An outbreak of artemisinin resistant falciparum malaria in Eastern Thailand
An outbreak of artemisinin resistant falciparum malaria in Eastern Thailand
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DOI：
10.1038/srep17412
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发表时间：
2015-11-30
影响因子：
4.6
通讯作者：
Dondorp, Arjen M.
中科院分区：
文献类型：
--
作者：
Imwong, Mallika;Jindakhad, Thantip;Dondorp, Arjen M.
青蒿素耐药性恶性疟疾在东南亚是一个日益严重的问题，但尚未与该疾病传播的增加相关。 2014 年泰国东部乌汶叻差他尼最近爆发的一次疟疾爆发期间，对 101 名恶性疟疾患者的寄生虫进行了抗疟药物耐药性标记基因分型。 93% 的样本中存在青蒿素耐药性 Kelch13 标记突变，主要是通过微卫星分型鉴定出的来自 2 个主要簇的 C580Y。抗叶酸剂和氯喹的耐药性标记也非常普遍。大多数菌株 (91%) 携带单拷贝数 PfMDR1，表明对甲氟喹持续敏感，甲氟喹是当地一线青蒿素联合疗法 (ACT) 的配合药物。在最近的疟疾爆发中，青蒿素耐药性的高流行表明但并没有证明青蒿素耐药性在传播增加中发挥了因果作用。有必要仔细监测 ACT 疗效并进行额外的遗传流行病学研究，以指导公共卫生部门应对疫情。
Artemisinin resistant falciparum malaria is an increasing problem in Southeast Asia, but has not been associated with increased transmission of the disease, yet. During a recent outbreak in 2014 in Ubon Ratchatani, Eastern Thailand, parasites from 101 patients with falciparum malaria were genotyped for antimalarial drug resistance markers. Mutations in the Kelch13 marker for artemisinin resistance were present in 93% of samples, mainly C580Y from 2 major clusters as identified by microsatellite typing. Resistance markers for antifolates and chloroquine were also highly prevalent. Most strains (91%) carried single copy number PfMDR1, suggesting sustained sensitivity to mefloquine, the partner drug in the local first-line artemisinin combination therapy (ACT). The high prevalence of artemisinin resistance in this recent malaria outbreak suggests but does not prove a causative role in increased transmission. Careful monitoring of ACT efficacy and additional genetic epidemiological studies are warranted to guide the public health response to the outbreak.