Molecular surveillance of the antifolate-resistant mutation I164L in imported african isolates of Plasmodium falciparum in Europe: sentinel data from TropNetEurop

Background: Malaria parasites that carry the DHFR-mutation I164L
are not only highly resistant to sulfadoxine-pyrimethamine but also
to the new antimalarial drug chlorproguanil-dapsone. The spread of
this mutation in Africa would result in a public health disaster
since there is a lack of effective alternatives that are both
affordable and safe. Up to now, this mutation has only been
described in Asian and Latin-American countries. The objective of
this study was to assess the prevalence of this mutation in African
isolates of Plasmodium falciparum that have been imported into
Europe through travellers. Methods: TropNetEurop is a network for
the surveillance of travel-associated diseases and seems to cover
approximately 12% of all malaria cases imported into Europe. Within
this network we screened 277 imported African isolates of P.
falciparum with the help of PCR- and enzyme-digestion-methods for
the antifolate-resistant mutation I164L. Results: The I164L
mutation was not detected in any of the isolates tested.
Discussion: Continuous molecular surveillance of mutations in P.
falciparum, as it is practised within TropNetEurop, is an essential
tool for the understanding and early detection of the spread of
antimalarial drug resistance in Africa.