Beshir, Khalid B; Sutherland, Colin J; Sawa, Patrick; Drakeley, Chris J; Okell, Lucy; Mweresa, Collins K; Omar, Sabah A; Shekalaghe, Seif A; Kaur, Harparkash; Ndaro, Arnold; +5 more... Chilongola, Jaffu; Schallig, Henk DFH; Sauerwein, Robert W; Hallett, Rachel L; Bousema, Teun; (2013) Residual Plasmodium falciparum parasitemia in Kenyan children after artemisinin-combination therapy is associated with increased transmission to mosquitoes and parasite recurrence. The Journal of infectious diseases, 208 (12). pp. 2017-2024. ISSN 0022-1899 DOI: https://doi.org/10.1093/infdis/jit431
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Abstract
BACKGROUND: Parasite clearance time after artemisinin-based combination therapy (ACT) may be increasing in Asian and African settings. The association between parasite clearance following ACT and transmissibility is currently unknown. METHODS: We determined parasite clearance dynamics by duplex quantitative polymerase chain reaction (qPCR) in samples collected in the first 3 days after treatment of uncomplicated malaria with ACT. Gametocyte carriage was determined by Pfs25 quantitative nucleic acid sequence-based amplification assays; infectiousness to mosquitoes by membrane-feeding assays on day 7 after treatment. RESULTS: Residual parasitemia was detected by qPCR in 31.8% (95% confidence interval [CI], 24.6-39.8) of the children on day 3 after initiation of treatment. Residual parasitemia was associated with a 2-fold longer duration of gametocyte carriage (P = .0007), a higher likelihood of infecting mosquitoes (relative risk, 1.95; 95% CI, 1.17-3.24; P = .015), and a higher parasite burden in mosquitoes (incidence rate ratio, 2.92; 95% CI, 1.61-5.31; P < .001). Children with residual parasitemia were also significantly more likely to experience microscopically detectable parasitemia during follow-up (relative risk, 11.25; 95% CI, 4.08-31.01; P < .001). CONCLUSIONS: Residual submicroscopic parasitemia is common after ACT and is associated with a higher transmission potential. Residual parasitemia may also have consequences for individual patients because of its higher risk of recurrent parasitemia.
Item Type | Article |
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Keywords | artemisinin, PCR, resistance, submicroscopic, transmission, infectivity, anopheles, ARRAY(0x11cf064c), ARRAY(0x11b9c0f4), ARRAY(0xe02ff24), ARRAY(0x7e72058), ARRAY(0x79fb320), ARRAY(0x8e042f8), ARRAY(0x71cba00), ARRAY(0x7a61fd0), ARRAY(0x7380478), ARRAY(0x7ba3f60), ARRAY(0x827f210) |
Faculty and Department |
Faculty of Infectious and Tropical Diseases > Department of Infection Biology Faculty of Infectious and Tropical Diseases > Dept of Clinical Research |
Research Centre | Malaria Centre |
PubMed ID | 23945376 |
ISI | 327544600012 |
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