected to have continued progressively in P. falciparum and P. vivax [5]. Since 2010, vivax malaria cases in Indonesia are treated with artemisinin-based combination therapy (ACT) [6]

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Conclusion