Evidence of Artemisinin-Resistant Malaria in Africa
Betty Balikagala, Naoyuki Fukuda, Mie Ikeda, Osbert T. Katuro, Shin‐Ichiro Tachibana, Masato Yamauchi, Walter Opio, Sakurako Emoto, Denis A. Anywar, Eisaku Kimura, Nirianne Palacpac, Emmanuel Igwaro Odongo-Aginya, Martin Ogwang, Toshihiro Horii, Toshihiro Mita
Abstract
BACKGROUND: has developed resistance to derivatives of artemisinin, the main component of first-line treatments for malaria. Clinical resistance to artemisinin monotherapy in other global regions, including Africa, would be problematic. METHODS: infection with intravenous artesunate (a water-soluble artemisinin derivative) and estimated the parasite clearance half-life. We evaluated ex vivo susceptibility of the parasite using a ring-stage survival assay and genotyped resistance-related genes. RESULTS: mutations increased significantly, from 3.9% in 2015 to 19.8% in 2019, due primarily to the increased frequency of the A675V and C469Y alleles (P<0.001 and P = 0.004, respectively). Single-nucleotide polymorphisms flanking the A675V mutation in Uganda were substantially different from those in Southeast Asia. CONCLUSIONS: mutations may be markers for detection of these resistant parasites. (Funded by the Japan Society for the Promotion of Science and others.).