Artemether-lumefantrine treatment failure of uncomplicated Plasmodium falciparum malaria in travellers coming from Angola and Mozambique

Abstract

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Malaria Transmission Dynamics in a High-Transmission Setting of Western Kenya and the Inadequate Treatment Response to Artemether-Lumefantrine in an Asymptomatic Population

“…In a longitudinal study conducted in children under 6 years of age in the same patient population in 2005, none of the participants had microscopically detected asexual or sexual parasites on day 28 after treatment with artemether-lumefantrine [ 36 ]. Our data raise the concern that the efficacy of artemether-lumefantrine may have declined in this study population over time, corroborating recent reports across the continent [ 19–21 , 37–39 ].…”

“…The observed high rates of parasite recurrence despite monthly treatment are consistent with an earlier study in western Kenya [ 18 ] and recent findings in Africa of persistent submicroscopic P. falciparum parasitemia 72 hours after treatment with artemether-lumefantrine, which predicted 42-day treatment failure [ 19–21 ]. This finding has previously been observed to vary depending on transmission intensity [ 20 ], which we also observed in our study.…”

Updates on Malaria Epidemiology and Prevention Strategies

“…Molecular studies of parasites to determine their genetic profile by PCR and sequencing may be useful to understand the parasite’s behaviour in relation to the treatment used. Experts have raised concerns that a three-day treatment may be insufficient to achieve cure and that patients should be followed-up closely beyond the 3-day treatment period [ 40 ].…”

Leveraging genome editing to functionally evaluate Plasmodium diversity

“…The Pfkelch13-mediated ART-R has been reported predominantly from Southeast Asia [29][30][31]; the gene has been shown not to be under strong selection pressure in the African region [32]. The widespread emergence of ART-R-conferring mutations across the world, along with recent reports of de novo emergence mutations in South America [33] and recently in Africa [34][35][36][37], further emphasizes the urgency of ongoing molecular surveillance for drug resistance markers, but also the need to anticipate the emergence of resistance-associated mutations globally. To truly confirm genotype-phenotype associations that arise through natural selective pressures on the genome, genome editing provides a valuable tool to determine causality (Figure 3).…”