Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China.
Department of Infectious Diseases, Shanglin County People's Hospital, Guangxi, China.
Front Cell Infect Microbiol. 2022 Oct 14;12:1015957. doi: 10.3389/fcimb.2022.1015957. eCollection 2022.
Drug resistance in compromises the effectiveness of antimalarial therapy. This study aimed to evaluate the extent of drug resistance in parasites obtained from international travelers returning from Ghana to guide the management of malaria cases. Eighty-two clinical parasite isolates were obtained from patients returning from Ghana in 2016-2018, of which 29 were adapted to continuous culture. Their geometric mean IC values to a panel of 11 antimalarial drugs, assessed using the standard SYBR Green-I drug sensitivity assay, were 2.1, 3.8, 1.0, 2.7, 17.2, 4.6, 8.3, 8.3, 19.6, 55.1, and 11,555 nM for artemether, artesunate, dihydroartemisinin, lumefantrine, mefloquine, piperaquine, naphthoquine, pyronaridine, chloroquine, quinine, and pyrimethamine, respectively. Except for chloroquine and pyrimethamine, the IC values for other tested drugs were below the resistance threshold. The mean ring-stage survival assay value was 0.8%, with four isolates exceeding 1%. The mean piperaquine survival assay value was 2.1%, all below 10%. Mutations associated with chloroquine resistance ( K76T and N86Y) were scarce, consistent with the discontinuation of chloroquine a decade ago. Instead, the 86N-184F-1246D haplotype was predominant, suggesting selection by the extensive use of artemether-lumefantrine. No mutations in the propeller domain were detected. The quadruple mutant IRNGK associated with resistance to sulfadoxine-pyrimethamine reached an 82% prevalence. In addition, five isolates had gene amplification but, intriguingly, increased susceptibilities to pyrimethamine. This study showed that parasites originating from Ghana were susceptible to artemisinins and the partner drugs of artemisinin-based combination therapies. Genotyping drug resistance genes identified the signature of selection by artemether-lumefantrine. Parasites showed substantial levels of resistance to the antifolate drugs. Continuous resistance surveillance is necessary to guide timely changes in drug policy.
耐药性降低了抗疟疗法的效果。本研究旨在评估从加纳返回的国际旅行者所携带寄生虫的耐药程度,以指导疟疾病例的管理。2016-2018 年,从加纳返回的患者中获得了 82 株临床寄生虫分离株,其中 29 株适应了连续培养。使用标准 SYBR Green-I 药物敏感性测定法评估了它们对 11 种抗疟药物的几何平均 IC 值,结果分别为:蒿甲醚、青蒿琥酯、双氢青蒿素、咯萘啶、氯喹、奎宁、伯氨喹、萘酚喹、青蒿素、哌喹、甲氟喹和乙胺嘧啶的 2.1、3.8、1.0、2.7、17.2、4.6、8.3、8.3、19.6、55.1 和 11555 nM。除氯喹和乙胺嘧啶外,其他测试药物的 IC 值均低于耐药阈值。环早期存活率测定值的平均值为 0.8%,有 4 株分离株超过 1%。哌喹存活率测定值的平均值为 2.1%,均低于 10%。与氯喹耐药相关的突变(K76T 和 N86Y)很少见,这与十年前停用氯喹一致。相反,86N-184F-1246D 单倍型占主导地位,表明青蒿素- 咯萘啶的广泛使用选择了它。未检测到桨叶结构域的突变。与磺胺多辛-乙胺嘧啶耐药相关的四重突变 IRNGK 达到 82%的流行率。此外,有 5 株分离株发生了基因扩增,但令人费解的是,对乙胺嘧啶的敏感性增加。本研究表明,来自加纳的寄生虫对青蒿素及其基于青蒿素的联合疗法的伴侣药物敏感。耐药基因的基因分型确定了青蒿素- 咯萘啶选择的特征。寄生虫对叶酸类药物表现出相当高的耐药性。需要进行持续的耐药性监测,以指导及时改变药物政策。