Grupo Malaria, Universidad de Antioquia, Medellín, Colombia.
Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.
Antimicrob Agents Chemother. 2017 Nov 22;61(12). doi: 10.1128/AAC.01036-17. Print 2017 Dec.
High treatment failure rates for malaria have been reported in Colombia for chloroquine, amodiaquine, and sulfadoxine-pyrimethamine. Artemisinin combination therapies were introduced in 2006 in Colombia, where artemether-lumefantrine (AL) is currently used to treat uncomplicated malaria. Artemisinin (ART) resistance was initially observed in Southeast Asia as an increased parasite clearance time, manifesting as a positive thick-blood smear on day 3 after treatment (D3 positivity). Recently, mutations in the propeller domain of the gene ( propeller) have been associated with ART resistance. In this study, we surveyed AL effectiveness at D3 and molecular markers of drug resistance among 187 uncomplicated cases in 4 regions of Colombia from June 2014 to July 2015. We found that 3.2% (4/125) of patients showed D3 positivity, 100% (163/163) of isolates carried wild-type propeller alleles, 12.9% (23/178) of isolates had multiple copies of the multidrug resistance 1 gene (), and 75.8% (113/149) of isolates harbored the double mutant NSD haplotype (the underlining indicates mutant alleles). These data suggest that ART resistance is not currently suspected in Colombia but that monitoring for lumefantrine resistance and AL failures should continue.
在哥伦比亚,氯喹、阿莫地喹和磺胺多辛-乙胺嘧啶的疟疾治疗失败率很高。2006 年在哥伦比亚引入了青蒿素联合疗法,目前使用青蒿琥酯-咯萘啶(AL)治疗无并发症疟疾。青蒿素(ART)耐药性最初在东南亚观察到,表现为治疗后第 3 天(D3)寄生虫清除时间延长,即治疗后第 3 天厚血涂片阳性(D3 阳性)。最近,与 ART 耐药性相关的基因( propeller)的螺旋桨结构域中的突变。在这项研究中,我们调查了 2014 年 6 月至 2015 年 7 月在哥伦比亚 4 个地区的 187 例无并发症疟疾患者中 AL 在 D3 的有效性以及耐药性的分子标记。我们发现,3.2%(4/125)的患者 D3 阳性,100%(163/163)的分离株携带野生型 propeller 等位基因,12.9%(23/178)的分离株携带多个多药耐药基因 1 基因(),75.8%(113/149)的分离株携带双突变 NSD 单倍型(下划线表示突变等位基因)。这些数据表明,目前哥伦比亚尚未怀疑存在 ART 耐药性,但应继续监测咯萘啶耐药性和 AL 失效情况。