Possible artemisinin-based combination therapy-resistant malaria in Nigeria: a report of three cases

Ajayi, Nnennaya A.; Ukwaja, Kingsley Nnanna

doi:10.1590/0037-8682-0098-2013

Cited by 36 publications

(35 citation statements)

References 9 publications

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“…The absence of ETF and low recurrent malaria (only 1 LCF) in the present study could imply high therapeutic efficacy of both components of AL in the study site. Studies in Ethiopia [23] and Nigeria [40] reported two and three ETF cases of AL treatment respectively.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria in a high-transmission area in northwest Ethiopia

et al. 2017

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Malaria, particularly due to Plasmodium falciparum, remains a major public health threat in Ethiopia. Artemether-lumefantine (AL) has been the first-line antimalarial drug against uncomplicated P. falciparum malaria in the country since 2004. Regular monitoring of antimalarial drugs is recommended by the World Health Organization (WHO) to help early detection of drug resistant strains of the parasite and contain their rapid spread. The objective of this study was to assess the therapeutic efficacy of AL in a high-transmission setting in Ethiopia. The study site was Setit Humera, northwest Ethiopia. Single-arm prospective study of a 28-day follow-up was conducted from October 2014 to January 2015 according to the revised WHO 2009 drug efficacy study protocol. Study end-points were classified into primary end-point and secondary end-point. While the primary end-point was the day-28 adequate clinical and parasitological response the secondary end-points were clinical and parasitological evaluations (parasite, fever and gametocyte clearance rate, incidence of drug adverse events) and the relative increment in hemoglobin (Hb) level from baseline to day (D) 14 and D28. A total of 92 patients were enrolled and 79 had completed the 28-day follow-up period. The overall cure rate was 98.8% with 95% confidence interval of 0.915–0.998 without polymerase chain reaction correction. The parasite clearance rate was high with fast resolution of clinical symptoms; 100% of the study participants cleared parasitaemia and fever on D3. Gametocyte carriage was reduced from 7% on D0 to 1% on D3 and complete clearance was achieved on D14. Mean Hb concentration significantly increased on D28 compared to that on D14. There was no serious adverse event. AL was efficacious and safe in a high-transmission setting for treatment of uncomplicated falciparum malaria.

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Section: Discussionmentioning

confidence: 99%

Therapeutic efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria in a high-transmission area in northwest Ethiopia

et al. 2017

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“…Reports indicate that about 9% of the Ghanaian population use HPs for malaria treatment [3]. With the looming possibility of parasite resistance to the recommended ACT [14] coupled with difficulties in affordability and accessibility to these drugs in remote and poor areas in the country, anti-malarial herbal preparations would continue to be an important and sustainable source of malaria treatment in Ghana. It must however be emphasized that the use of these preparations must be closely monitored.…”

Section: Discussionmentioning

confidence: 99%

In vivo efficacy of top five surveyed Ghanaian herbal anti-malarial products

Wilmot

Ameyaw

Amoako-Sakyi

et al. 2017

Malar J

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BackgroundAnti-malarial herbal preparations (HPs) continue to enjoy high patronage in Ghana despite reports that the artemisinin-based combination therapy (ACT), the recommended first choice for treatment of uncomplicated malaria in the country, remains efficacious. A major issue with the use of these preparations is inadequate or unreliable data on their efficacy and quality. An assessment of the potency and quality of the most popular commercial anti-malarial HPs in Ghana was, therefore, carried out. The outcome of this investigation is herein discussed preceded by a short literature review of herbal medicines in Ghana.MethodsUsing a questionnaire survey of 344 individuals in parts of Ghana, five of the most frequently used HPs were identified and selected for test of their efficacy and quality. The effect of the selected compounds on Plasmodium berghei in vivo was assessed using standard methods.ResultsAll five tested HPs (HP-A, HP-B, HP-C, HP-D and HP-E) showed chemo-suppressive activity against P. berghei in vivo. However the degree of parasites inhibition is significantly lower compared to the WHO-recommended artemether–lumefantrine combination (p < 0.05, 99.9% chemosuppression/activity, 28 days survival). Using the Solomon Saker’s Test, two of the preparations were found to contain chloroquine or compounds with chemical properties like that of chloroquine.ConclusionPopular anti-malarial HPs used in southern Ghana were found to have chemo-suppressive properties. Intentional addition of chloroquine or SCs to these preparations in order to enhance their effectiveness has serious public health concerns as it may induce cross resistance to amodiaquine, one of the partner drugs in the recommended ACT for use in Ghana.

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“…Although ACT-resistant malaria is rare in Africa, there is a historical precedence of resistance to antimalarial medicine emerging in Asia and spreading to Africa [26]. Three cases of early treatment failure due to possible ACT-resistant P. falciparum malaria have been reported in Nigeria [27]. There has also been a case of possible artemether-lumefantrine treatment failure in an Italian traveler with uncomplicated P. falciparum malaria imported from the Democratic Republic of the Congo [28].…”

Section: Discussionmentioning

confidence: 99%

Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria

Zhang

et al. 2017

Infect Dis Poverty

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BackgroundThe spleen plays a pivotal role in the rapid clearance of parasitized red blood cells in patients with falciparum malaria after artemisinin treatment. Prolonged parasite clearance can be found in patients who have had a splenectomy, or those with hemoglobin abnormalities and/or reduced immunity, which are all distinguishable from artemisinin resistance. This paper reports on a case of prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria.Case presentationA 35-year-old Chinese male suffered 2 days of febrile illness after returning to Zhumadian city of Henan province from Nigeria on October 1, 2014. The main symptoms were febrile, including the highest axillary temperature of 40 °C, headache, and chills. A peripheral blood smear showed parasitemia (53 913 asexual parasites/μl) of Plasmodium falciparum. The patient had not used any chemoprophylaxis against malaria in Nigeria when he worked there as a construction worker between 2009 and 2014. The patient had three episodes of malaria in Nigeria and had a splenectomy due to a traffic accident 8 years ago from the time he was admitted to hospital. The patient was orally administrated a total of 320 mg/2.56 g dihydroartemisinin-piperaquine for 2 days and intravenously administrated a total of 3 000 mg artesunate for 18 days. The axillary temperature of the patient ranged between 37.0 and 37.7 °C from Day 0 to Day 3, and blood microscopy revealed falciparum malaria parasitemia (26 674 asexual parasites/μl) on Day 3. The patient was afebrile on Day 4, falciparum malaria parasitemia was continuously present and then gradually decreased on the next days, and was negative on Day 21. The patient was cured and left hospital on Day 24 after no plasmodium falciparum was found in the blood on Day 21 to Day 23. No mutation was found in the K13 propeller gene when compared with the PF3D7_1343700 K13 propeller gene reference sequence.ConclusionsThis is the first reported case in China of prolonged parasite clearance in a splenectomized patient with imported falciparum malaria. Artemisinin resistance should be distinguished when prolonged parasite clearance is found in a malaria patient who has had splenectomy.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0259-5) contains supplementary material, which is available to authorized users.

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Possible artemisinin-based combination therapy-resistant malaria in Nigeria: a report of three cases

Cited by 36 publications

References 9 publications

Therapeutic efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria in a high-transmission area in northwest Ethiopia

Therapeutic efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria in a high-transmission area in northwest Ethiopia

In vivo efficacy of top five surveyed Ghanaian herbal anti-malarial products

Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria

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