Emergence of Plasmodium falciparum triple mutant in Cambodia

The rationale for this combination relies on evidence that parasites carrying markers of resistance both to artemisinin (pfKelch13-580Y mutant) and piperaquine (later associated with the amplification of pfplasmepsin2)3,4 have regained susceptibility to mefloquine (low in vitro IC50 [half maximal in...

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Bibliographic Details
Published in:The Lancet infectious diseases 2017-12, Vol.17 (12), p.1233-1233
Main Authors: Rossi, Gabriele, De Smet, Martin, Khim, Nimol, Kindermans, Jean-Marie, Menard, Didier
Format: Article
Language:English
Subjects:
Antimalarials
Cambodia
Drug Resistance
Erythrocytes
Genotype & phenotype
Human health and pathology
Humans
Infectious diseases
Life Sciences
Malaria
Malaria, Falciparum
Mutation
Parasites
Plasmodium falciparum
Vector-borne diseases
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Summary:The rationale for this combination relies on evidence that parasites carrying markers of resistance both to artemisinin (pfKelch13-580Y mutant) and piperaquine (later associated with the amplification of pfplasmepsin2)3,4 have regained susceptibility to mefloquine (low in vitro IC50 [half maximal inhibitory concentration] values and the single-copy pfmdr1, the amplification of which has been associated with mefloquine resistance).2 One valuable hypothesis is that these genetic events could represent counteracting resistance mechanisms, allowing strategies of alternating mefloquine and piperaquine (or a combination of all three drugs) to be considered as reasonable treatment options.In October, 2015, MSF strengthened the malaria passive case detection activity by adding the systematic collection of blood samples for subsequent real-time PCR analysis.5 Over this period, the first-line treatment changed from DHA-PPQ (before February, 2016) to ASMQ (after February, 2016), and 194 clinical cases of P falciparum were confirmed (130 before and 64 after February, 2016).In view of these data, vigilant drug resistance surveillance and investment in alternative treatment options are warranted.
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(17)30635-7