Malaria parasite getting resistant to key drug

Indian researchers have captured the first evidence of malaria parasite becoming resistant to Artemisinin, the drug of choice to treat the most dangerous form of malaria.

While Artemisinin resistance was reported from South Asia and Africa in the past, India was so far free from the threat that has the potential to hit malaria eradication targets set by the government. Malarial parasite Plasmodium falciparum causes the most virulent form of malaria. According to WHO, nearly 4,45,000 people were killed by malaria in 2016 and almost all of them by P. falciparum.

In what may be a worrying signal to Indian doctors and health policy planners, a group of West Bengal-based researchers found the first instance of the parasite getting resistant to a derivative of Artemisinin in India.

The findings have been published in the November 15 issue of the New England Journal of Medicine — one of the top medical journals in the world.

“Doctors and health monitoring agencies should look into the findings seriously and reconsider the drug therapy for malaria control,” Somenath Roy, a scientist at Vidyasagar University and corresponding author of the study, told DH.

Roy, with his colleagues from the Calcutta School of Tropical Medicine and National Centre for Cell Science, Pune, examined 136 patients with uncomplicated P. falciparum infection and found that five of them didn’t respond to the standard treatment. The patients attended a health camp in lower Gangetic part of West Bengal.

They reported that those five patients carry two genetic mutations that made them resistant to artesunate — an artemisinin derivative. One of the mutations has been seen in the past in South East Asia, but the other is a novel one.

“The novelty of our work lies in the identification of specific genetic mutation in the parasite that leads to drug resistance,” he said.

Clinical evidence for artemisinin resistance in southeast Asia was first reported in 2008 from western Cambodia. Subsequently, resistance in neighbouring Thailand was reported in 2012 followed by reports from northern Cambodia, Vietnam and Eastern Myanmar in 2014. Emerging resistance has also been reported in Southern Laos and central Myanmar.

According to last year’s world malaria report, India remains the only country outside Africa that contributes to 80% of the global malaria burden and death. Fifteen countries accounted for 80% of global malaria deaths in 2016; all of these countries are in sub-Saharan Africa, except India.