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Open AccessArticle

Contrasting Asymptomatic and Drug Resistance Gene Prevalence of Plasmodium falciparum in Ghana: Implications on Seasonal Malaria Chemoprevention

1
Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
2
Department of Medical Microbiology, College of Health Sciences, University of Ghana, P.O. Box LG 25, Accra, Ghana
3
Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG 25, Accra, Ghana
*
Authors to whom correspondence should be addressed.
Genes 2019, 10(7), 538; https://doi.org/10.3390/genes10070538
Received: 13 June 2019 / Revised: 11 July 2019 / Accepted: 12 July 2019 / Published: 16 July 2019
(This article belongs to the Special Issue Genetics and Genomics of Malaria Parasites)
Malaria is a significant public health problem in Ghana. Seasonal Malaria Chemoprevention (SMC) using a combination of sulfadoxine-pyrimethamine and amodiaquine has been implemented since 2015 in northern Ghana where malaria transmission is intense and seasonal. In this study, we estimated the prevalence of asymptomatic P. falciparum carriers in three ecological zones of Ghana, and compared the sensitivity and specificity of different molecular methods in identifying asymptomatic infections. Moreover, we examined the frequency of mutations in pfcrt, pfmdr1, pfdhfr, and pfdhps that relate to the ongoing SMC. A total of 535 asymptomatic schoolchildren were screened by microscopy and PCR (18s rRNA and TARE-2) methods. Among all samples, 28.6% were detected as positive by 18S nested PCR, whereas 19.6% were detected by microscopy. A high PCR-based asymptomatic prevalence was observed in the north (51%) compared to in the central (27.8%) and south (16.9%). The prevalence of pfdhfr-N51I/C59R/S108N/pfdhps-A437G quadruple mutant associated with sulfadoxine-pyrimethamine resistance was significantly higher in the north where SMC was implemented. Compared to 18S rRNA, TARE-2 serves as a more sensitive molecular marker for detecting submicroscopic asymptomatic infections in high and low transmission settings. These findings establish a baseline for monitoring P. falciparum prevalence and resistance in response to SMC over time. View Full-Text
Keywords: Plasmodium falciparum; pfdhps; phdhfr; asymptomatic infections; antimalarial drug resistance; Sulfadoxine-Pyrimethamine; quantitative real-time PCR; TARE-2 Plasmodium falciparum; pfdhps; phdhfr; asymptomatic infections; antimalarial drug resistance; Sulfadoxine-Pyrimethamine; quantitative real-time PCR; TARE-2
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Dieng, C.C.; Gonzalez, L.; Pestana, K.; Dhikrullahi, S.B.; Amoah, L.E.; Afrane, Y.A.; Lo, E. Contrasting Asymptomatic and Drug Resistance Gene Prevalence of Plasmodium falciparum in Ghana: Implications on Seasonal Malaria Chemoprevention. Genes 2019, 10, 538.

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