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PLASMODIUM FALCIPARUM GENOTYPES ASSOCIATED WITH CHLOROQUINE AND AMODIAQUINE RESISTANCE IN GUINEA-BISSAU

Chloroquine is the most commonly used antimalarial in Guinea-Bissau and high doses are routinely prescribed. Blood from 497 patients treated with different doses of chloroquine or amodiaquine were genotyped. Pfcrt and pfmdr1 polymorphisms were identified. Pfmsp2 analysis identified recrudescent infections. The pfcrt 72–76 haplotypes were CVIET and CVMNK. The pfcrt 76T prevalence was 23% at day 0 and 96%, 83% and 100% at recrudescence following treatment with 25mg/kg and 50mg/kg of chloroquine and 15mg/kg of amodiaquine respectively. When treating pfcrt 76T carrying P. falciparum the efficacy of 50 mg/kg and 25mg/kg of chloroquine was 78% and 34% respectively (P = 0.007). The genetic basis of chloroquine resistance is probably the same in Guinea-Bissau as in the rest of Africa. The low pfcrt 76T prevalence suggests that resistance to normal dose chloroquine does not confer a major advantage to falciparum in Bissau and could be a result of treatment with high-dose chloroquine.

Received August 25, 2006. Accepted for publication February 13, 2007.

Acknowledgments: The authors thank all the staff and children in Bandim for work and participation.

Disclaimer: None of the authors have any conflicting interests.

^* Address correspondence to Johan Ursing, Department of Infectious Diseases, Karolinska Sjukhuset, Stockholm, Sweden. E-mail: johan.ursing{at}ki.se

Authors’ addresses: Johan Ursing, Department of Infectious Diseases, Karolinska Sjukhuset, Stockholm, Sweden, Telephone: 46-8-58580000, Fax: 46-8-51776740, E-mail: johan.ursing{at}ki.se. Poul-Erik Kofoed, Department of Paediatrics, Kolding Hospital, 6000 Kolding, Denmark, Telephone: 45-76362230, Fax: 45-76363474, E-mail: pekofoed{at}dadlnet.dk. Amabelia Rodrigues, Projecto de Saúde de Bandim, Apartado 861, 1004 Bissau Codex, Guiné-Bissau, Telephone: 245-204460/201489, Fax: 245-201672, E-mail: a.rodrigues{at}bandim.org. Lars Rombo, Division of Infectious Diseases, Thoracic Medicine and Dermatology, Mälarsjukhuset, Eskilstuna, Sweden, Telephone: 46-16103519, Fax: 46-16103551, E-mail: Lars.Rombo{at}dll.se. José Pedro Gil, Malaria Research Laboratory, M9:02, Karolinska Sjukhuset, 171 76 Stockholm, Sweden, Telephone: 46-8-51776850, Fax: 46-8-51776740, E-mail: jose.pedro.gil{at}ki.se.

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