Analysis of drug resistance in Plasmodium falciparum – the causative agent of imported tropical malaria in St. Petersburg (molecular-genetic research)

Drug resistance to Plasmodium falciparum is a leading cause of ineffective etiotropic therapy for tropical malaria in non-immune individuals returning from regions endemic for this infection. Genetic markers of resistance to major antimalarial drugs are single nucleotide polymorphisms of genes such as PfCRT, PfMDR 1, PfDHFR, PfDHPS, PfATP6, and PfKelch 13, which encode key proteins involved in the metabolism parasites cells. PCR-based methods using alternative primer technology and real-time PCR were used to examine venous blood samples from 63 tropical malaria patients treated in infectious diseases hospitals in St. Petersburg during 2018–2023. The study found that the most frequently detected genetic markers of P. falciparum drug resistance in patients blood samples with imported tropical malaria were S 1034C (58.7 %), A578S (55.56 %) and S 108N (49.21 %). The D 1246Y (4.76 %) and A630S (6.35 %) mutations were less frequent. The majority of cases showed mutations in the PfMDR 1 gene (over 76 %). Polymorphisms in the PfATP6 and PfCRT genes were detected in 32 % and 14 % of cases, respectively. In most cases, markers of parasite resistance to mefloquine and its derivatives were present (about 80 %). The proportion of P. falciparum resistance markers to artemisinin and its derivatives was about 63.5 %, and to sulfadoxine-pyrimethamine, less than 10 %. The study found that 39 % of cases showed genetic markers of resistance to both mefloquine and artemisinin, while 35 % of cases showed resistance to both mefloquine and sulfadoxine. Therefore, it is recommended to prescribe combination drugs with different mechanisms of pharmacological action for the treatment in each specific case of tropical malaria. Combining this approach with laboratory methods for early determination of the malaria drug resistance will reduce the latal cases.

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