Cross-sectional analysis links SP resistance polymorphisms to gametocyte carriage in Mozambican malaria isolates.
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Key Takeaway
Note significant association between quintuple SP resistance mutants and gametocyte carriage in Mozambican isolates.
This cross-sectional molecular analysis evaluated 100 P. falciparum isolates collected from pregnant women at delivery in Mozambique. The study assessed the presence of specific resistance polymorphisms in the pfdhfr and pfdhps genes alongside the detection of gametocytes. No active intervention was administered; rather, the study characterized the genetic profile of parasites present at the time of delivery.
Among the isolates analyzed, 54% harbored quintuple mutants and 7% harbored sextuple mutants. Gametocytes were detected in 34% of the total isolates. The analysis found that 80% of infections with detectable gametocytes were accounted for by isolates carrying quintuple mutants.
Statistical analysis revealed a significant positive association between gametocyte carriage and infections harboring quintuple mutant haplotypes. The adjusted odds ratio for this association was 7.5, with a p-value of 0.001. No safety data, adverse events, or tolerability information were reported in this observational molecular analysis.
The study highlights the relevance of ongoing surveillance of sulfadoxine-pyrimethamine resistance to guide future evaluation of alternative intermittent preventive treatment approaches. Continued drug pressure may contribute to the emergence of resistant parasites and potentially impact gametocyte carriage and subsequent infectiousness. These findings underscore the need for monitoring resistance patterns in this population.
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View Original Abstract ↓
The intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) remains the main strategy to prevent malaria in pregnancy. However, continued drug pressure may also contribute to the emergence of resistant parasites and impact the gametocyte carriage and subsequent infectiousness. Pregnant women are thought to be a potential reservoir for malaria transmission due to the increased carriage of gametocytes following long-lasting infections. We used molecular methods to examine 100 Plasmodium falciparum (P. falciparum) isolates collected from Mozambican women at delivery in 2014-15, to determine SP resistance polymorphisms in P. falciparum dihydrofolate reductase (pfdhfr) and dihydropteroate synthetase (pfdhps) genes as well as the presence of gametocytes by RT-qPCR. Overall, 54% and 7% of parasites harbored quintuple and sextuple pfdhfr/pfdhps mutant haplotypes, respectively. Gametocytes were detected in 34% of isolates. Gametocyte carriage was significantly associated with quintuple mutant infections (AOR = 7.5, p = 0.001), which accounted for 80% of infections with detectable gametocytes. Results indicate the relevance of ongoing surveillance of SP resistance in Mozambique to guide future evaluation of alternative IPTp approaches as resistance levels evolve and to anticipate potential implications for parasite transmission and maternal-fetal health.
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