Abstract
BackgroundThe Kingdom of Saudi Arabia is seeking malaria eradication. Malaria transmission has been very low over the last few years. Discovered cases of Plasmodium falciparum infection are assigned a treatment protocol of artemisinin-based combination therapy, which consists of artesunate in addition to sulfadoxine-pyrimethamine rather than the traditional chloroquine, which has high resistance rates worldwide. This study aims to investigate the presence of different gene mutations concerning anti-malarial drug resistance (pfdhfr, pfdhps, pfmdr1, pfcrt, pfcytb, pfketch13) to identify whether drug-resistant alleles are present in this area of the Kingdom and whether the country’s treatment protocol is still suitable for Plasmodium bearing a resistance mutation.MethodsBlood samples were collected from patients suffering from symptoms suggesting malaria coming to King Faisal Hospital, Taif, from February to August 2016. Diagnosis was performed by Giemsa-stained thin and thick blood films, rapid diagnostic test and PCR. Positive P. falciparum samples were further subjected to series of PCR amplification reactions targeting genes related with drug resistance (pfdhfr, pfdhps, pfmdr1, pfcrt, pfcytb, pfketch13).ResultsTwenty-six cases were positives, 13 infected with P. falciparum, of those, 4 cases were autochthonous, and 13 with Plasmodium vivax. The results of the gene mutation detection confirmed that there was no mutation related to resistance to artemisinin or atovaquone, on the other hand chloroquine resistance alleles were detected in 31% of samples. Moreover, point mutations in the pfdhfr and pfdhps genes, related resistance to antifolate drugs, were detected in all characterized samples.ConclusionsHaplotypes of P. falciparum in the western region of the Kingdom of Saudi Arabia exhibit high resistance against antifolate drugs. These results should be extensively discussed when planning to modify anti-malarial drug protocols in the future.
Highlights
The Kingdom of Saudi Arabia is seeking malaria eradication
Saudi Arabia is included in the E-2020 initiative by the World Health Organization (WHO), given a target of zero indigenous cases for 2020, but in the last published data, the country shows a rise in cases passing from 83 in 2015 to 272 in 2016 [1]
The aim of this study is to analyse malaria cases characterized in a reference hospital in Taif, a city close to Mecca in the west of Saudi Arabia with a low transmission malaria rate, and to identify the genes associated with resistance that are present in the region
Summary
The Kingdom of Saudi Arabia is seeking malaria eradication. Malaria is considered one of the main ongoing causes of morbidity and mortality globally, affecting vulnerable groups, such as pregnant women and children [1]. This major health hazard is encountered in countries. The Arabian Peninsula stretches out at the fringes of malaria endemicity where disease transmission has undergone different stages of reduction as a consequence of continuous vector control efforts. In Saudi Arabia, the biggest country in the gulf area with more of 32 million inhabitants, malaria was a noteworthy health issue in the middle of the last Century with frequent transmission all over the country, with 48,000 people living in foci areas. Plasmodium falciparum counts for most of the cases of indigenous malaria, 270 in 2016, with sporadic cases of Plasmodium vivax (two in the last WHO report [1])
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