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Am. J. Trop. Med. Hyg., 75(1), 2006, pp. 152-154
Copyright © 2006 by The American Society of Tropical Medicine and Hygiene

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SHORT REPORT


MOLECULAR MARKERS ASSOCIATED WITH PLASMODIUM FALCIPARUM RESISTANCE TO SULFADOXINE-PYRIMETHAMINE IN THE DEMOCRATIC REPUBLIC OF CONGO

SANDRA COHUET, MARYLINE BONNET, MICHEL VAN HERP, CHANTAL VAN OVERMEIR, UMBERTO D’ALESSANDRO, AND JEAN-PAUL GUTHMANN*
Epicentre, Paris, France; Médecins Sans Frontières, Brussels, Belgium; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

 

ABSTRACT

Sulfadoxine-pyrimethamine (SP) is the first line antimalarial treatment in the Democratic Republic of Congo. Using polymerase chain reaction, we assessed the prevalence of mutations in the dihydrofolate reductase (dhfr) (codons 108, 51, 59) and dihydropteroate synthase (dhps) (codons 437, 540) genes of Plasmodium falciparum, which have been associated with resistance to pyrimethamine and sulfadoxine, respectively. Four hundred seventy-four patients were sampled in Kilwa (N = 138), Kisangani (N = 112), Boende (N = 106), and Basankusu (N = 118). The proportion of triple mutations dhfr varied between sites but was always > 50%. The proportion of dhps double mutations was < 20%, with some sites as low as 0.9%. A quintuple mutation was present in 12.8% (16/125) samples in Kilwa; 11.9% (13/109) in Kisangani, 2.9% (3/102) in Boende, and 0.9% (1/112) in Basankusu. These results suggest high resistance to pyrimethamine alone or combined with sulfadoxine. Adding artesunate to SP does not seem a valid alternative to the current monotherapy.

Received October 3, 2005. Accepted for publication February 9, 2006.

Acknowledgments: The authors thank Dr. Nsibu Ndosimao, General Director of the PNLP, for authorizing this study, Dr. Alphonse Swana-Nimy for representing PNLP on the field, and Dr. Kristina Persson and Dr. Anja Huefner who supervised the data collection on the field. We also thank Rebecca Freeman Grais at Epicentre headquarters for reviewing an earlier draft of the manuscript.

Financial support: This study was funded by Médecins sans Frontières. The American Society of Tropical Medicine and Hygiene (ASTMH) assisted with publication expenses.

* Address correspondence to Jean-Paul Guthmann, Epicentre, 8 rue Saint Sabin, 75011 Paris, France. E-mail: jguthmann{at}epicentre.msf.org

Authors’ addresses: Sandra Cohuet, Maryline Bonnet, and Jean-Paul Guthmann, Epicentre, 8 rue Saint Sabin, 75011 Paris, France. E-mails: sandra.cohuet{at}lshtm.ac.uk, maryline.bonnet{at}geneva.msf.org, and jguthmann{at}epicentre.msf.org; Michel van Herp, Médecins sans Frontières, 94 rue Dupré, 1090 Brussels, Belgium, E-mail: michel.vanherp{at}msf.be; Chantal van Overmeir and Umberto D’Alessandro, Prince Léopold Institute of Tropical Medicine, 155 Nationalestraat, B-2000 Antwerp, Belgium, E-mails: cvoverm{at}itg.be and udalessandro{at}itg.be.

Reprints requests: Jean-Paul Guthmann, Epicentre, 8 rue Saint Sabin, 75011 Paris, France. E-mail: jguthmann{at}epicentre.msf.org.




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