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Molecular genotyping in a malaria treatment trial in Uganda - unexpected high rate of new infections within 2 weeks after treatment.
- Source :
-
Tropical medicine & international health : TM & IH [Trop Med Int Health] 2007 Feb; Vol. 12 (2), pp. 219-23. - Publication Year :
- 2007
-
Abstract
- Polymerase chain reaction (PCR) genotyping of malaria parasites in drug efficacy trials helps differentiate reinfections from recrudescences. A combination therapy trial of one (n = 115) or three (n = 117) days artesunate (1AS, 3AS 4 mg/kg/day) plus sulphadoxine-pyrimethamine (SP) vs. SP alone (n = 153) was conducted in Mbarara, a mesoendemic area of western Uganda. All paired recurrent Plasmodium falciparum parasitaemias on days 7, 14, 21 and 28 post-treatment were genotyped by PCR amplification and analysis of glutamate-rich protein (glurp) and merozoite surface proteins (msp) 1 and 2 genes to distinguish recrudescent from new infections. A total of 156 (1AS = 61, 3AS = 35, SP alone = 60) of 199 paired recurrent samples were successfully analysed and were resolved as 79 recrudescences (1AS = 32, 3AS = 8, SP = 39) and 77 as new infections (1AS = 29, 3AS = 27, SP = 21). The ratios of proportions of new to recrudescent infections were 0.2, 0.9, 1.4 and 1.9 on days 7, 14, 21 and 28, respectively (P < 0.001, chi(2) test for linear trend). Unexpected high new infection rates were observed early in follow-up on days 7 [5/26 (19.2%)] and 14 [24/51 (47.1%)]. These results impact significantly on resistance monitoring and point to the value of genotyping all recurrent infections in antimalarial trials.
- Subjects :
- Animals
Artesunate
Child
Drug Combinations
Drug Therapy, Combination
Endemic Diseases
Genes, Protozoan genetics
Genotype
Humans
Merozoite Surface Protein 1 analysis
Parasitemia drug therapy
Parasitemia genetics
Polymerase Chain Reaction methods
Protozoan Proteins analysis
Recurrence
Uganda epidemiology
Antimalarials administration & dosage
Artemisinins administration & dosage
Malaria, Falciparum drug therapy
Malaria, Falciparum genetics
Malaria, Falciparum parasitology
Plasmodium falciparum genetics
Pyrimethamine administration & dosage
Sesquiterpenes administration & dosage
Sulfadoxine administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1360-2276
- Volume :
- 12
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Tropical medicine & international health : TM & IH
- Publication Type :
- Academic Journal
- Accession number :
- 17300628
- Full Text :
- https://doi.org/10.1111/j.1365-3156.2007.01813.x