Publication
Title
Uncomplicated clinical malaria features, the efficacy of artesunate-amodiaquine and their relation with multiplicity of infection in the Democratic Republic of Congo
Author
Abstract
Background In the Democratic Republic of Congo, artesunate-amodiaquine (ASAQ) is the first-line medication recommended for uncomplicated malaria treatment. We conducted a study in Kinshasa to describe the clinical features of the disease and assess the efficacy of ASAQ and its impact on the multiplicity of infection in children with uncomplicated malaria. Methods Children aged 12 to 59 months with uncomplicated P. falciparum malaria were treated with ASAQ and followed up passively for 42 days. To distinguish new infections from recrudescent parasites, samples were genotyped using a stepwise strategy with three molecular markers (GLURP, MSP2 and MSP1). We then assessed PCR-corrected and -uncorrected day-42 cure rates and multiplicity of infection (MOI). Results In total, 2,796 patients were screened and 865 enrolled in the study. Clinical features were characterized by history of fever (100%), coryza (59.9%) and weakness (59.4%). The crude and PCR-corrected efficacies of ASAQ were 55.3% (95%CI: 51.858.8) and 92.8% (95%CI: 91.094.6) respectively, as 83.6% (95%CI: 79.187.2) of the recurrences were new infections. Compared to monoclonal infections, polyclonal infections were more frequent at enrollment (88.1%) and in recurrences (80.1%; p = 0.005; OR: 1.8, 95%CI: 1.202.8). The median MOI at enrollment (MOI = 3.7; IQR: 0.76.7) decreased to 3 (IQR: 15) in the recurrent samples (p<0.001). Patients infected with a single haplotype on day 0 had no recrudescence; the risk of recrudescence increased by 28% with each additional haplotype (HR: 1.3, 95%CI: 1.241.44). Conclusion The PCR-corrected efficacy of ASAQ at day 42 was 92.8%, but crude efficacy was relatively poor due to high reinfection rates. Treatment outcomes were positively correlated with MOI. Continued monitoring of the efficacy of ACTsASAQ, in this caseis paramount.
Language
English
Source (journal)
PLoS ONE
Publication
2016
ISSN
1932-6203
Volume/pages
11:6(2016), 16 p.
Article Reference
e0157074
ISI
000377563000078
Medium
E-only publicatie
Full text (Publisher's DOI)
Full text (open access)
UAntwerpen
Faculty/Department
Research group
[E?say:metaLocaldata.cgzprojectinf]
The impact of artesunateamodiaquine retreatment and specific malaria humoral immunity on recrudescent malaria infections.
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
Identification
Creation 16.06.2016
Last edited 14.09.2017
To cite this reference