The landscape of drug resistance in Plasmodium falciparum malaria in the Democratic Republic of Congo: a mapping systematic review.

IF 3.6 Q1 TROPICAL MEDICINE
Nadine Kalenda Kayiba, Evariste Tshibangu-Kabamba, Angel Rosas-Aguirre, Natsuko Kaku, Yu Nakagama, Akira Kaneko, Dieudonné Mvumbi Makaba, Doudou Yobi Malekita, Brecht Devleesschauwer, Joris Losimba Likwela, Pius Kabututu Zakayi, Patrick DeMol, Georges Mvumbi Lelo, Marie-Pierre Hayette, Paul Lusamba Dikassa, Yasutoshi Kido, Niko Speybroeck
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Abstract

Context: The Democratic Republic of Congo (DRC), one of the most malaria-affected countries worldwide, is a potential hub for global drug-resistant malaria. This study aimed at summarizing and mapping surveys of malaria parasites carrying molecular markers of drug-resistance across the country.

Methods: A systematic mapping review was carried out before July 2023 by searching for relevant articles through seven databases (PubMed, Embase, Scopus, African Journal Online, African Index Medicus, Bioline and Web of Science).

Results: We identified 1541 primary studies of which 29 fulfilled inclusion criteria and provided information related to 6385 Plasmodium falciparum clinical isolates (collected from 2000 to 2020). We noted the PfCRT K76T mutation encoding for chloroquine-resistance in median 32.1% [interquartile interval, IQR: 45.2] of analyzed malaria parasites. The proportion of parasites carrying this mutation decreased overtime, but wide geographic variations persisted. A single isolate had encoded the PfK13 R561H substitution that is invoked in artemisinin-resistance emergence in the Great Lakes region of Africa. Parasites carrying various mutations linked to resistance to the sulfadoxine-pyrimethamine combination were widespread and reflected a moderate resistance profile (PfDHPS A437G: 99.5% [IQR: 3.9]; PfDHPS K540E: 38.9% [IQR: 47.7]) with median 13.1% [IQR: 10.3] of them being quintuple IRN-GE mutants (i.e., parasites carrying the PfDHFR N51I-C59R-S108N and PfDHPS A437G-K540E mutations). These quintuple mutants tended to prevail in eastern regions of the country. Among circulating parasites, we did not record any parasites harboring mutations related to mefloquine-resistance, but we could suspect those with decreased susceptibility to quinine, amodiaquine, and lumefantrine based on corresponding molecular surrogates.

Conclusions: Drug resistance poses a serious threat to existing malaria therapies and chemoprevention options in the DRC. This review provides a baseline for monitoring public health efforts as well as evidence for decision-making in support of national malaria policies and for implementing regionally tailored control measures across the country.

刚果民主共和国恶性疟原虫疟疾耐药情况:制图系统回顾。
背景:刚果民主共和国(DRC)是世界上受疟疾影响最严重的国家之一,是全球耐药疟疾的潜在中心。本研究旨在总结和绘制全国携带耐药分子标记的疟原虫的调查结果。方法:通过PubMed、Embase、Scopus、African Journal Online、African Index Medicus、Bioline和Web of Science等7个数据库检索2023年7月前的相关文献,进行系统的图谱回顾。结果:我们确定了1541项初步研究,其中29项符合纳入标准,并提供了与6385株恶性疟原虫临床分离株(收集于2000年至2020年)相关的信息。我们发现PfCRT K76T突变编码氯喹耐药,在所分析的疟原虫中位数为32.1%[四分位数间隔,IQR: 45.2]。携带这种突变的寄生虫的比例随着时间的推移而下降,但广泛的地理差异仍然存在。单个分离株编码了在非洲大湖地区出现的青蒿素耐药中所使用的PfK13 R561H替代。携带与磺胺多辛-乙胺嘧啶联合抗性相关的各种突变的寄生虫广泛存在,反映了中等抗性谱(PfDHPS A437G: 99.5% [IQR: 3.9];PfDHPS K540E: 38.9% [IQR: 47.7]),中位数为13.1% [IQR: 10.3]为五重IRN-GE突变体(即携带PfDHFR N51I-C59R-S108N和PfDHPS A437G-K540E突变的寄生虫)。这些五重突变体倾向于在该国东部地区流行。在流行的寄生虫中,我们没有记录到任何寄生虫携带与甲氟喹耐药相关的突变,但我们可以根据相应的分子替代物怀疑这些寄生虫对奎宁、阿莫地喹和氟苯曲明的敏感性降低。结论:耐药性对刚果民主共和国现有的疟疾治疗和化学预防方案构成严重威胁。这项审查为监测公共卫生工作提供了基线,并为支持国家疟疾政策和在全国实施适合区域的控制措施的决策提供了证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Tropical Medicine and Health
Tropical Medicine and Health TROPICAL MEDICINE-
CiteScore
7.00
自引率
2.20%
发文量
90
审稿时长
11 weeks
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