Genetic variation of the dihydrofolate reductase gene in Plasmodium vivax in Snoul, northeastern Cambodia.

In Plasmodium vivax, pyrimethamine resistance is associated with amino acid substitutions Ser117Asn and Ser58Arg in dihydrofolate reductase (DHFR), which correspond to Ser108Asn and Cys59Arg in the Plasmodium falciparum homolog, respectively. Sequence variations within the DHFR domain of 32 P. vivax isolates from Snoul, Cambodia, were analyzed by direct sequencing of polymerase chain reaction (PCR) products. Sequence polymorphisms within the entire DHFR domain were limited to codons 58 and 117 and GGDN tandem repeat units. A large majority (30 of 32) of isolates were characterized to be double mutants (Arg-58 and Asn-117) and associated with the presence of two GGDN repeat units. Only one isolate was of wild-type with three GGDN repeat units, and an additional isolate was of mixed type. Our data suggest that most Cambodian P. vivax isolates display double dhfr mutations associated with pyrimethamine resistance, as in the neighboring countries in Southeast Asia. Further molecular characterization of P. vivax isolates from different endemic areas may be a useful alternative approach to establish the epidemiology of drug-resistant malaria.