EC Microbiology

Malaria remains a major public health concern worldwide. According to the World Health Organization (WHO), in 2017, an estimat- ed 219 million people were infected with malaria, leading to 435,000 deaths, predominantly affecting vulnerable populations in Africa. In 2004, Sudan implemented the Artesunate and Sulfadoxine/Pyrimethamine (SP) combination as its primary treatment due to the significant resistance of falciparum to antimalarial medications. Every year, epidemic malaria claims the lives of around one million people, the majority of whom are not African. With an estimated 7.5 million cases and 35,000 fatalities annually, malaria remains a serious health issue in Sudan. The purpose of this comprehensive study was to identify the antidrug-resistant gene (1-Pfmdr) across four states in Sudan. This cross-sectional study, conducted from July 2019 to December 2022, involved the collection of three ml blood samples from all study participants to identify the malaria parasite falciparum using blood smears stained with Giemsa. The study focused on 225 positive samples of falciparum, collected from five states: Kassala, Khartoum, Singa, Abu Hojar, and Damazin, including 50.3% males and 49.7% females, for the detection of the multidrug resistance gene (1-Pfmdr), which encompasses com- prehensive, intermediate, and low endemic areas in Sudan. Of the 193 samples screened using PCR, seventeen positive results were sent for genetic sequencing to analyze genetic mutations across different areas in Sudan from ages 1 to 60 years. The highest preva- lence of the mutant allele N (26.9%) was recorded in Ad-Damazin, while the lowest prevalence of N (8.8%) was found in Khartoum. The study indicated the presence of five genetic mutations of the malaria resistance gene P. falciparum at position 184 of the gene sequence, revealing a significant relationship between the parasite load and the study site P value = 0.000 while showing no signifi- cant relationship between parasite load and age group P value = 0.655 or sex P value = 0.148. The findings suggest the occurrence of genetic mutations in malaria resistance markers following the implementation of dual treatment.

 Keywords: Malaria; Drug Resistance; Sudan; 1-Pfmdr; Prevalence

1. Dronamraju K and Arese P. “Emerging Infectious Diseases of the 21st Century: Malaria - Genetic and Evolutionary Aspects”. New York: Springer US (2006): 125-146.
2. Warrell DA and Gilles HM. “Essential malariology”. CRC Press (2017).
3. Hildebrandt JP. “Malaria--biological aspects of an infectious disease of importance to humans”. Die Naturwissenschaften 83.8 (1996): 359-369.
4. Mueller I., et al. “Plasmodium malariae and Plasmodium ovale-the ‘bashful’ malaria parasites”. Trends in Parasitology 23.6 (2007): 278-283.
5. Mendis K., et al. “The neglected burden of Plasmodium vivax malaria”. The American Journal of Tropical Medicine and Hygiene 64.1-2 (2001): 97-106.
6. Escalante AA and Ayala FJ. “Phylogeny of the malarial genus Plasmodium, derived from rRNA gene sequences”. Proceedings of the National Academy of Sciences 91.24 (1994): 11373-11377.
7. Philips A and Nicky S. “Gorillas in the midst of malaria mystery”. Sydney Morning Herald 18 (2010): 23-26.
8. World Health Organization. “Guidelines for the treatment of malaria”. World Health Organization (2015).
9. Dondorp AM., et al. “Artemisinin resistance in Plasmodium falciparum malaria”. New England Journal of Medicine 361.5 (2009): 455-467.
10. Ibrahim ME., et al. “A case of Plasmodium falciparum malaria sensitive to chloroquine but resistant to pyrimethamine/sulfadoxine in Sennar, Sudan”. Transactions of the Royal Society of Tropical Medicine and Hygiene 85.4 (1991): 446.
11. A-Elbasit IE., et al. “High frequency of Plasmodium falciparum CICNI/SGEAA and CVIET haplotypes without association with resistance to sulfadoxine/pyrimethamine and chloroquine combination in the Daraweesh area in Sudan”. European Journal of Clinical Microbiology and Infectious Diseases 27.8 (2008): 725-732.
12. A-Elbasit IE., et al. “The efficacy of sulfadoxine-pyrimethamine alone and in combination with chloroquine for malaria treatment in rural eastern Sudan: the interrelation between resistance, age, and gametocytogenesis”. Tropical Medicine and International Health 11.5 (2006): 604-612.
13. Alifrangis M., et al. “Prediction of Plasmodium falciparum resistance to sulfadoxine/pyrimethamine in vivo by mutations in the dihydrofolate reductase and dihydropteroate synthetase genes: a comparative study between sites of differing endemicity”. American Journal of Tropical Medicine and Hygiene 69.6 (2003): 601-606.
14. Gadalla NB., et al. “Selection of pfdhfr/pfdhps alleles and declining artesunate/sulphadoxine-pyrimethamine efficacy against Plasmodium falciparum eight years after deployment in eastern Sudan”. Malaria Journal 12 (2013): 255.
15. Jalousian F., et al. “Mutation in pfmdr1 gene in chloroquine-resistant Plasmodium falciparum isolates, Southeast Iran”. International Journal of Infectious Diseases 12.6 (2008): 630-634.
16. Abd Alla AB., et al. “Detection of single point mutation of Plasmodium falciparum multi-drug resistance 1 gene in three different areas in Sudan”. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 16.11 (2017): 89-94.