Imported and autochthonous malaria in West Saudi Arabia: results from a reference hospital

Abstract

BackgroundThe Kingdom of Saudi Arabia is seeking malaria eradication. Malaria transmission has been very low over the last few years. Discovered cases of Plasmodium falciparum infection are assigned a treatment protocol of artemisinin-based combination therapy, which consists of artesunate in addition to sulfadoxine-pyrimethamine rather than the traditional chloroquine, which has high resistance rates worldwide. This study aims to investigate the presence of different gene mutations concerning anti-malarial drug resistance (pfdhfr, pfdhps, pfmdr1, pfcrt, pfcytb, pfketch13) to identify whether drug-resistant alleles are present in this area of the Kingdom and whether the country’s treatment protocol is still suitable for Plasmodium bearing a resistance mutation.MethodsBlood samples were collected from patients suffering from symptoms suggesting malaria coming to King Faisal Hospital, Taif, from February to August 2016. Diagnosis was performed by Giemsa-stained thin and thick blood films, rapid diagnostic test and PCR. Positive P. falciparum samples were further subjected to series of PCR amplification reactions targeting genes related with drug resistance (pfdhfr, pfdhps, pfmdr1, pfcrt, pfcytb, pfketch13).ResultsTwenty-six cases were positives, 13 infected with P. falciparum, of those, 4 cases were autochthonous, and 13 with Plasmodium vivax. The results of the gene mutation detection confirmed that there was no mutation related to resistance to artemisinin or atovaquone, on the other hand chloroquine resistance alleles were detected in 31% of samples. Moreover, point mutations in the pfdhfr and pfdhps genes, related resistance to antifolate drugs, were detected in all characterized samples.ConclusionsHaplotypes of P. falciparum in the western region of the Kingdom of Saudi Arabia exhibit high resistance against antifolate drugs. These results should be extensively discussed when planning to modify anti-malarial drug protocols in the future.

Malaria Prevalence in a Low Transmission Area, Jazan District of Southwestern Saudi Arabia

“…Researchers attributed the reduction of the native malaria cases in the study site to the effective control protocol and to the low rainfall practiced, 2000–2014 [11]. In Taif, a low transmission area, western Saudi Arabia and close to Mecca, much lower estimates of both imported and indigenous malaria have been reported in a hospital-based population [20]. Perhaps, the endemicity pattern of malaria in the study’s site, the study’s population, the clinical samples and the diagnostic methods used could explain the variation of the imported and indigenous malaria burden among studies.…”

Correction to: Imported and autochthonous malaria in West Saudi Arabia: results from a reference hospital

“…Following publication of the original article [ 1 ], it was flagged by one of the authors that the name of the P. falciparum gene marker of artemisinin resistance ‘pfkelch13’ was (incorrectly) written as “pfketch13”, which was repeated seven times in different parts of the published paper.…”

Influx of diverse, drug resistant and transmissible Plasmodium falciparum into a malaria-free setting in Qatar

“…The increased investments in control efforts beginning in the 1950s, are largely responsible for the interruption of local transmission, and ultimately led to malaria-free status in four of the six GCC countries. In Saudi Arabia, limited foci of indigenous malaria still exist [1,2], and in Oman sporadic outbreaks still occur periodically [3]. These successes have encouraged health ministries in GCC countries to shift policy toward a malaria-free Arabian Peninsula [4] and to focus on preventing reintroduction via sustainable vector control policy, improved surveillance, and prompt case management [5].…”