Alternate Title: Disponibilité des traitements à base d’artémisinine et autres anti-paludiques à Kinshasa (French)

المؤلفون: Nkoli Mandoko, P., Sinou, V., Moke Mbongi, D., Ngoyi Mumba, D., Kahunu Mesia, G., Losimba Likwela, J., Bi Shamamba Karhemere, S., Muepu Tshilolo, L., Tamfum Muyembe, J.-J., Parzy, D.

المصدر: In Médecine et Maladies Infectieuses June 2018 48(4):269-277

المؤلفون: Nkoli Mandoko P; National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo., Rouvier F; Department of Biology, K-Plan, Grand Luminy Technopôle, Marseille, France., Matendo Kakina L; National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo., Moke Mbongi D; Centre de Formation et d'Appui Sanitaire (CEFA)/Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo., Latour C; Department of Biology, K-Plan, Grand Luminy Technopôle, Marseille, France., Losimba Likwela J; Department of Public Health, Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo.; National Malaria Control Program, Kinshasa, Democratic Republic of the Congo., Ngoyi Mumba D; National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo., Bi Shamamba SK; National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo., Tamfum Muyembe JJ; National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo., Muepu Tshilolo L; Centre de Formation et d'Appui Sanitaire (CEFA)/Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo., Parzy D; Department of Biology, K-Plan, Grand Luminy Technopôle, Marseille, France., Sinou V; UMR-MD3, University of Aix-Marseille, Faculty of Pharmacy, Marseille, France.

المصدر: The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2018 Oct 01; Vol. 73 (10), pp. 2704-2715.

نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: Oxford University Press Country of Publication: England NLM ID: 7513617 Publication Model: Print Cited Medium: Internet ISSN: 1460-2091 (Electronic) Linking ISSN: 03057453 NLM ISO Abbreviation: J Antimicrob Chemother Subsets: MEDLINE

مواضيع طبية MeSH: Antimalarials/*pharmacology , Drug Resistance, Multiple/*genetics , Plasmodium falciparum/*drug effects , Protozoan Proteins/*genetics , Pyrimethamine/*pharmacology , Sulfadoxine/*pharmacology , Tetrahydrofolate Dehydrogenase/*genetics, Adolescent ; Adult ; Alleles ; Ambulatory Care Facilities/statistics & numerical data ; Child ; Child, Preschool ; Democratic Republic of the Congo ; Female ; Genotype ; Humans ; Malaria, Falciparum/blood ; Malaria, Falciparum/drug therapy ; Male ; Mutation ; Polymorphism, Genetic ; Prevalence ; Young Adult

مستخلص: Background: In 2005, the Democratic Republic of the Congo (DRC) switched to artesunate/amodiaquine as the first-line antimalarial in response to increasing sulfadoxine/pyrimethamine resistance and adopted intermittent preventive treatment using sulfadoxine/pyrimethamine in pregnancy.
Objectives: To determine the prevalence of molecular markers of sulfadoxine/pyrimethamine resistance in southwestern DRC 10 years after the new policy was instituted.
Methods: From March 2014 to December 2015, blood samples were collected from symptomatic patients presenting to outpatient centres in urban and rural areas. A total of 2030 confirmed Plasmodium falciparum isolates were genotyped at codons associated with sulfadoxine/pyrimethamine resistance.
Results: The prevalence of pfdhfr-N51I, C59R and S108N and pfdhps-A437G mutations was consistently high; the prevalence of the pfdhps-K540E mutation was low but increased since its first report in 2008 in the same region, reaching 17.6% by 2015. The pfdhps-A581G mutation increased from ∼4.5% in 2014 to ∼14.0% in 2015 at urban sites while in rural areas it remained low (∼4.0%). The mutations pfdhfr-I164L and pfdhps-A613S were detected for the first time in DRC. Also, 11 (0.8%) isolates revealed the presence of the newly described pfdhps-I431V mutation. Combining pfdhfr and pfdhps alleles, quintuple and sextuple mutations were observed, with the emergence of septuple (IRNI/IAGEGA)- and octuple (IRNI/VAGKGS)-mutant genotypes.
Conclusions: Intermittent preventive treatment using sulfadoxine/pyrimethamine during pregnancy remains warranted in southwestern DRC. However, the expansion of pfdhps-K540E mutation and emergence of mutants that cause higher levels of sulfadoxine/pyrimethamine resistance is concerning and may present a challenge for future preventive interventions in the country.