Independent origin of Plasmodium falciparum antifolate super-resistance, Uganda, Tanzania, and Ethiopia

Michael Alifrangis, Sidsel Nag, Mette L Schousboe, Deus Ishengoma, John Lusingu, Hirva Pota, Reginald A Kavishe, Richard Pearce, Rosalynn Ord, Caroline Lynch, Seyoum Dejene, Jonathan Cox, John Rwakimari, Daniel T R Minja, Martha M Lemnge, Cally Roper

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Abstract

Super-resistant Plasmodium falciparum threatens the effectiveness of sulfadoxine-pyrimethamine in intermittent preventive treatment for malaria during pregnancy. It is characterized by the A581G Pfdhps mutation on a background of the double-mutant Pfdhps and the triple-mutant Pfdhfr. Using samples collected during 2004-2008, we investigated the evolutionary origin of the A581G mutation by characterizing microsatellite diversity flanking Pfdhps triple-mutant (437G+540E+581G) alleles from 3 locations in eastern Africa and comparing it with double-mutant (437G+540E) alleles from the same area. In Ethiopia, both alleles derived from 1 lineage that was distinct from those in Uganda and Tanzania. Uganda and Tanzania triple mutants derived from the previously characterized southeastern Africa double-mutant lineage. The A581G mutation has occurred multiple times on local Pfdhps double-mutant backgrounds; however, a novel microsatellite allele incorporated into the Tanzania lineage since 2004 illustrates the local expansion of emergent triple-mutant lineages.

Original languageEnglish
JournalEmerging Infectious Diseases (Print Edition)
Volume20
Issue number8
Pages (from-to)1280-6
Number of pages7
ISSN1080-6040
DOIs
Publication statusPublished - Aug 2014

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Alifrangis, M., Nag, S., Schousboe, M. L., Ishengoma, D., Lusingu, J., Pota, H., Kavishe, R. A., Pearce, R., Ord, R., Lynch, C., Dejene, S., Cox, J., Rwakimari, J., Minja, D. T. R., Lemnge, M. M., & Roper, C. (2014). Independent origin of Plasmodium falciparum antifolate super-resistance, Uganda, Tanzania, and Ethiopia. Emerging Infectious Diseases (Print Edition), 20(8), 1280-6. https://doi.org/10.3201/eid2008.131897