Increased incidence of cycloguanil resistance in malaria cases entering France from Africa, determined as point mutations in the parasites' dihydrofolate-reductase genes

Ann Trop Med Parasitol. 1999 Jan;93(1):25-30. doi: 10.1080/00034989958762.

Abstract

The incidence of cycloguanil resistance in 501 Plasmodium falciparum isolates from individuals entering France from Africa was estimated by a method based on PCR-restriction-fragment-length polymorphisms. None of the subjects had taken antifol prophylaxis. Annual incidence of the resistance, detected as a point mutation at codon 108 in the parasite's dihydrofolate-reductase gene, increased from 19.8% in 1995 to 43.6% in 1997 (P < 0.001). The proportion of isolates found to be susceptible (i.e. wild-type) among travellers returning from the African countries known as Group 2 in France (i.e. Burkina Faso, Côte d'Ivoire, Gambia, Ghana, Guinea, Liberia, Madagascar, Mali, Mauritania, Niger, Senegal, Sierra Leone, Tchad and Togo) was reasonably high (62.9%) and much higher than in the other subjects returning from other identifiable countries in Africa (35.3%). The antimalarial prophylaxis recommended in France to those travelling to Group-2 countries, chloroquine-proguanil, therefore still seems reasonable, although cycloguanil resistance may seriously undermine the efficacy of this drug combination in the future.

MeSH terms

  • Africa
  • Animals
  • Antimalarials / therapeutic use*
  • Drug Resistance*
  • Folic Acid Antagonists / therapeutic use
  • France
  • Genes, Protozoan*
  • Humans
  • Malaria, Falciparum / drug therapy*
  • Plasmodium falciparum / genetics*
  • Point Mutation
  • Polymerase Chain Reaction
  • Polymorphism, Restriction Fragment Length
  • Proguanil
  • Tetrahydrofolate Dehydrogenase / genetics*
  • Triazines / therapeutic use*

Substances

  • Antimalarials
  • Folic Acid Antagonists
  • Triazines
  • cycloguanil
  • Tetrahydrofolate Dehydrogenase
  • Proguanil