Bureau of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health (MOPH), Nonathaburi, Thailand.
Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Antimicrob Agents Chemother. 2018 Mar 27;62(4). doi: 10.1128/AAC.02141-17. Print 2018 Apr.
Artemisinin-based combination therapy (ACT) is the most effective and widely used treatment for uncomplicated malaria and is a cornerstone for malaria control and prevention globally. Resistance to artemisinin derivatives has been confirmed in the Greater Mekong Subregion (GMS) and manifests as slow parasite clearance in patients and reduced ring stage susceptibility to artemisinins in survival assays. The gene mutations associated with artemisinin-resistant parasites are now widespread in the GMS. We genotyped 277 samples collected during an observational study from 2012 to 2016 from eight provinces in Thailand to identify mutations. The results were combined with previously reported genotyping results from Thailand to construct a map illustrating the evolution of mutations from 2007 to 2016 in that country. Different mutant alleles were found in strains with different geographical origins. The artemisinin resistance-conferring Y493H and R539T mutations were detected mainly in eastern Thailand (bordering Cambodia), while P574L was found only in western Thailand and R561H only in northwestern Thailand. The C580Y mutation was found across the entire country and was nearing fixation along the Thai-Cambodia border. Overall, the prevalence of artemisinin resistance mutations increased over the last 10 years across Thailand, especially along the Thai-Cambodia border. Molecular surveillance and therapeutic efficacy monitoring should be intensified in the region to further assess the extent and spread of artemisinin resistance.
青蒿素为基础的联合疗法(ACT)是治疗无并发症疟疾最有效和广泛应用的治疗方法,也是全球疟疾控制和预防的基石。在大湄公河次区域(GMS)已经确认了对青蒿素衍生物的耐药性,表现为患者寄生虫清除缓慢和生存试验中对青蒿素的环体阶段敏感性降低。与抗青蒿素寄生虫相关的基因突变现在在 GMS 广泛存在。我们对 2012 年至 2016 年期间在泰国 8 个省进行的一项观察性研究中收集的 277 个样本进行了基因分型,以鉴定突变。将结果与之前来自泰国的基因分型报告结果结合起来,构建了一张图表,说明了 2007 年至 2016 年期间该国 突变的进化情况。不同的突变等位基因存在于具有不同地理起源的菌株中。在靠近柬埔寨边境的泰国东部地区,检测到了具有青蒿素耐药性的 Y493H 和 R539T 突变,而 P574L 仅在泰国西部发现,R561H 仅在泰国西北部发现。C580Y 突变在全国范围内都有发现,并且在泰国-柬埔寨边境附近接近固定。总的来说,在过去的 10 年里,泰国各地青蒿素耐药突变的流行率上升,特别是在泰国-柬埔寨边境地区。应加强该地区的分子监测和治疗效果监测,以进一步评估青蒿素耐药的程度和传播范围。