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. 2014 Oct 1;210(7):1110-4.
doi: 10.1093/infdis/jiu216. Epub 2014 Apr 9.

Return of widespread chloroquine-sensitive Plasmodium falciparum to Malawi

Anne E P Frosch  1 , Miriam K Laufer  2 , Don P Mathanga  3 , Shannon Takala-Harrison  2 , Jacek Skarbinski  4 , Cassidy W Claassen  2 , Fraction K Dzinjalamala  5 , Christopher V Plowe  2
Affiliations

Return of widespread chloroquine-sensitive Plasmodium falciparum to Malawi

Anne E P Frosch et al. J Infect Dis. .

Abstract

Background: The return of chloroquine-sensitive Plasmodium falciparum to the limited area of Blantyre, Malawi, has been well demonstrated in several studies.

Methods: To characterize chloroquine susceptibility over a wide geographic area, infants and children aged 6-59 months were selected using 2-stage cluster sampling in 8 Malawian districts. Pyrosequencing of the pfcrt gene codon 76 region was performed for children with asexual parasitemia.

Results: Of 7145 children, 1150 had microscopic asexual parasitemia, and sequencing was performed in 685, of whom 1 had a chloroquine-resistant genotype.

Conclusions: Systematic countrywide sampling demonstrates that the chloroquine pfcrt genotype has reached near-fixation, raising the possibility of reintroducing chloroquine for malaria prevention and treatment.

Keywords: Africa; Malawi; PfCRT; Plasmodium falciparum; chloroquine; malaria; resistance.

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Figures

Figure 1.
Figure 1.
Map of sample distribution. Dots indicating chloroquine-sensitive samples represent multiple geographically proximal samples.
Figure 2.
Figure 2.
Pyrosequencing results. Pyrograms from a positive control, chloroquine-resistant strain Dd2 (A); a negative control, chloroquine-sensitive strain HB3 (B); and a field sample from Mwanza district with evidence of mixed chloroquine-resistant and chloroquine-sensitive infections (C). Note presence of guanine in the 76th codon of the field sample, which is the second nucleotide added in pyrosequencing, indicating the presence of chloroquine-resistant parasites. This field sample also contains adenosine in the 75th codon, which is the fourth nucleotide added, indicating the presence of chloroquine-sensitive parasites.
See this image and copyright information in PMC

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