Chloroquine had been used extensively during the last five decades in Cameroon. Its decreasing clinical effectiveness, supported by high proportions of clinical isolates carrying the mutant pfcrt haplotype (CVIET), led the health authorities to resort to amodiaquine monotherapy in 2002 and artemisinin-based combination therapy (ACT) in 2004 (artesunate–amodiaquine, with artemether–lumefantrine as an alternative since 2006) as the first-line treatment of uncomplicated malaria. The aim of the present study was to investigate whether the withdrawal of chloroquine was associated with a reduction in pfcrt mutant parasite population and reemergence of chloroquine-sensitive parasites in southeastern Cameroon between 2003 and 2012.
The frequency of pfcrt haplotypes at positions 72–76 in Plasmodium falciparum isolates collected from individuals in 2003 and 2012 in southeastern Cameroon was determined by sequence specific oligonucleotide probes-enzyme linked immunosorbent assay (SSOP-ELISA).
The proportions of parasites carrying the mutant haplotype CVIET and the wild-type CVMNK were 53.0 and 28.0% in 2003, respectively. The proportion of the mutant haplotype in samples collected 9 years later decreased to 25.3% whereas the proportion of parasites carrying the wild-type CVMNK haplotype was 53.7%.
Even though the proportion of chloroquine-sensitive parasites seems to be increasing in southeastern Cameroon, a reintroduction of chloroquine cannot be recommended at present in Cameroon. The current national anti-malarial drug policy should be implemented and reinforced to combat drug-resistant malaria.
Peters W. Chemotherapy and drug resistance in malaria. London: Academic Press; 1987.
Ringwald P, Same Ekobo A, Keundjian A, Kedy Mangamba D, Basco LK. Chemoresistance of Plasmodium falciparum in urban areas of Yaounde, Cameroon. Part 1: surveillance of in vitro and in vivo resistance of Plasmodium falciparum to chloroquine from 1994 to 1999 in Yaounde, Cameroon. Trop Med Int Health. 1994;2000(5):612–9.
Basco LK, Foumane Ngane V, Ndounga M, Same-Ekobo A, Youmba JC, Okalla Abodo RT, et al. Molecular epidemiology of malaria in Cameroon. XXI. Baseline therapeutic efficacy of chloroquine, amodiaquine, and sulfadoxine–pyrimethamine monotherapies before national drug policy change. Am J Trop Med Hyg. 2006;75:388–95. PubMed
Whegang Youdom S, Tahar R, Foumane Ngane V, Soula G, Gwet H, Thalabard JC, et al. Efficacy of non-artemisinin and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon. Malar J. 2010;9:56. CrossRef
Nagesha HS, Rieckmann KH, Fryauff DJ, Laksana BS, Reeder JC, Maguire JD, et al. New haplotypes of the Plasmodium falciparum chloroquine resistance transporter (pfcrt) gene among chloroquine-resistant parasite isolates. Am J Trop Med Hyg. 2003;68:398–402. PubMed
Echeverry DF, Holmgren G, Murillo C, Higuita JC, Björkman A, Gil JP, et al. Polymorphisms in the pfcrt and pfmdr1 genes of Plasmodium falciparum and in vitro susceptibility to amodiaquine and desethylamodiaquine. Am J Trop Med Hyg. 2007;77:1034–8. PubMed
Valderramos SG, Valderramos JC, Musset L, Purcell LA, Mercereau-Puijalon O, Legrand E, et al. Identification of a mutant PfCRT-mediated chloroquine tolerance phenotype in Plasmodium falciparum. PLoS Pathog. 2010;6:e10000887. CrossRef
Basco LK. Molecular epidemiology of malaria in Cameroon. XIX. Quality of antimalarial drugs used for self-medication. Am J Trop Med Hyg. 2004;70:245–50. PubMed
Tahar R, Basco LK. Molecular epidemiology of malaria in Cameroon. XXII. Geographic mapping and distribution of Plasmodium falciparum dihydrofolate reductase (dhfr) mutant alleles. Am J Trop Med Hyg. 2006;75:396–401. PubMed
Alifrangis M, Enosse S, Pearce R, Drakeley C, Roper C, Khalil IF, et al. A simple, high-throughput method to detect Plasmodium falciparum single nucleotide polymorphisms in the dihydrofolate reductase, dihydropteroate synthase, and P. falciparum chloroquine resistance transporter genes using polymerase chain reaction- and enzyme-linked immunosorbent assay-based technology. Am J Trop Med Hyg. 2005;72:155–62. PubMed
Basco LK. Molecular epidemiology of malaria in Cameroon. XIII. Analysis of pfcrt mutations and in vitro chloroquine resistance. Am J Trop Med Hyg. 2002;67:388–91. PubMed
Mbacham WF, Evehe MSB, Netongo PM, Ateh IA, Mimche PN, Ajua A, et al. Efficacy of amodiaquine, sulphadoxine–pyrimethamine and their combination for the treatment of uncomplicated Plasmodium falciparum malaria in children in Cameroon at the time of policy change to artemisinin-based combination therapy. Malar J. 2010;9:34. CrossRefPubMedPubMedCentral
Menard S, Morlais I, Tahar R, Sayang C, Mayengue PI, Iriart X, et al. Molecular monitoring of Plasmodium falciparum drug susceptibility at the time of the introduction of artemisinin-based combination therapy in Yaoundé, Cameroon: implications for the future. Malar J. 2012;11:113. CrossRefPubMedPubMedCentral
- Reemergence of chloroquine-sensitive pfcrt K76 Plasmodium falciparum genotype in southeastern Cameroon
Nicaise Tuikue Ndam
Leonardo K. Basco
Vincent Foumane Ngane
Eitel Mpoudi Ngolle
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II