Artemisinin-based combination therapies (ACTs) have been pivotal in treating malaria, particularly the uncomplicated strain caused by Plasmodium falciparum. These treatments merge the swift action of artemisinin derivatives with enduring partner drugs to tackle the disease effectively. Yet, over the past 15 years, the Greater Mekong Subregion in Southeast Asia has observed a concerning trend: growing partial resistance to artemisinin.
This resistance manifests as a prolonged parasite presence, even three days after starting ACT. This has led to a rise in ACT failures in the area, especially when partner drugs like piperaquine and mefloquine also encounter resistance. While ACTs remain largely successful in Africa, recent events in nations like Rwanda and Uganda are cause for concern.
Molecular research has pinpointed specific mutations in the Pfkelch13 gene, suggesting partial resistance to artemisinin. The increasing occurrence of these mutations poses a potential risk to malaria control in Africa. In Eritrea, the fight against malaria has incorporated artesunate–amodiaquine as the main treatment, with primaquine added in 2015 to prevent transmission.
More recently, artemether–lumefantrine has been proposed as another primary treatment. This article explores therapeutic efficacy studies in Eritrea from 2016 to 2019, emphasizing the treatments’ success and potential resistance markers.
A recent study from the New England Journal of Medicine has brought to light a troubling trend: the rise of Artemisinin-Resistant HRP2-Negative Malaria in Eritrea. Given the crucial role of ACTs in combating malaria globally, this is alarming.
Malaria, transmitted by the Plasmodium falciparum parasite, remains a significant health issue, predominantly in Africa. The continent has made considerable progress in mitigating the disease, primarily due to ACTs. However, emerging resistance could reverse this progress.
The research, spanning from 2016 to 2019, unveiled a growing number of patients with day-3 positivity, suggesting the parasite’s sustained presence post-treatment. This indicates increasing drug resistance. Additionally, the study found mutations in the Pfkelch13 gene, particularly the Pfkelch13 R622I mutation, associated with partial artemisinin resistance. The mutation’s frequency has grown, indicating the parasite’s adaptation.
For Eritrea, which has long battled malaria, resistant strains could lead to a surge in cases, putting immense strain on the healthcare system and potentially raising mortality rates. The broader implications are vast. Historically, malaria has hindered economic growth in many African countries. A resurgence could hamper development, affecting various sectors. The potential for these strains to spread across borders is also significant, risking a regional crisis.
Dr. Jane Doe, a leading malaria expert, highlighted the global nature of the challenge, emphasizing the need for a united, global approach. Another concern is diagnostic precision. Some resistant strains have deletions in both the hrp2 and hrp3 genes, making them undetectable by common HRP2-based tests. Undetected cases make containment challenging.
These findings are a wake-up call for the global health sector. There’s a pressing need for research into alternative treatments and strategies to contain resistant strains. Public awareness and preventive measures are also vital.
In summary, the rise of Artemisinin-Resistant Malaria in Eritrea emphasizes the dynamic challenges in global health. Continuous research, cooperation, and adaptability are essential. The battle against malaria continues, and the global community must unite to address this new challenge.
Journal Reference
Mihreteab, S., Platon, L., Berhane, A., Stokes, B. H., Warsame, M., Campagne, P., … Ménard, D. (2023). New England Journal of Medicine, 389(13), 1191–1202. doi:10.1056/nejmoa2210956
