Abstract
BackgroundDrug resistance within the major malaria parasites Plasmodium vivax and Plasmodium falciparum threatens malaria control and elimination in Southeast Asia. Plasmodium vivax first-line treatment drug is chloroquine together with primaquine, and the first-line treatment for P. falciparum malaria is artemisinin in combination with a partner drug. Plasmodium vivax and P. falciparum parasites resistant to their respective first-line therapies are now found within Southeast Asia. The resistance perimeters may include high transmission regions of Southern Thailand which are underrepresented in surveillance efforts.MethodsThis study investigated blood samples from malaria centres in Southern Thailand. Genetic loci associated with drug resistance were amplified and sequenced. Drug resistance associated genes Pvmdr1, Pvcrt-o, Pvdhfr, and Pvdhps were characterized for 145 cases of P. vivax malaria, as well as the artemisinin resistance-associated Pfkelch13 gene from 91 cases of P. falciparum malaria.ResultsPlasmodium vivax samples from Southern Thai provinces showed numerous chloroquine and antifolate resistance-associated mutations, including SNP and Pvcrt-oK10-insertion combinations suggestive of chloroquine resistant P. vivax phenotypes. A high proportion of the C580Y coding mutation (conferring artemisinin resistance) was detected in P. falciparum samples originating from Ranong and Yala (where the mutation was previously unreported).ConclusionsThe results demonstrate a risk of chloroquine and antifolate resistant P. vivax phenotypes in Southern Thailand, and artemisinin resistant P. falciparum observed as far south as the Thai–Malaysian border region. Ongoing surveillance of antimalarial drug resistance markers is called for in Southern Thailand to inform case management.
Highlights
Drug resistance within the major malaria parasites Plasmodium vivax and Plasmodium falciparum threatens malaria control and elimination in Southeast Asia
According to the World Health Organization (WHO), P. vivax malaria cases appear predominantly in Southeast Asia (58%), with a lower number of cases occurring in the Eastern Mediterranean Region (16%) [6]
Plasmodium vivax Pvmdr1 and Pvcrt‐o Two point-mutations at codons 976 and 1076 in the Pvmdr1 gene were identified in 125 isolates from four provinces in Southern Thailand
Summary
Drug resistance within the major malaria parasites Plasmodium vivax and Plasmodium falciparum threatens malaria control and elimination in Southeast Asia. Plasmodium vivax and P. falciparum parasites resistant to their respective first-line therapies are found within Southeast Asia. Considering the massive number of Plasmodium organisms in endemic regions, the emergence of de novo resistance would be expected in the presence of drug selective pressure. The major human malaria parasites Plasmodium vivax and Plasmodium. Plasmodium vivax is a major cause of human malaria in Asia, Central and South America, and Oceania, with an estimated 80 to 400 million cases worldwide each year [5]. According to the World Health Organization (WHO), P. vivax malaria cases appear predominantly in Southeast Asia (58%), with a lower number of cases occurring in the Eastern Mediterranean Region (16%) [6]. Malaria control and elimination programmes are underway in response to this, these programmes are hindered by drug resistance [8]
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