Molecular surveillance of drug resistance through imported isolates of Plasmodium falciparum in Europe

Tomas Jelinek¹ , Gabriele Peyerl-Hoffmann¹ , Nikolai Mühlberger¹ , Ole Wichmann¹ , Michael Wilhelm¹ , Nadja Schmider¹ , Martin P Grobusch²^,4 , Frank von Sonnenburg¹ , Joaquim Gascon⁷ , Hermann Laferl¹⁰ , Christoph Hatz⁹ , Michael Alifrangis¹⁵ , Gerd Burchard³ , Paul McWhinney¹² , Marco Schulze⁵ , Herwig Kollaritsch¹¹ , Saraiva da Cunha¹³ , Jiři Beřan¹⁴ , Peter Kern⁶ , Ida Gjørup¹⁶ and Juan Cuadros⁸

¹Department of Infectious Diseases and Tropical Medicine, University of Munich, Leopoldstr. 5, 80802 Munich, Germany

²Department of Medicine (Infectious Diseases), Charité / Campus Virchow-Klinikum, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany

³Institute of Tropical Medicine, Humboldt-University, Spandauer Damm 130, 14050 Berlin, Germany

⁴Institut für Tropenmedizin, Eberhard-Karls-Universität Tübingen Keplerstr. 15, 72074 Tübingen, Germany

⁵Städtische Kliniken "St. Georg", 2. Klinik für Innere Medizin, Delitzscher Straβ 141, 04129 Leipzig, Germany

⁶Sektion Infektiologie und Klinische Immunologie, Universität Ulm, Robert-Koch-Straβ 8, 89081 Ulm, Germany

⁷Sección de Medicina Tropical, Hospital Clinic, Villaroel 170, 08036 Barcelona, Spain

⁸Department of Clinical Microbiology and Parasitology, Hospital Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain

⁹Swiss Tropical Institute, Medizin & Diagnostik, Socinstr. 57, 4002 Basel, Switzerland

¹⁰Kaiser-Franz-Josef-Spital der Stadt Wien, 4. Medizinische Abteilung mit Infektions- und Tropenmedizin, Kundratstr. 3, 1100 Vienna, Austria

¹¹Abteilung für spezifische Prophylaxe und Tropenmedizin am Institut für Pathophysiologie, Universität Wien, Kinderspitalgasse 15, 1095 Vienna, Austria

¹²Bradford Royal Infirmary, Infection and Tropical Medicine, Duckworth Lane, BD9 6RJ Bradford, United Kingdom

¹³Consulta de Medicina do Viajante, Departamento de Doenças Infecciosas, Hospital Universitário, 3000 Coimbra, Portugal

¹⁴Epidemiological Services, Purkinje Military Academy, P.O. Box 35, 50001 Hradec Kralove, Czech Republic

¹⁵Centre of Medical Parasitology, Panum Institute 24-2, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark

¹⁶Department of Infectious Diseases M 5132, University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark

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Malaria Journal 2002, 1:11doi:10.1186/1475-2875-1-11


Published:	11 October 2002

Abstract

Background

Results from numerous studies point convincingly to correlations between mutations at selected genes and phenotypic resistance to antimalarials in Plasmodium falciparum isolates. In order to move molecular assays for point mutations on resistance-related genes into the realm of applied tools for surveillance, we investigated a selection of P. falciparum isolates that were imported during the year 2001 into Europe to study the prevalence of resistance-associated point mutations at relevant codons. In particular, we tested for parasites which were developing resistance to antifolates and chloroquine. The screening results were used to map the prevalence of mutations and, thus, levels of potential drug resistance in endemic areas world-wide.

Results

337 isolates have been tested so far. Prevalence of mutations that are associated with resistance to chloroquine on the pfcrt and pfmdr genes of P. falciparum was demonstrated at high levels. However, the prevalence of mutations associated with resistance to antifolates at the DHFR and DHPS genes was unexpectedly low, rarely exceeding 60% in endemic areas.

Conclusions

Constant screening of imported isolates will enable TropNetEurop to establish a screening tool for emerging resistance in endemic areas.