High rates of parasite recrudescence following intermittent preventive treatment with sulphadoxine-pyrimethamine during pregnancy in Benin

Malaria Journal

Research

Achille Massougbodji¹  Yolande Sissinto-Savi De Tove¹  Michael Alifrangis²  Adrian JF Luty³  Philippe Deloron³  Justin Doritchamou⁴  Nicaise Tuikue Ndam⁴  Azizath Moussiliou⁴ 

[1] Centre d’Etude et de Recherche sur le Paludisme associé à la Grossesse et à l’Enfance, Faculté des Science de Santé, Université d’Abomey-Calavi, 01 BP 188, Cotonou, Benin;Department of International Health, Immunology and Microbiology, Centre for Medical Parasitology Faculty of Health, Medical Sciences, University of Copenhagen, K 1014, Copenhagen, Denmark;Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), K 1014, Copenhagen, Denmark;Institut de Recherche pour le Développement, UMR216 Mère et enfant face aux infections tropicales, Faculté des sciences biologiques et pharmaceutiques, 4, avenue de l’observatoire, 75006, Paris, France;Faculté de Pharmacie, Université Paris Descartes, PRES Sorbonne Paris Cité, 75270, Paris, France;Institut de Recherche pour le Développement, UMR216 Mère et enfant face aux infections tropicales, Faculté des sciences biologiques et pharmaceutiques, 4, avenue de l’observatoire, 75006, Paris, France;Faculté de Pharmacie, Université Paris Descartes, PRES Sorbonne Paris Cité, 75270, Paris, France;Centre d’Etude et de Recherche sur le Paludisme associé à la Grossesse et à l’Enfance, Faculté des Science de Santé, Université d’Abomey-Calavi, 01 BP 188, Cotonou, Benin;

关键词: Plasmodium falciparum;    Pregnancy;    IPTp;    Sulphadoxine-pyrimethamine;    Mutations;    pfdhfr;    pfdhps;    Benin;   

DOI  :  10.1186/1475-2875-12-195

 received in 2013-04-08, accepted in 2013-06-04,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundDespite widespread parasite resistance to sulphadoxine-pyrimethamine (SP) its use for intermittent preventative treatment during pregnancy remains the policy in Benin and throughout most of sub-Saharan Africa.MethodsIn a prospective study, 982 pregnant women were recruited in Benin and followed until delivery. The prevalence of point mutations in the pfdhfr and pfdhps genes associated with Plasmodium falciparum resistance to SP during consecutive antenatal visits was determined. Parasites clearance among women infected at SP intake was assessed by microscopy and PCR. Association between the persistence of parasites and malaria consequences, were investigated. Recurrent parasites were genotyped to identify recrudescences from re-infections.ResultsThe prevalence of pfdhfr/pfdhps quadruple mutants (triple pfdhfr + single pfdhps) was consistently above 80% while quintuple and sextuple mutants remained low. Importantly the higly mutated parasites apparently never included the two key mutations, pfdhfr 164 L or pfdhps 540E. Based on PCR results, SP failed to clear existing parasitaemia in half (48%) of the women who were infected at IPTp schedule. The frequency of recrudescence reached 76% after the second dose. Women with persistent parasitaemia had an increased prevalence of anaemia (P = 0.03).ConclusionThe data presented here, highlight the inability of SP to ensure optimal antiplasmodial protection in late pregnancy, and invite urgent consideration of an alternative drug or strategy.

【 授权许可】

Unknown   
© Moussiliou et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.