Molecular surveillance of the antifolate-resistant mutation I164L in imported african isolates of Plasmodium falciparum in Europe: sentinel data from TropNetEurop

Ole Wichmann^*¹ , Tomas Jelinek¹ , Gabriele Peyerl-Hoffmann³ , Nikolai Mühlberger¹ , Martin P Grobusch²^,4 , Joaquim Gascon⁸ , Alberto Matteelli¹⁰ , Christoph Hatz¹¹ , Hermann Laferl¹² , Marco Schulze⁵ , Gerd Burchard¹^,6 , Saraiva da Cunha¹⁴ , Jiøi Beran¹⁵ , Paul McWhinney¹⁶ , Herwig Kollaritsch¹³ , Peter Kern⁷ , Juan Cuadros⁹ , Michael Alifrangis¹⁷ and Ida Gjørup¹⁷ for the European Network on Surveillance of Imported Infectious Diseases (TropNetEurop)

¹Institute of Tropical Medicine. Charité, Humboldt University, Berlin, Germany

²Department of Medicine (Infectious Diseases), Charité, Humboldt University, Berlin, Germany

³Department of Infectious Diseases and Tropical Medicine, University of Munich, Germany

⁴Institut für Tropenmedizin, Eberhard-Karls-Universität Tübingen, Germany

⁵Städtische Kliniken "St. Georg", 2. Klinik für Innere Medizin, Leipzig, Germany

⁶Bernhard-Nocht-Institute for Tropical Medicine, University of Hamburg, Germany

⁷Sektion Infektiologie und Klinische Immunologie, Universität Ulm, Ulm, Germany

⁸Secció Medicina Tropical, Hospital Clinic, IDIBAPS, Barcelona, Spain

⁹Department of Clinical Microbiology and Parasitology, Hospital Príncipe de Asturias, Madrid, Spain

¹⁰Clinica di Malattie Infettive e Tropicali, Universitá di Bresci, Italy

¹¹Swiss Tropical Institute, Basel, Switzerland

¹²Kaiser-Franz-Josef-Spital der Stadt Wien, 4. Medizinische Abteilung mit Infektions-und Tropenmedizin, Germany

¹³Abteilung für spezifische Prophylaxe und Tropenmedizin am Institut für Pathophysiologie, University of Vienna and Kaiser-Franz-Josef-Spital der Stadt Wien, Vienna, Austria

¹⁴Consulta de Medicina do Viajante, Departamento de Doenças Infecciosas, Hospital Universitário, Coimbra, Portugal

¹⁵Department of Infectious Diseases, University Hospital, Hradec Kralove, Czech Republic

¹⁶Bradford Royal Infirmary, Infection and Tropical Medicine, Bradford, United Kingdom

¹⁷Department of Infectious Diseases, University Hospital and Centre of Medical Parasitology, Panum Institute, University of Copenhagen, Denmark

author email corresponding author email* Contributed equally

Malaria Journal 2003, 2:17doi:10.1186/1475-2875-2-17


Published:	25 June 2003

Abstract

Background

Malaria parasites that carry the DHFR-mutation I164L are not only highly resistant to sulfadoxine-pyrimethamine but also to the new antimalarial drug chlorproguanil-dapsone. The spread of this mutation in Africa would result in a public health disaster since there is a lack of effective alternatives that are both affordable and safe. Up to now, this mutation has only been described in Asian and Latin-American countries. The objective of this study was to assess the prevalence of this mutation in African isolates of Plasmodium falciparum that have been imported into Europe through travellers.

Methods

TropNetEurop is a network for the surveillance of travel-associated diseases and seems to cover approximately 12% of all malaria cases imported into Europe. Within this network we screened 277 imported African isolates of P. falciparum with the help of PCR- and enzyme-digestion-methods for the antifolate-resistant mutation I164L.

Results

The I164L mutation was not detected in any of the isolates tested.

Discussion

Continuous molecular surveillance of mutations in P. falciparum, as it is practised within TropNetEurop, is an essential tool for the understanding and early detection of the spread of antimalarial drug resistance in Africa.