SULFADOXINE–PYRIMETHAMINE EFFICACY AND SELECTION OF PLASMODIUM FALCIPARUM DHFR MUTATIONS IN BURKINA FASO BEFORE ITS INTRODUCTION AS INTERMITTENT PREVENTIVE TREATMENT FOR PREGNANT WOMEN

HALIDOU TINTO Centre Muraz, Bobo Dioulasso, Burkina Faso; Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso; University of Antwerp, Antwerp, Belgium; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

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JEAN BOSCO OUÉDRAOGO Centre Muraz, Bobo Dioulasso, Burkina Faso; Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso; University of Antwerp, Antwerp, Belgium; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

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ISSAKA ZONGO Centre Muraz, Bobo Dioulasso, Burkina Faso; Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso; University of Antwerp, Antwerp, Belgium; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

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CHANTAL VAN OVERMEIR Centre Muraz, Bobo Dioulasso, Burkina Faso; Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso; University of Antwerp, Antwerp, Belgium; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

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ERIC VAN MARCK Centre Muraz, Bobo Dioulasso, Burkina Faso; Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso; University of Antwerp, Antwerp, Belgium; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

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TINGA ROBERT GUIGUEMDÉ Centre Muraz, Bobo Dioulasso, Burkina Faso; Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso; University of Antwerp, Antwerp, Belgium; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

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UMBERTO D’ALESSANDRO Centre Muraz, Bobo Dioulasso, Burkina Faso; Institut de Recherche en Sciences de la Santé, Bobo Dioulasso, Burkina Faso; University of Antwerp, Antwerp, Belgium; Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

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Sulfadoxine-pyrimethamine efficacy was determined with a 28-day follow-up in 97 children between 6 months and 15 years of age. The polymerase chain reaction (PCR)-corrected treatment failure was 8.2% and the uncorrected was 21.6%. The presence of the dihydrofolate reductase (DHFR) and dihydropteroate synthetase (DHPS) mutations linked to sulfadoxine-pyrimethamine resistance before and after treatment was determined by PCR-restriction fragment length polymorphism (RFLP) and by a fluorogenic PCR assay. Before treatment, the prevalence of the triple DHFR mutations was higher among the patients having had a recurrent parasitemia (either recrudescence or new infection; 28.6% versus 9.3%), although the difference was not significant (P = 0.1). The double mutation Ala-436/Gly-437 was observed in 67% of samples, whereas no Glu-540 mutation was found. After treatment, the triple DHFR mutation was found in 76.2% of patients with recurrent parasitemia, recrudescence, and new infection alike. Such high prevalence of mutant parasites indicates that sulfadoxine-pyrimethamine should not be used as monotherapy.

Author Notes

Reprint requests: Umberto D’Alessandro, Institute of Tropical Medicine, Nationalestraat 155, Antwerp B-2000, Belgium. E-mail: udalessandro@itg.be (cc to tintohalidou@yahoo.fr).
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