On the front of the fight against malaria, worrying news is added to the alerts of previous years: in Africa, resistance to standard malaria treatments is increasing among children. According to a study published on November 14 in the Journal of the American Medical Association (JAMA), more than 10% of children suffering from severe malaria in Uganda carry a strain of Plasmodium falciparum. This parasite presents genetic mutations that lead to its resistance to molecules derived from artemisinin, pillars of current treatments.
The arrival of these medications, about twenty years ago, represented a great advance: they managed to quickly cure infections, but also overcome the problem of the loss of effectiveness of previous families of antimalarials.
However, partial resistance to artemisinin derivatives appeared in Cambodia as early as 2008. An alert was followed, in 2013, by the detection of complete resistance to these treatments in certain parasites in Southeast Asia. In 2021, the problem is spreading to East Africa: Uganda, Rwanda and Djibouti, in turn, are affected; then Ethiopia, in 2023.
Serious or complicated shapes
Initially it was believed that this resistance had spread from Asia to Africa. Mistakenly: “ The resistant strains that appeared in Africa did not carry the same mutations responsible for resistance, in the K13 gene, as those isolated in Asiaexplains Dr. Marc Thellier, head of the National Reference Center for Malaria, at the Pitié-Salpêtrière hospital (AP-HP), in Paris. In Africa, resistance emerged independently and later than in Asia: there the pressure exerted by drugs is less strong and the genetic variety of parasite strains is greater. »
This new study, carried out jointly by teams from Uganda, Kenya, the United States and England, was carried out on 100 children between 6 months and 12 years (mean age, 3.72 years; 47% girls). All had been hospitalized for severe or complicated forms of malaria, putting them at risk of severe anemia or life-threatening brain complications.
All received the standard treatment for complicated malaria infections: an intravenous infusion of an artemisinin derivative (artesunate), lasting one to three days (sometimes longer), followed by oral treatment with a combination therapy. of artemisinin (in this case, artemether) with another. family of antimalarials (lumefantrine). “Initial intravenous treatment, for these severe forms, offers the advantage of acting quickly”explains Professor Sandrine Houzé, head of the parasitology-mycology department of the National Reference Center against Malaria, at the Bichat hospital (AP-HP), in Paris. On the other hand, in non-severe forms, treatment is started immediately with combined oral therapy.
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