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

Abstract

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.

Evidence of Self-Medication with Chloroquine before Consultation for Malaria in the Southern Pacific Coast Region of Colombia

“…One of the most negative effects of self-medication is the selection of drug-resistant microorganisms. 11 It has previously been shown that the availability and use of CQ is linked to high prevalence of pfcrt mutant alleles, 23 and that withdrawal of CQ has been associated with the reduction of CQresistant parasites. 24 The frequencies of CQ-susceptible parasites as high as 91% were recently reported in samples from countries of Africa where CQ use was discontinued.…”

Antibody responses to two new Lactococcus lactis-produced recombinant Pfs48/45 and Pfs230 proteins increase with age in malaria patients living in the Central Region of Ghana

“…1 ) from January to December 2012. These districts have been shown to harbor parasites with varying drug resistance susceptibilities [ 19 ] and a parasite prevalence ranging from 11.4 to 15.4% [ 20 ].

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“…This study utilized paired archived filter paper blood blots and serum samples from 95 volunteers who had been confirmed as P. falciparum positive at the three district hospitals in a larger study conducted in 2012 and previously reported by Asare et al [ 19 ].…”

Natural antibody responses to Plasmodium falciparum MSP3 and GLURP(R0) antigens are associated with low parasite densities in malaria patients living in the Central Region of Ghana

“…Peripheral whole blood samples used for dried filter paper blood blots, thick and thin blood smears and harvesting of serum were collected from each participant as part of a larger study from three districts in the Central Region of Ghana [ 24 ]. The hemoglobin concentrations of the blood samples were measured directly using automated blood analyzers in the various study hospitals.…”