Experts have long been worried about the emergence of drug resistance across the continent, which accounts for more than 90% of malaria deaths in 2019.
Researchers reported the first clinical evidence that the drug-resistant mutations of the malaria parasite are at work in Africa.
Experts have long been worried about the emergence of drug resistance across the continent, which accounts for more than 90% of all malaria deaths worldwide in 2019.
A new study published in The Lancet on Thursday seems to confirm those fears.
In clinical trials, the disease lasted longer in children on standard malaria treatment if they were infected with mutant strains of the disease, research found.
The effectiveness of artemisinin-based combination therapies (ACTs) remains high, but the researchers report a “urgent need” to be monitored more in Rwanda, where research is conducted, as well as in other Neighbor country.
According to the World Health Organization (WHO), there are an estimated 229 million malaria cases worldwide.
The disease has killed more than 400,000 people in 2019, more than two-thirds of them are children.
Malaria is caused by the parasite Plasmodium falciparum, which is carried by female mosquitoes from any of the several dozen species in the genus Anopheles.
“Our research shows that resistant strains of bacteria are starting to become more common,” said lead author Aline Uwimana, a researcher at the Rwanda Biomedical Center in Kigali.
Introduced in the early 2000s, ACTs are the most effective and widely used treatment for malaria.
Artemisinin combines most of the pathogens from the patient’s body within three days, and a long-acting counterpart helps to remove the remaining parasites.
Resistance to the artemisinin component is suspected if Plasmodium falciparum, the malaria parasite, persists after the third day of treatment.
Currently, 10 mutations in one of the parasite’s genes, called pfk13, have been confirmed as a marker of partial resistance.
Partially resistant artemisinin was first identified in Cambodia in 2008 and today has been fully documented in many Southeast Asian countries.
Evidence from the Mekong region – Cambodia, Laos, Myanmar, Thailand, and Vietnam – has shown that once artemisinin resistance becomes widespread, counterpart resistance often leads to treatment. ACT failed.
In 2006, Rwanda introduced the most widely used antimalarial drug as the first treatment for the disease.
One study in 2013 and 2014 showed some mutations, but there was no evidence that the drug combination was less effective.
However, follow-up study in 2018, for the first time, showed mutations in the pfk13 gene and the so-called slow parasitic clearance in patients, although the effectiveness of ACT remains above the critical threshold. 90%.
In the trial, more than 200 children – from six months to five years old – infected with the parasite were treated as standard for three days and then followed for 28 days.
About 15% have detectable parasites after three days of treatment.
“Recent data show that we are on the brink of clinically significant artemisinin resistance in Africa,” wrote Philip Rosenthal, a professor at the University of California in San Francisco, in a comment, also in The Lancet. .
“The inactivity of critical ACTs” could have serious consequences, as happened when chloroquine resistance led to a significant increase in malaria deaths by the end of the twentieth century, he said. “.