High prevalence of PfCRT K76T mutation in Plasmodium falciparum isolates in Ghana

Afoakwah, Richmond; Boampong, Johnson Nyarko; Egyir-Yawson, Alexander; Nwaefuna, Ekene K.; Orish, Verner N.; Asare, Kwame Kumi

doi:10.1016/j.actatropica.2014.03.030

Cited by 21 publications

(23 citation statements)

References 25 publications

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“…This indicates the possibility of spontaneous or unintentional induction of parasite resistance to quinine or quinoline, by the use of an HP with similar chemical structure. The presence of these analogs in the HPs could probably explain the reasons for slow recovery of chloroquine sensitive clones in Ghana as reported by Afoakwah et al [16]. Elsewhere, disuse of chloroquine resulted in the reversion of chloroquine sensitivity after a period [17].…”

Section: Discussionmentioning

confidence: 96%

In vivo efficacy of top five surveyed Ghanaian herbal anti-malarial products

Wilmot

Ameyaw

Amoako-Sakyi

et al. 2017

Malar J

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BackgroundAnti-malarial herbal preparations (HPs) continue to enjoy high patronage in Ghana despite reports that the artemisinin-based combination therapy (ACT), the recommended first choice for treatment of uncomplicated malaria in the country, remains efficacious. A major issue with the use of these preparations is inadequate or unreliable data on their efficacy and quality. An assessment of the potency and quality of the most popular commercial anti-malarial HPs in Ghana was, therefore, carried out. The outcome of this investigation is herein discussed preceded by a short literature review of herbal medicines in Ghana.MethodsUsing a questionnaire survey of 344 individuals in parts of Ghana, five of the most frequently used HPs were identified and selected for test of their efficacy and quality. The effect of the selected compounds on Plasmodium berghei in vivo was assessed using standard methods.ResultsAll five tested HPs (HP-A, HP-B, HP-C, HP-D and HP-E) showed chemo-suppressive activity against P. berghei in vivo. However the degree of parasites inhibition is significantly lower compared to the WHO-recommended artemether–lumefantrine combination (p < 0.05, 99.9% chemosuppression/activity, 28 days survival). Using the Solomon Saker’s Test, two of the preparations were found to contain chloroquine or compounds with chemical properties like that of chloroquine.ConclusionPopular anti-malarial HPs used in southern Ghana were found to have chemo-suppressive properties. Intentional addition of chloroquine or SCs to these preparations in order to enhance their effectiveness has serious public health concerns as it may induce cross resistance to amodiaquine, one of the partner drugs in the recommended ACT for use in Ghana.

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Section: Discussionmentioning

confidence: 96%

In vivo efficacy of top five surveyed Ghanaian herbal anti-malarial products

Wilmot

Ameyaw

Amoako-Sakyi

et al. 2017

Malar J

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“…Chloroquine resistance in Ghana dates back to 1965 [20], with chloroquine-resistant P. falciparum isolates documented increasingly thereafter [21e24], up until artemisinin-based combination therapy replaced chloroquine nation-wide in 2004e05 [25]. Now, rates of chloroquine resistant P. falciparum in Ghana are approximately 59%, with predominant mutations of Pfcrt position 76 [26]. "Susceptible" Pfcrt 76 alleles have been found in 25e76% of P. falciparum isolates in Ghana as recently as 2010 [19].…”

Section: Discussionmentioning

confidence: 99%

Failure of atovaquone-proguanil malaria chemoprophylaxis in a traveler to Ghana

Boggild

Lau

Reynaud

et al. 2015

Travel Medicine and Infectious Disease

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“…Various studies since the change in malaria treatment policy in Ghana have reported different levels in prevalence of the mutant pfcrt T76 in P. falciparum isolates collected from different parts of the country [4,5,16]. CQ pressure is driven by high CQ usage in an area and it is a major determinant of selection and spread of CQ resistance genes among P. falciparum population [17-19].…”

Section: Discussionmentioning

confidence: 99%

“…The current high prevalence of pfcrt threatens anti-malarial treatment policy in the country. Since mutations in pfcrt have shown to confer resistance to amodiaquine which co-partners artesunate in the combination therapy as first line malaria treatment regimen in the country, it is important to constantly monitor the efficacy of all ACT regimen especially amodiaquine-based ACT for early detection of P. falciparum resistance [16,26,32,45-48]. Also the level of quinine and amodiaquine resistance [5] as well as treatment failures with artesunate + amodiaquine in the country requires constant monitoring.…”

Section: Discussionmentioning

confidence: 99%

Use of proscribed chloroquine is associated with an increased risk of pfcrt T76 mutation in some parts of Ghana

Asare

Boampong

Afoakwah

et al. 2014

Malar J

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BackgroundAfter years of disuse of chloroquine (CQ) as first-line anti-malarial drug in Ghana, reports from molecular studies conducted in parts of the country indicate varying prevalence of T76 mutation in the pfcrt gene. This situation has several health implications, one being that mutations that confer resistance to CQ have been reported to show substantial cross-resistance to other anti-malarial drugs. It is important to identify some of the factors contributing to the continuous presence of CQ resistance markers in the country. This study determined the prevalence of T76 mutation in pfcrt gene of Plasmodium falciparum isolates collected from selected areas of the Central region of Ghana and correlated with the level of CQ use in these areas.MethodsPlasmodium falciparum DNA was extracted from collected blood-blot filter paper samples in the study sites. The prevalence of T76 point mutation in pfcrt gene was assessed using nested PCR followed by RFLP. CQ from pharmacy and chemical shops was obtained using mystery buying method. The extent of CQ use by the participants was determined by measuring the level of the drug in their urine samples using the Saker-Solomon method.ResultsOf the 214 P. falciparum isolates analysed, 71.9% were found to have T76 mutation of pfcrt gene. The study revealed that 14.49% of community pharmacies and chemical shops had stocks of CQ for sale while 16.9% of the participants had CQ in their urine samples. There is five times more risks of becoming infected with CQ resistant strain for staying in an area where CQ is stocked for sale [RR = 0.20, p < 0.0001] and thirteen times more risks of having CQ-resistant mutant from those who still use CQ than non-users [OR = 0.08, p < 0.0001].ConclusionThis study has shown that high variation in the prevalence of T76 mutations of P. falciparum is linked with the level of CQ stocking and usage within study area.

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High prevalence of PfCRT K76T mutation in Plasmodium falciparum isolates in Ghana

Cited by 21 publications

References 25 publications

In vivo efficacy of top five surveyed Ghanaian herbal anti-malarial products

In vivo efficacy of top five surveyed Ghanaian herbal anti-malarial products

Failure of atovaquone-proguanil malaria chemoprophylaxis in a traveler to Ghana

Use of proscribed chloroquine is associated with an increased risk of pfcrt T76 mutation in some parts of Ghana

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