Das, S. and Saha, B. and Hati, A.K. and Roy, S. (2018) Evidence of Artemisinin-Resistant Plasmodium falciparum Malaria in Eastern India. New England Journal of Medicine, 379 (20). pp. 1962-1964.

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Abstract

Artemisinins are an important class of antimalarial medication.1 Because artemisinin resistance among malaria parasites may lead to severe consequences, we assessed the possible emergence of artemisinin resistance in West Bengal, India, by evaluating parasite clearance half-life, kelch13 mutations, and survival of parasites (as measured with an ex vivo ring-stage survival assay performed 0 to 3 hours after invasion of red cells by ring-stage parasites [RSA0-3h]) in isolates obtained from April 2013 through March 2014. Our study involved 136 patients with uncomplicated Plasmodium falciparum infection (median parasite load, 72,000 parasites per microliter; 95% confidence interval [CI], 31,500 to 172,000) who received artesunate–sulfadoxine–pyrimethamine treatment in accordance with local guidelines.2 Therapeutic efficacy was monitored from day 1 to day 42. Thick blood smears were prepared in duplicate every 6 hours until the smears became free of parasites. The parasite clearance half-life was estimated with the use of parasite clearance estimator software.3 We followed World Health Organization (WHO) guidelines for the definition of artemisinin resistance4: the presence of parasitemia at 72 hours (±2 hours) after treatment, with a parasite-clearance half-life of more than 5 hours, persistence of a parasite survival rate greater than 10% (on the basis of ex vivo RSA0-3h), and the presence of a mutation in kelch13 distal to codon 440 (i.e., in the DNA sequence encoding the propeller domain). The study was approved by the Human Ethics Committee, Vidyasagar University, and written informed consent was obtained from every patient. A detailed description of the methods is provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.

Item Type:	Article
Depositing User:	Mr. Rameshwar Nema
Date Deposited:	11 Feb 2020 05:41
Last Modified:	11 Feb 2020 05:45
URI:	http://nccs.sciencecentral.in/id/eprint/604

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