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Antimicrobial Agents and Chemotherapy, March 2005, p. 1101-1105, Vol. 49, No. 3
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.3.1101-1105.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

High Prevalence of Markers for Sulfadoxine and Pyrimethamine Resistance in Plasmodium falciparum in the Absence of Drug Pressure in the Ashanti Region of Ghana

Florian Marks,¹ Jennifer Evans,² Christian G. Meyer,¹ Edmund N. Browne,³ Christa Flessner,¹ Vera von Kalckreuth,¹ Teunis A. Eggelte,⁴ Rolf D. Horstmann,¹ and Jürgen May^1*

Department of Molecular Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany,¹ Kumasi Centre for Collaborative Research in Tropical Medicine,² Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,³ Division of Infectious Diseases, Tropical Medicine & AIDS, Academic Hospital, Amsterdam, The Netherlands⁴

Received 30 July 2004/ Returned for modification 21 September 2004/ Accepted 26 October 2004

Markers of Plasmodium falciparum resistance to chloroquine (CQ) and pyrimethamine-sulfadoxine (PYR-SDX) are widespread in areas where malaria is endemic. In an area where the use PYR-SDX is negligible, the Ashanti Region of Ghana, West Africa, adult individuals were enrolled in an analysis of CQ- and PYR-SDX-associated molecular resistance markers in 2001 (n = 177) and 2003 (n = 180). Parasite prevalence, as assessed by PCR assays, were 56.5 and 48.8% in 2001 and 2003, respectively. A high frequency of CQ, PYR, and SDX resistance markers was observed, whereby, as a weak trend, the frequency was higher in 2003. The quintuple combination of three pfdhfr mutations and two pfdhps mutations has previously been recognized to be the most important determinant of PYR-SDX resistance. Approximately 60% of parasite carriers harbored fourfold mutated parasites, indicative of a considerable risk for a switch to high-level PYR-SDX resistance in an area where the rate of PYR-SDX use is low. Among the factors contributing to the high frequency of PYR-SDX resistance-associated mutations are background use of PYR-SDX, past use of PYR for malaria prophylaxis, cross-resistance of trimethoprim with PYR, and the sufficient biological fitness of resistant parasites in the absence of drug pressure.

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* Corresponding author. Mailing address: Department of Molecular Medicine, Bernhard-Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359 Hamburg, Germany. Phone: 49 40 42818-369. Fax: 49 40 42818-512. E-mail: may{at}bni.uni-hamburg.de.

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Antimicrobial Agents and Chemotherapy, March 2005, p. 1101-1105, Vol. 49, No. 3
0066-4804/05/$08.00+0     doi:10.1128/AAC.49.3.1101-1105.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

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