Therapeutic efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in four malaria endemic states of India

• Published in: Malaria Journal
• Main Authors: Sri Krishna, Sweta Mishra, Prakash Tiwari, Anup K. Vishwakarma, Sushrikanta Khandai, Suyesh Shrivastava, Anil K. Verma, Shashikant Tiwari, Hari Barman, Surendra Jhariya, Pradeep Tiwari, Anup S. Tidgam, Brij M. Varun, Sunil Singh, Naresh Yerane, Chintaman R. Tembhurne, Prem L. Mandavi, Shyam S. Tekam, Manas Malik, Kali P. Behera, Himanshu Jayswar, Khemraj Sonwani, Mukund S. Diggikar, Madan M. Pradhan, Sher S. Khasotiya, Avdhesh Kumar, Neeraj Dhingra, Maria Dorina G. Bustos, Eva-Maria Christophel, Pascal Ringwald, Roop Kumari, Man M. Shukla, Neeru Singh, Aparup Das, Praveen K. Bharti
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2021
• Subjects: Therapeutic efficacy; Artemether-lumefantrine; Plasmodium falciparum; Malaria; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-021-03762-7; https://doaj.org/article/553f219d277645bfb5ca7a7619651836

Abstract Background Malaria is a major public health problem in India and accounts for about 88% of malaria burden in South-East Asia. India alone accounted for 2% of total malaria cases globally. Anti-malarial drug resistance is one of the major problems for malaria control and elimination programme. Artemether-lumefantrine (AL) is the first-line treatment of uncomplicated Plasmodium falciparum in north eastern states of India since 2013 after confirming the resistance against sulfadoxine-pyrimethamine. In the present study, therapeutic efficacy of artemether-lumefantrine and k13 polymorphism was assessed in uncomplicated P. falciparum malaria. Methods This study was conducted at four community health centres located in Koraput district of Odisha, Bastar district of Chhattisgarh, Balaghat district of Madhya Pradesh and Gondia district of Maharashtra state. Patients with uncomplicated P. falciparum malaria were administered with fixed dose combination (6 doses) of artemether-lumefantrine for 3 days and clinical and parasitological response was recorded up to 28 days as per World Health Organization protocol. Nucleotide sequencing of msp1 and msp2 gene was performed to differentiate between recrudescence and reinfection. Amplification and sequencing of k13 propeller gene region covering codon 450–680 was also carried out to identify the polymorphism. Results A total 376 malaria patients who fulfilled the enrolment criteria as well as consented for the study were enrolled. Total 356 patients were followed up successfully up to 28 days. Overall, the adequate clinical and parasitological response was 98.9% and 99.4% with and without PCR correction respectively. No case of early treatment failure was observed. However, four cases (1.1%) of late parasitological failure were found from the Bastar district of Chhattisgarh. Genotyping of msp1 and msp2 confirmed 2 cases each of recrudescence and reinfection, respectively. Mutation analysis of k13 propeller gene showed one non-synonymous mutation Q613H in one isolate from ...