High prevalence of drug-resistance mutations in Plasmodium falciparum and Plasmodium vivax in southern Ethiopia

Mirjam Schunk,Frank P Mockenhaupt,Thomas Löscher,Susanne Roewer,Wondimagegn P Kumma,Abraham Alano,Maha E Osman,Isabel Barreto Miranda,Ulrich Bienzle

doi:10.1186/1475-2875-5-54

Abstract

BackgroundIn Ethiopia, malaria is caused by both Plasmodium falciparum and Plasmodium vivax. Drug resistance of P. falciparum to sulfadoxine-pyrimethamine (SP) and chloroquine (CQ) is frequent and intense in some areas.MethodsIn 100 patients with uncomplicated malaria from Dilla, southern Ethiopia, P. falciparum dhfr and dhps mutations as well as P. vivax dhfr polymorphisms associated with resistance to SP and P. falciparum pfcrt and pfmdr1 mutations conferring CQ resistance were assessed.ResultsP. falciparum and P. vivax were observed in 69% and 31% of the patients, respectively. Pfdhfr triple mutations and pfdhfr/pfdhps quintuple mutations occurred in 87% and 86% of P. falciparum isolates, respectively. Pfcrt T76 was seen in all and pfmdr1 Y86 in 81% of P. falciparum. The P. vivax dhfr core mutations N117 and R58 were present in 94% and 74%, respectively.ConclusionThese data point to an extraordinarily high frequency of drug-resistance mutations in both P. falciparum and P. vivax in southern Ethiopia, and strongly support that both SP and CQ are inadequate drugs for this region.

Highlights

In Ethiopia, malaria is caused by both Plasmodium falciparum and Plasmodium vivax
In Ethiopia, malaria is endemic in three quarters of the national territory [1] with Plasmodium falciparum predominating over Plasmodium vivax
The study was conducted in Dilla located in a region characterized by the gentle slopes of the southern Ethiopian rift valley system ranging between an altitude of 1,400 to 2,000 metres above sea level

Summary

Introduction

In Ethiopia, malaria is caused by both Plasmodium falciparum and Plasmodium vivax. Drug resistance of P. falciparum to sulfadoxine-pyrimethamine (SP) and chloroquine (CQ) is frequent and intense in some areas. In Ethiopia, malaria is endemic in three quarters of the national territory [1] with Plasmodium falciparum predominating over Plasmodium vivax. In 1998, intense resistance of P. falciparum to chloroquine (CQ) necessitated a change to sulfadoxine-pyrimethamine (SP) as first-line antimalarial drug in Ethiopia. Recent data show a high mean SP treatment failure rate of 72% in some areas [4]. Another change to artemether-lumefantrine (AL) was suggested in 2004 [5]. Availability of AL is limited and 85% of the population are living in rural areas with restricted access to health care giving rise to a high rate of presumptive treatment with available drugs like CQ or SP [6]

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Discussion

Conclusion