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Am. J. Trop. Med. Hyg., 45(4), 1991, pp. 492-497
Copyright © 1991 by The American Society of Tropical Medicine and Hygiene

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Prevalence of the Dihydrofolate Reductase Asn-108 Mutation as the Basis for Pyrimethamine-Resistant Falciparum Malaria in the Brazilian Amazon

David S. Peterson, Silvia M. Di Santi, Marinete Povoa, Vanja S. Calvosa, Virgilio E. Do Rosario AND Thomas E. Wellems
Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda Maryland; SUCEN, Sao Paulo, SP, Brazil; Instituto Evandro Chagas, Belem, Brazil; Instituto de Higiene e Medicina Tropical, Lisbon, Portugal

Pyrimethamine resistance in cultivated laboratory isolates of Plasmodium falciparum is linked to the dihydrofolate reductase mutation Asn-108, a mutation that acts by interrupting drug binding within the active site of the enzyme. To determine the prevalence of this mutation in endemic regions harboring pyrimethamine-resistant malaria, we used a mutation-specific polymerase chain reaction assay to survey P. falciparum strains from a wide section of the Brazilian Amazon. Mutations were identified directly from blood samples without intervening steps of in vitro cultivation. Of 42 samples collected from four states in Brazil, 38 (90%) contained the Asn-108 codon AAC that confers pyrimethamine resistance, four samples contained only the wild-type Ser-108 codon AGC, and none contained the Thr-108 codon ACC found in cycloguanil-resistant pyrimethamine-sensitive strains. These findings indicate that a very high incidence of the Asn-108 DHFR mutation is responsible for pyrimethamine resistance in the Amazon, and they are consistent with recent failure rates reported for Fansidar (pyrimethamine-sulfadoxine). We suggest that limited use of proguanil be evaluated as an alternative to pyrimethamine.




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Copyright © 1991 by the American Society of Tropical Medicine and Hygiene.