Emergence of artemisinin-resistant malaria on the western border of Thailand: a longitudinal study.
Emergence of artemisinin-resistant malaria on the western border of Thailand: a longitudinal study.
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DOI：
10.1016/s0140-6736(12)60484-x
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发表时间：
2012-05-26
期刊：
影响因子：
168.9
通讯作者：
Nosten, Francois
中科院分区：
文献类型：
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作者：
Phyo, Aung Pyae;Nkhoma, Standwell;Stepniewska, Kasia;Ashley, Elizabeth A.;Nair, Shalini;McGready, Rose;Moo, Carit Ler;Al-Saai, Salma;Dondorp, Arjen M.;Lwin, Khin Maung;Singhasivanon, Pratap;Day, Nicholas P. J.;White, Nicholas J.;Anderson, Tim J. C.;Nosten, Francois
柬埔寨西部出现了抗青蒿素恶性疟疾。国际社会正在共同努力遏制对青蒿素耐药的恶性疟原虫，但遏制策略取决于其他地方是否出现了耐药性。我们的目的是确定青蒿素耐药性是否已在泰缅边境蔓延或出现。在位于泰国西北边境的疟疾诊所，我们测量了自 2001 年以来接受各种口服含青蒿酯治疗方案的无并发症高寄生性恶性疟疾患者（感染红细胞≥4%）的每 6 小时寄生虫计数。估计了寄生虫清除半衰期，并对寄生虫的 93 个单核苷酸多态性进行了基因分型。 2001 年至 2010 年间，对 3202 名患者进行了研究。寄生虫清除半衰期从 2001 年的几何平均值 2·6 小时（95% CI 2·5–2·7）延长至 2010 年的 3·7 小时（3·6–3·8），而柬埔寨西部 119 名患者的平均半衰期为 5·5 小时（5·2–5·9）。 2007 年和 2010 年。缓慢清除感染（半衰期≥6·2 小时）的比例从 2001 年的 0·6% 增加到 2010 年的 20%，而 2007 年至 2010 年柬埔寨西部的这一比例为 42%。在 1583 例感染基因分型中，鉴定出 148 种多位点寄生虫基因型，每种基因型感染人数在 2 至 13 之间。患者。由寄生虫基因引起的寄生虫清除率变异的比例从 2001 年至 2004 年的 30% 增加到 2007 年至 2010 年的 66%。 恶性疟原虫中基因决定的青蒿素抗性至少在 8 年前在泰缅边境出现，此后大幅增加。按照这个增长速度，耐药性将在 2-6 年内达到柬埔寨西部报道的水平。威康信托基金会和国立卫生研究院。
Artemisinin-resistant falciparum malaria has arisen in western Cambodia. A concerted international effort is underway to contain artemisinin-resistant Plasmodium falciparum, but containment strategies are dependent on whether resistance has emerged elsewhere. We aimed to establish whether artemisinin resistance has spread or emerged on the Thailand–Myanmar (Burma) border. In malaria clinics located along the northwestern border of Thailand, we measured six hourly parasite counts in patients with uncomplicated hyperparasitaemic falciparum malaria (≥4% infected red blood cells) who had been given various oral artesunate-containing regimens since 2001. Parasite clearance half-lives were estimated and parasites were genotyped for 93 single nucleotide polymorphisms. 3202 patients were studied between 2001 and 2010. Parasite clearance half-lives lengthened from a geometric mean of 2·6 h (95% CI 2·5–2·7) in 2001, to 3·7 h (3·6–3·8) in 2010, compared with a mean of 5·5 h (5·2–5·9) in 119 patients in western Cambodia measured between 2007 and 2010. The proportion of slow-clearing infections (half-life ≥6·2 h) increased from 0·6% in 2001, to 20% in 2010, compared with 42% in western Cambodia between 2007 and 2010. Of 1583 infections genotyped, 148 multilocus parasite genotypes were identified, each of which infected between two and 13 patients. The proportion of variation in parasite clearance attributable to parasite genetics increased from 30% between 2001 and 2004, to 66% between 2007 and 2010. Genetically determined artemisinin resistance in P falciparum emerged along the Thailand–Myanmar border at least 8 years ago and has since increased substantially. At this rate of increase, resistance will reach rates reported in western Cambodia in 2–6 years. The Wellcome Trust and National Institutes of Health.