Artemisinin Resistance: The More We Know, the More Complicated It Appears

The Journal of Infectious Diseases | September 1, 2014

Plasmodium falciparum, one of the most deadly human malaria parasites, consistently has evolved resistance to antimalarials that have been intensively used. The genetic basis of resistance to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) has been most completely studied. The genes associated with the resistance to each drug are different, but in each case, a few single-nucleotide polymorphisms (SNPs) in 1 or 2 genes were shown to be responsible. These SNPs were then used as molecular markers to trace retrospectively the path of the resistant parasites. For both CQ and SP, these parasites spread from very few points of origin that included the northwest region of Cambodia in Southeast Asia. Studies showed that parasites with the molecular markers were present far from this origin long before intensive drug use increased their prevalence, resulting in high levels of treatment failure. Even more remarkable, each resistant population was introduced from Southeast Asia into East Africa by individuals carrying the resistant strain and then spread throughout the continent more »

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