Sri Krishna1, Sweta Mishra1, Prakash Tiwari1, Anup K Vishwakarma1, Sushrikanta Khandai1, Suyesh Shrivastava1, Anil K Verma1, Shashikant Tiwari1, Hari Barman1, Surendra Jhariya1, Pradeep Tiwari1, Anup S Tidgam2, Brij M Varun3, Sunil Singh4, Naresh Yerane5, Chintaman R Tembhurne6, Prem L Mandavi7, Shyam S Tekam8, Manas Malik9, Kali P Behera10, Himanshu Jayswar11, Khemraj Sonwani12, Mukund S Diggikar13, Madan M Pradhan14, Sher S Khasotiya15, Avdhesh Kumar15, Neeraj Dhingra15, Maria Dorina G Bustos16, Eva-Maria Christophel17, Pascal Ringwald18, Roop Kumari19, Man M Shukla1, Neeru Singh1, Aparup Das1, Praveen K Bharti20. 1. ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India. 2. Medical Officer, Balaghat, Madhya Pradesh, India. 3. District Malaria Office, Balaghat, Madhya Pradesh, India. 4. Community Health Centre Damoh, Balaghat, Madhya Pradesh, India. 5. Community Health Centre Darekasa, Gondia, Maharashtra, India. 6. District Malaria Office, Gondia, Maharashtra, India. 7. Community Health Centre, District Bastar, Darbha, Chhattisgarh, India. 8. District Malaria Office, District Bastar, Jagdalpur, Chhattisgarh, India. 9. Community Health Centre Bandhgram, District Koraput, Dasmantpur, Odisha, India. 10. District Malaria Office, District Koraput, Dasmantpur, Odisha, India. 11. Directorate of Health Services, Satpura Bhawan, Bhopal, Madhya Pradesh, India. 12. Directorate of Health Services, Indravati Bhawan, Raipur, Chhattisgarh, India. 13. Arogya Bhavan, Yerawada, Pune, Maharashtra, India. 14. State NVBDCP, Public Health Directorate, Bhubaneswar, Odisha, India. 15. National Vector Borne Disease Control Programme (NVBDCP), New Delhi, India. 16. Country Office for Thailand, World Health Organization, Bangkok, Thailand. 17. World Health Organization, Regional Office for South-East Asia, New Delhi, India. 18. Global Malaria Programme, World Health Organization, Geneva, Switzerland. 19. World Health Organization, Country Office for India, New Delhi, India. 20. ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India. saprapbs@yahoo.co.in.
Abstract
BACKGROUND: Malaria is a major public health problem in India and accounts for about 88% of malaria burden in South-East Asia. India alone accounted for 2% of total malaria cases globally. Anti-malarial drug resistance is one of the major problems for malaria control and elimination programme. Artemether-lumefantrine (AL) is the first-line treatment of uncomplicated Plasmodium falciparum in north eastern states of India since 2013 after confirming the resistance against sulfadoxine-pyrimethamine. In the present study, therapeutic efficacy of artemether-lumefantrine and k13 polymorphism was assessed in uncomplicated P. falciparum malaria. METHODS: This study was conducted at four community health centres located in Koraput district of Odisha, Bastar district of Chhattisgarh, Balaghat district of Madhya Pradesh and Gondia district of Maharashtra state. Patients with uncomplicated P. falciparum malaria were administered with fixed dose combination (6 doses) of artemether-lumefantrine for 3 days and clinical and parasitological response was recorded up to 28 days as per World Health Organization protocol. Nucleotide sequencing of msp1 and msp2 gene was performed to differentiate between recrudescence and reinfection. Amplification and sequencing of k13 propeller gene region covering codon 450-680 was also carried out to identify the polymorphism. RESULTS: A total 376 malaria patients who fulfilled the enrolment criteria as well as consented for the study were enrolled. Total 356 patients were followed up successfully up to 28 days. Overall, the adequate clinical and parasitological response was 98.9% and 99.4% with and without PCR correction respectively. No case of early treatment failure was observed. However, four cases (1.1%) of late parasitological failure were found from the Bastar district of Chhattisgarh. Genotyping of msp1 and msp2 confirmed 2 cases each of recrudescence and reinfection, respectively. Mutation analysis of k13 propeller gene showed one non-synonymous mutation Q613H in one isolate from Bastar. CONCLUSIONS: The study results showed that artemether-lumefantrine is highly effective in the treatment of uncomplicated P. falciparum malaria among all age groups. No functional mutation in k13 was found in the study area. The data from this study will be helpful in implementation of artemether-lumefantrine in case of treatment failure by artesunate plus sulfadoxine-pyrimethamine.
BACKGROUND:Malaria is a major public health problem in India and accounts for about 88% of malaria burden in South-East Asia. India alone accounted for 2% of totalmalaria cases globally. Anti-malarial drug resistance is one of the major problems for malaria control and elimination programme. Artemether-lumefantrine (AL) is the first-line treatment of uncomplicated Plasmodium falciparum in north eastern states of India since 2013 after confirming the resistance against sulfadoxine-pyrimethamine. In the present study, therapeutic efficacy of artemether-lumefantrine andk13 polymorphism was assessed in uncomplicated P. falciparum malaria. METHODS: This study was conducted at four community health centres located in Koraput district of Odisha, Bastar district of Chhattisgarh, Balaghat district of Madhya Pradesh and Gondia district of Maharashtra state. Patients with uncomplicated P. falciparum malaria were administered with fixed dose combination (6 doses) of artemether-lumefantrine for 3 days and clinical and parasitological response was recorded up to 28 days as per World Health Organization protocol. Nucleotide sequencing of msp1 and msp2 gene was performed to differentiate between recrudescence and reinfection. Amplification and sequencing of k13 propeller gene region covering codon 450-680 was also carried out to identify the polymorphism. RESULTS: A total 376 malariapatients who fulfilled the enrolment criteria as well as consented for the study were enrolled. Total 356 patients were followed up successfully up to 28 days. Overall, the adequate clinical and parasitological response was 98.9% and 99.4% with and without PCR correction respectively. No case of early treatment failure was observed. However, four cases (1.1%) of late parasitological failure were found from the Bastar district of Chhattisgarh. Genotyping of msp1 and msp2 confirmed 2 cases each of recrudescence and reinfection, respectively. Mutation analysis of k13 propeller gene showed one non-synonymous mutation Q613H in one isolate from Bastar. CONCLUSIONS: The study results showed that artemether-lumefantrine is highly effective in the treatment of uncomplicated P. falciparum malaria among all age groups. No functional mutation in k13 was found in the study area. The data from this study will be helpful in implementation of artemether-lumefantrine in case of treatment failure by artesunate plus sulfadoxine-pyrimethamine.
Authors: Naman K Shah; Gajender P S Dhillon; Adtiya P Dash; Usha Arora; Steven R Meshnick; Neena Valecha Journal: Lancet Infect Dis Date: 2011-01 Impact factor: 25.071
Authors: Praveen Kumar Bharti; Mohammad Tauqeer Alam; Robert Boxer; Man Mohan Shukla; Sant P Gautam; Yagya D Sharma; Neeru Singh Journal: Trop Med Int Health Date: 2009-11-11 Impact factor: 2.622
Authors: Livingstone Tavul; Manuel W Hetzel; Albina Teliki; Dorish Walsh; Benson Kiniboro; Lawrence Rare; Justin Pulford; Peter M Siba; Stephan Karl; Leo Makita; Leanne Robinson; Johanna H Kattenberg; Moses Laman; Gilchrist Oswyn; Ivo Mueller Journal: Malar J Date: 2018-10-05 Impact factor: 2.979