oa Antifolate Drug Resistance: Novel Mutations and Therapeutic Efficacy Study from Arunachal Pradesh, NE India

Malaria is a major public health concern in north east India with the preponderance of drug resistance strains. Till recently partner drug for Artemisinin Combination Therapy was Sulphadoxine Pyrimethamine. The antifolate drug resistance has been associated with the mutations at dihydropteroate synthase (dhps) and dihydrofolatereductase (dhfr) gene. The study was aimed to investigate the antifolate drug resistance at molecular level and therapeutic efficacy in 35 patients. Three novel point mutations were found in dhps gene with 10 haplotypes along with the already reported mutations. A single haplotype having quadruple mutation was found in dhfr gene. The study reports higher degree of antifolate drug resistance as evidenced by the presence of multiple point mutations in dhps and dhfr genes. The therapeutic efficacy revealed one early treatment failure and three late clinical failure. The findings of the study recommends to stop the use of SP as partner drug in malaria treatment for NE India.

Keywords

Plasmodium falciparum, North East India, Drug resistance, therapeutic efficacy