Antimalarial drug resistance; Democratic Republic of Congo; Malaria; Molecular markers of drug resistance; Mutations; Public Health, Environmental and Occupational Health; Infectious Diseases
Abstract :
[en] [en] CONTEXT: The Democratic Republic of Congo (DRC), one of the most malaria-affected countries worldwide, is a potential hub for global drug-resistant malaria. This study aimed at summarizing and mapping surveys of malaria parasites carrying molecular markers of drug-resistance across the country.
METHODS: A systematic mapping review was carried out before July 2023 by searching for relevant articles through seven databases (PubMed, Embase, Scopus, African Journal Online, African Index Medicus, Bioline and Web of Science).
RESULTS: We identified 1541 primary studies of which 29 fulfilled inclusion criteria and provided information related to 6385 Plasmodium falciparum clinical isolates (collected from 2000 to 2020). We noted the PfCRT K76T mutation encoding for chloroquine-resistance in median 32.1% [interquartile interval, IQR: 45.2] of analyzed malaria parasites. The proportion of parasites carrying this mutation decreased overtime, but wide geographic variations persisted. A single isolate had encoded the PfK13 R561H substitution that is invoked in artemisinin-resistance emergence in the Great Lakes region of Africa. Parasites carrying various mutations linked to resistance to the sulfadoxine-pyrimethamine combination were widespread and reflected a moderate resistance profile (PfDHPS A437G: 99.5% [IQR: 3.9]; PfDHPS K540E: 38.9% [IQR: 47.7]) with median 13.1% [IQR: 10.3] of them being quintuple IRN-GE mutants (i.e., parasites carrying the PfDHFR N51I-C59R-S108N and PfDHPS A437G-K540E mutations). These quintuple mutants tended to prevail in eastern regions of the country. Among circulating parasites, we did not record any parasites harboring mutations related to mefloquine-resistance, but we could suspect those with decreased susceptibility to quinine, amodiaquine, and lumefantrine based on corresponding molecular surrogates.
CONCLUSIONS: Drug resistance poses a serious threat to existing malaria therapies and chemoprevention options in the DRC. This review provides a baseline for monitoring public health efforts as well as evidence for decision-making in support of national malaria policies and for implementing regionally tailored control measures across the country.
Disciplines :
Microbiology
Author, co-author :
Kayiba, Nadine Kalenda; Research Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium ; Department of Public Health, Faculty of Medicine, University of Mbujimayi, Mbujimayi, Democratic Republic of Congo ; Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
Tshibangu-Kabamba, Evariste; Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan ; Department of Internal Medicine, Faculty of Medicine, University of Mbujimayi, Mbujimayi, Democratic Republic of Congo
Rosas-Aguirre, Angel; Research Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
Kaku, Natsuko; Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
Nakagama, Yu; Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
Kaneko, Akira; Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
Makaba, Dieudonné Mvumbi; Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo ; Department of Quality of Laboratories, Sciensano, Brussels, Belgium
Malekita, Doudou Yobi; Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
Devleesschauwer, Brecht; Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium ; Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
Likwela, Joris Losimba; Department of Public Health, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of Congo
Zakayi, Pius Kabututu; Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
De Mol, Patrick ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques
Lelo, Georges Mvumbi; Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
Hayette, Marie-Pierre ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Bactériologie, mycologie, parasitologie, virologie et microbiologie
Dikassa, Paul Lusamba; School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
Kido, Yasutoshi ; Research Center for Infectious Disease Science & Department of Virology and Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan. kidoyasu@omu.ac.jp
Speybroeck, Niko; Research Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
ARES - Academy for Research and Higher Education JSPS - Japan Society for the Promotion of Science AMED - Japan Agency for Medical Research and Development
Funding text :
NKK received a Ph.D. scholarship under a funding from the Belgian Cooperation Agency through the Academy of Research and Higher Education (ARES). This work also received a support from the Japan Society for the Promotion of Science (JSPS) KAKENHI under grant number JP18KK0454 and the Japan Agency for Medical Research and Development (AMED) under grant numbers JP21wm0125003 and JP19fm0208020 (all to YK).
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