Assessment of Plasmodium falciparum Artemisinin Resistance Independent of <i>kelch13</i> Polymorphisms and with Escalating Malaria in Bangladesh
Maisha Khair Nima, Angana Mukherjee, Saiful Arefeen Sazed, Muhammad Riadul Haque Hossainey, Ching Swe Phru, Fatema Tuj Johora, Innocent Safeukui, Anjan Saha, Afsana Alamgir Khan, Aung Swi Prue Marma, Russell E. Ware, Narla Mohandas, Barbara Calhoun, Rashidul Haque, Wasif Ali Khan, Mohammad Shafiul Alam, Kasturi Haldar
Abstract
Malaria elimination is a Millennium Development Goal. Artemisinins, fast-acting antimalarial drugs, have played a key role in malaria elimination. Emergence of artemisinin resistance threatens the global elimination of malaria. Over the last decade, advanced clinical and laboratory methods have documented its spread throughout South East Asia and Myanmar. Neighboring Bangladesh lies in the historical path of dissemination of antimalarial resistance to the rest of the world, yet it has not been evaluated by combinations of leading methods, particularly in the highland Chittagong Hill Tracts adjacent to Myanmar which contain >90% of malaria in Bangladesh. We show the first establishment of capacity to assess clinical artemisinin resistance directly in patients in the hilltops and laboratory adaptation of Bangladeshi parasite strains from a remote, sparsely populated malaria frontier that is responsive to climate. Our study also provides a generalized model for comprehensive monitoring of drug resistance for countries where malaria is endemic.