Abstract
The emergence of artemisinin-resistant parasites since the late 2000s at the border of Cambodia and Thailand poses serious threats to malaria control globally, particularly in Africa which bears the highest malaria transmission burden. This study aimed to obtain reliable data on the current state of the kelch13 molecular marker for artemisinin resistance in Plasmodium falciparum in Cameroon. DNA was extracted from the dried blood spots collected from epidemiologically distinct endemic areas in the Center, Littoral and North regions of Cameroon. Nested PCR products from the Kelch13-propeller gene were sequenced and analyzed on an ABI 3730XL automatic sequencer. Of 219 dried blood spots, 175 were sequenced successfully. We identified six K13 mutations in 2.9% (5/175) of samples, including 2 non-synonymous, the V589I allele had been reported in Africa already and one new allele E612K had not been reported yet. These two non-synonymous mutations were uniquely found in parasites from the Littoral region. One sample showed two synonymous mutations within the kelch13 gene. We also observed two infected samples with mixed K13 mutant and K13 wild-type infection. Taken together, our data suggested the circulation of the non-synonymous K13 mutations in Cameroon. Albeit no mutations known to be associated with parasite clearance delays in the study population, there is need for continuous surveillance for earlier detection of resistance as long as ACTs are used and scaled up in the community.
Highlights
Malaria Risk in Africa (MARA) epidemiological stratification, Cameroon is categorized from South to North under 3 major epidemiological facets: (i) the Equatorial facet that is characterized by large forests and dense vegetation with extensive hydrographic network, hot and humid climate, heavy rainfall (5000 mm per year), and perennial transmission of malaria parasites, (ii) the Tropical/Sudanian facet that include the North Region, characterized by savannas, steppes, shrubs and gallery forests, and marked by long (4–6 months) and intense seasonal transmission of malaria parasites, and (iii) the Sahelian facet in the Far North zone characterized by hot and dry tropical climate where malaria transmission is short seasonal (1 to 3 months)
One hundred and sixty-nine patients (169) of the 219 samples were obtained from patients who attended hospitals and, the remain was from the community
Our findings showed the absence of all previously characterized artemisinin resistanceassociated Single Nucleotide Polymorphisms (SNPs) reported in Southeast Asia, from sequencing analyses of 219 P. falciparum isolates representing a cross section of parasite populations in Cameroon
Summary
This study aimed to obtain reliable data on the current state of the kelch molecular marker for artemisinin resistance in Plasmodium falciparum in Cameroon. This study aimed to investigate the level of polymorphism of K13 gene of P. falciparum isolates from three epidemiologically distinct regions of Cameroon to assess the artemisinin-based treatment failure in Cameroon from the perspective of parasite genetics
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