Sulfadoxine-pyrimethamine parasitological efficacy against Plasmodium falciparum among pregnant women and molecular markers of resistance in Zambia: an observational cohort study.
Sulfadoxine-pyrimethamine parasitological efficacy against Plasmodium falciparum among pregnant women and molecular markers of resistance in Zambia: an observational cohort study.
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DOI：
10.1186/s12936-021-03596-3
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发表时间：
2021-01-22
期刊：
影响因子：
3
通讯作者：
Matthew Chico R
中科院分区：
文献类型：
--
作者：
Chaponda EB;Mharakurwa S;Michelo C;Bruce J;Chandramoha D;Matthew Chico R
世界卫生组织建议在疟疾传播强度中等至高度的地区，从妊娠第13周至分娩期间，每隔4周使用磺胺多辛-乙胺嘧啶间歇预防性治疗。然而，IPTp-SP的效果在一些地区由于寄生虫耐药而受到损害，这提高了寄生虫学和化学预防监测以及监测恶性疟原虫种群中sp耐药标记的重要性。2013年11月至2014年4月，在赞比亚恩切伦格，1086名孕妇在产前保健预约时接受了IPTp-SP。在治疗后第0天和第28天采集血样，检测疟疾寄生虫，并评估SP在治疗和预防寄生虫病方面的功效。分析了96个0天疟疾阳性样本的随机样本，以估计恶性疟原虫种群中sp耐药标记物的流行情况。在第0天和第28天进行配对血玻片检查的妇女中，总体寄生虫学和预防失败率为18.6% （95% CI 15.5, 21.8; 109 / 590）。在第0天无症状寄生虫血症的孕妇中，第28天pcr未纠正的寄生虫学失败为30.0% （95% CI: 23.7, 36.2； 207人中62人），第28天pcr纠正的寄生虫学失败为15.6% （95% CI: 10.6, 20.6； 205人中32人）。在第0天检测为阴性的妇女中，12.3% （95% CI: 9.0, 15.6； 383人中有47人）在第28天出现寄生虫血症。从第0天开始检测的96份疟疾阳性样本中，70.8% （95% CI: 60.8, 79.2）含有DHPS双突变（Gly-437 + Glu-540）， 92.7% （95% CI: 85.3, 96.5）含有DHFR三突变（Asn-108 + Ile-51 + Arg-59）。五倍突变（DHFR三倍+ DHPS双倍）和六倍突变（DHFR三倍+ DHPS双倍+ Arg-581）分别占68.8% （95% CI: 58.6, 77.3）和9.4% （95% CI: 4.2, 16.0）。SP的寄生虫学和化学预防失败，以及耐药标记物在恩切伦的患病率高得惊人。迫切需要替代疗法来保护孕妇免受疟疾感染。
The World Health Organization recommends the provision of intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) at 4-week intervals from gestational week 13 to delivery in areas of moderate to high malaria transmission intensity. However, the effect of IPTp-SP has been compromised in some areas due to parasite resistance, raising the importance of parasitological and chemoprophylactic surveillance, and monitoring SP-resistance markers in the Plasmodium falciparum population. Between November 2013 and April 2014 in Nchelenge, Zambia, 1086 pregnant women received IPTp-SP at antenatal-care bookings. Blood samples were collected on day 0, and on day 28 post-treatment to test for malaria parasites and to estimate SP parasitological efficacy in the treatment and prevention of parasitaemia. A random sample of 96, day 0 malaria-positive samples were analysed to estimate the prevalence of SP-resistance markers in the P. falciparum population. The overall parasitological and prophylactic failure among women who had paired day 0 and day 28 blood slides was 18.6% (95% CI 15.5, 21.8; 109 of 590). Among pregnant women who had asymptomatic parasitaemia on day 0, the day 28 PCR-uncorrected parasitological failure was 30.0% (95% CI 23.7, 36.2; 62 of 207) and the day 28 PCR-corrected parasitological failure was 15.6% (95% CI: 10.6, 20.6; 32 of 205). Among women who tested negative at day 0, 12.3% (95% CI: 9.0, 15.6; 47 of 383) developed parasitaemia at day 28. Among the 96 malaria-positive samples assayed from day 0, 70.8% (95% CI: 60.8, 79.2) contained the DHPS double (Gly-437 + Glu-540) mutation and 92.7% (95% CI: 85.3, 96.5) had the DHFR triple (Asn-108 + Ile-51 + Arg-59) mutation. The quintuple mutation (DHFR triple + DHPS double) and the sextuple mutant (DHFR triple + DHPS double + Arg-581) were found among 68.8% (95% CI: 58.6, 77.3) and 9.4% (95% CI: 4.2, 16.0) of samples, respectively. The parasitological and chemoprophylactic failure of SP, and the prevalence of resistance markers in Nchelenge is alarmingly high. Alternative therapies are urgently needed to safeguard pregnant women against malarial infection.
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影响因子：
3
作者：
Chaponda, Enesia Banda;Chandramohan, Daniel;Chico, R. Matthew
通讯作者：
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影响因子：
9.4
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通讯作者：
da Silva, AJ
影响因子：
3
作者：
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Mharakurwa, Sungano